***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: Purpose Medication adherence is a major challenge in HIV treatment . New mobile technologies such as smartphones facilitate the delivery of brief tailored messages to promote adherence . However , the best approach for tailoring messages is unknown . Persons living with HIV ( PLWH ) might be more receptive to some messages than others based on their current psychological state . Methods We recruited 37 PLWH from a parent study of motivational states and adherence . Participants completed smartphone-based surveys at a r and om time every day for 2 weeks , then immediately received intervention or control tailored messages , depending on r and om assignment . After 2 weeks in the initial condition , participants received the other condition in a crossover design . Intervention messages were tailored to match PLWH ’s current psychological state based on five variables – control beliefs , mood , stress , coping , and social support . Control messages were tailored to create a mismatch between message framing and participants ’ current psychological state . We evaluated intervention feasibility based on acceptance , ease of use , and usefulness measures . We also used pilot r and omized controlled trial methods to test the intervention ’s effect on adherence , which was measured using electronic caps that recorded pill-bottle openings . Results Acceptance was high based on 76 % enrollment and 85 % satisfaction . Participants found the hardware and software easy to use . However , attrition was high at 59 % , and usefulness ratings were slightly lower . The most common complaint was boredom . Unexpectedly , there was no difference between mismatched and matched messages ’ effects , but each group showed a 10%–15 % improvement in adherence after crossing to the opposite study condition . Conclusion Although smartphone-based tailored messaging was feasible and participants had clinical ly meaningful improvements in adherence , the mechanisms of change require further study . Possible explanations might include novelty effects , increased receptiveness to new information after habituation , or pseudotailoring , three ways in which attentional processes can affect behavior The authors of this study evaluated a structured 10-session psychosocial support group intervention for newly HIV-diagnosed pregnant South African women . Participants were expected to display increases in HIV disclosure , self-esteem , active coping and positive social support , and decreases in depression , avoidant coping , and negative social support .  Three hundred sixty-one pregnant HIV-infected women were recruited from four antenatal clinics in Tshwane townships from April 2005 to September 2006 . Using a quasi-experimental design , assessment s were conducted at baseline and two and eight months post-intervention . A series of r and om effects regression analyses were conducted , with the three assessment points treated as a r and