***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Few articles have examined specific counseling tools used to increase  antiretroviral therapy ( ART ) adherence . We present communication tools used in the context of Project MOTIV8 , a r and omized clinical trial . METHODS We developed , piloted , and evaluated pictorial images to communicate the importance of consistent dose timing and the concept of drug resistance . Electronic drug monitoring ( EDM ) review was also used to provide visual feedback and facilitate problem solving discussion s. Adherence knowledge of all participants ( n=204 ) was assessed at baseline and 48 weeks . Participant satisfaction with counseling was also assessed . RESULTS Adherence knowledge did not differ at baseline , however , at 48 weeks , intervention participants demonstrated significantly increased knowledge compared to controls F(1 , 172)=10.76 , p=0.001 ( 12.4 % increase among intervention participants and 1.8 % decrease among controls ) . Counselors reported that the tools were well-received , and 80 % of participants felt the counseling helped them adhere to their medications . CONCLUSIONS Counseling tools were both positively received and effective in increasing ART adherence knowledge among a diverse population . PRACTICE IMPLICATION S While developed for research , these counseling tools can be implemented into clinical practice to help patients ; particularly those with lower levels of education or limited abstract thinking skills to underst and medical concepts related to ART adherence Background Breastfeeding is a critical component of interventions to reduce child mortality .  Exclusive breastfeeding practice is extremely low in South Africa and there has been no improvement in this over the past ten years largely due to fears of HIV transmission . Early cessation of breastfeeding has been found to have negative effects on child morbidity and survival in several studies in Africa . This paper reports on determinants of early breastfeeding cessation among women in South Africa . Methods This is a sub group analysis of a community-based cluster-r and omized trial ( PROMISE EBF ) promoting exclusive breastfeeding  in three South African sites ( Paarl in the Western Cape Province , and Umlazi and Rietvlei in KwaZulu-Natal ) between 2006 and 2008 ( Clinical Trials.gov no : NCT00397150 ) . Infant feeding recall of 22 food and fluid items was collected at 3 , 6 , 12 and 24 weeks postpartum . Women ’s experiences of breast health problems were also collected at the same time points . 999 women who ever breastfed were included in the analysis . Univariable and multivariable logistic regression analysis adjusting for site , arm and cluster , was performed to determine predictors of stopping breastfeeding by 12 weeks postpartum . Results By 12 weeks postpartum , 20 % of HIV-negative women and 40 % of HIV-positive women had stopped all breastfeeding . About a third of women introduced other fluids , most commonly formula milk , within the first 3 days after birth . Antenatal intention not to breastfeed and being undecided about how to feed were most strongly associated with stopping breastfeeding by 12 weeks ( Adjusted odds ratio , AOR 5.6 , 95 % CI 3.4 – 9.5 and AOR 4.1 , 95 % CI 1.6 – 10.8 , respectively ) . Also important was self-reported breast health problems associated with a 3-fold risk of stopping breastfeeding ( AOR 3.1 , 95%CI 1.7 – 5.7 ) and the mother having her own income doubled the risk of stopping breastfeeding ( AOR 1.9 , 95 % CI 1.3 – 2.8 ) . Conclusion Early cessation of breastfeeding is common amongst both HIV-negative and positive women in South Africa . There is an urgent need to improve antenatal breastfeeding counselling taking into account the challenges faced by working women as well as early postnatal lactation support to prevent breast health problems Background Infant feeding recommendations for HIV-positive mothers differ from recommendations to mothers of unknown HIV-status . The aim of this study was to compare feeding practice s , including  breastfeeding  , between infants and young children of HIV-positive mothers and infants of mothers in the general population of Ug and a. Methods This study compares two cross-sectional surveys conducted in the end of 2003 and the beginning of 2005 in Eastern Ug and a using analogous question naires . The first survey consisted of 727 r and omly selected general- population mother-infant pairs with unknown HIV status . The second included 235 HIV-positive mothers affiliated to The Aids Support Organisation , TASO . In this article we compare early feeding practice s , breastfeeding duration , feeding patterns with dietary information and socio-economic differences in the two groups of mothers . Results Pre-lacteal feeding was given to 150 ( 64 % ) infants of the HIV-positive mothers and 414 ( 57 % ) infants of general- population mothers . Exclusive breastfeeding of infants under the age of 6 months was more common in the general population than among the HIV-positive mothers ( 186 [ 45 % ] vs. 9 [ 24 % ] respectively according to 24-hour recall ) . Mixed feeding was the most common practice in both groups of mothers . Solid foods were introduced to more than half of the infants under 6 months old among the HIV-positive mothers and a quarter of the infants in the general population . Among the HIV-positive mothers with infants below 12 months of age , 24 of 90 ( 27 % ) had stopped breastfeeding , in contrast to 9 of 727 ( 1 % ) in the general population . The HIV-positive mothers were poorer and had less education than the general- population mothers . Conclusion In many respects , HIV-positive mothers fed their infants less favourably than mothers in the general population , with potentially detrimental effects on both the child 's nutrition and the risk of HIV transmission .  Mixed feeding and pre-lacteal feeding were widespread . Breastfeeding duration was shorter among HIV-positive mothers . Higher educational level and being socio-economically better off were associated with more beneficial infant feeding practice Introduction The dilemma posed between lifesaving benefit and risk of transmission through breast feeding complicates infant feedings among communities grossly affected by HIV/AIDS . According to the world health organization ’s guideline which was revised in 2010 , exclusive breast feeding and exclusive replacement feeding are the recommended infant feeding practice s for HIV positive mothers . The aim of this study was to assess infant feeding practice and associated factors among HIV positive mothers in Debre Markos Referral Hospital , North West Ethiopia . Methods An institutional based cross sectional study was conducted from May to September 2013 . A R and omly selected 260 HIV positive mothers were included . The data were collected by using a pretested and structured question naire . Bivariate and multivariate analysis were performed to check association and to control confounders . Results From a total of 260 HIV positive mothers , 85.8 % of them were feeding their children based on the recommended feeding way of infant feeding practice with the remaining percentage 14.2 % were practicing mixed feeding . In multivariate analysis mothers attending high school and above AOR = 5.3 [ 95 % CI = 1.25 - 22.1 ] , having antenatal care follow up AOR = 5.5 [ 95 % CI = 1.5 - 20.16 ] , being on anti-retro viral therapy AOR = 6.5 [ 95 % CI = 1.88 - 22.51 ] and disclosure of HIV status AOR = 7.1 [ 95 % CI = 1.26 - 39.76 ] were found to be independently associated with infant feeding practice . Conclusion This study revealed that large proportion of HIV positive mothers had followed the recommended infant feeding practice and significantly high number of mothers had practice d mixed feeding . Educating mothers , increasing ANC utilization , counseling mothers to start ART , encouraging and supporting mothers to disclose their HIV status were recommended Abstract HIV serostatus disclosure among people living with HIV/AIDS ( PLWHA ) is an important component of preventing HIV transmission to sexual partners . Due to barriers like stigma , however , many PLWHA do not disclose their serostatus to all sexual partners . This study explored differences in HIV serostatus disclosure based on sexual behavior subgroup ( men who have sex with men [ MSM ] ; heterosexual men ; and women ) , characteristics of the sexual relationship ( relationship type and HIV serostatus of partner ) , and perceived stigma . We examined disclosure in a sample of 341 PLWHA : 138 MSM , 87 heterosexual men , and 116 heterosexual women who were enrolled in SafeTalk , a r and omized , controlled trial of a safer sex intervention .  We found that , overall , 79 % of participants disclosed their HIV status to all sexual partners in the past 3 months . However , we found important differences in disclosure by subgroup and relationship characteristics . Heterosexual men and women were more likely to disclose their HIV status than MSM ( 86 % , 85 % , and 69 % , respectively ) . Additionally , disclosure was more likely among participants with only primary partners than those with only casual or both casual and primary partners ( 92 % , 54 % , and 62 % , respectively ) . Participants with only HIV-positive partners were also more likely to disclose than those with only HIV-negative partners , unknown serostatus partners , or partners of mixed serostatus ( 96 % , 85 % , 40 % , and 60 % , respectively ) . Finally , people who perceived more HIV-related stigma were less likely to disclose their HIV serostatus to partners , regardless of subgroup or relationship characteristics . These findings suggest that interventions to help PLWHA disclose , particularly to serodiscordant casual partners , are needed and will likely benefit from inclusion of stigma reduction components CONTEXT Breastfeeding among women infected with human immunodeficiency virus type 1 ( HIV-1 ) is associated with substantial risk of HIV-1 transmission , but little is known about the morbidity risks associated with formula feeding in infants of HIV-1-infected women in re source -poor setting s. OBJECTIVE To compare morbidity , nutritional status , mortality adjusted for HIV-1 status , and cause of death among formula-fed and breastfed infants of HIV-1-infected women . DESIGN R and omized clinical trial conducted between 1992 and 1998 . SETTING Four antenatal clinics in Nairobi , Kenya . PARTICIPANTS Of 401 live-born , singleton , or first-born twin infants of r and omized HIV-1-seropositive mothers , 371 were included in the analysis of morbidity and mortality . INTERVENTIONS Mothers were r and omly assigned either to use formula ( n = 186 ) or to breastfeed ( n = 185 ) their infants . MAIN OUTCOME MEASURES Mortality rates , adjusted for HIV-1 infection status ; morbidity ; and nutritional status during the first 2 years of life . RESULTS Two-year estimated mortality rates among infants were similar in the formula-feeding and breastfeeding arms ( 20.0 % vs 24.4 % ; hazard ratio [ HR ] , 0.8 ; 95 % confidence interval [ CI ] , 0.5 - 1.3 ) , even after adjusting for HIV-1 infection status ( HR , 1.1 ; 95 % CI , 0.7 - 1.7 ) . Infection with HIV-1 was associated with a 9.0-fold increased mortality risk ( 95 % CI , 5.3 - 15.3 ) . The incidence of diarrhea during the 2 years of follow-up was similar in formula and breastfeeding arms ( 155 vs 149 per 100 person-years , respectively ) . The incidence of pneumonia was identical in the 2 groups ( 62 per 100 person-years ) , and there were no significant differences in incidence of other recorded illnesses . Infants in the breastfeeding arm tended to have better nutritional status , significantly so during the first 6 months of life . CONCLUSIONS In this r and omized clinical trial , infants assigned to be formula fed or breastfed had similar mortality rates and incidence of diarrhea and pneumonia during the first 2 years of life . However , HIV-1-free survival at 2 years was significantly higher in the formula arm . With appropriate education and access to clean water , formula feeding can be a safe alternative to breastfeeding for infants of HIV-1-infected mothers in a re source -poor setting OBJECTIVE To explore how the human immunodeficiency virus ( HIV ) epidemic has affected the infant-feeding experiences of HIV-positive mothers in South Africa . METHODS This was a qualitative interview study within a prospect i ve cohort study . We purposively selected a sub sample of 40 women from a larger cohort of 650 HIV-positive mothers for in-depth interviews . FINDINGS The HIV epidemic has changed the context in which infant-feeding choices are made and implemented . HIV-positive mothers in this study -- who were predominantly young , single and unemployed -- were struggling to protect their decision-making autonomy . Uncertainty about the safety of breastfeeding has increased the power and influence of health workers , who now act as gatekeepers to not only this new knowledge but also to essential re sources such as formula milk . Fear of disclosure of HIV status and stigma has also weakened the ability of mothers to resist entrenched family and community norms that encourage early introduction of fluids and foods and that question non-breastfeeding . Women who chose to exclusively formula feed had difficulties accessing formula milk because of inflexible policies and a lack of supplies at clinics . Limited postpartum 
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Counseling on feeding option with an odds ratio of 4.32 ( 95 % CI : 2.75 , 6.77 ) and HIV disclosure status to the spouse with an odds ratio of 6.05 ( 95 % CI : 3.03 , 12.06 ) were significantly associated with exclusive breast feedings practice s. Conclusion Most mothers report exclusive breastfeeding , but there are still almost a quarter of mothers who mix feed .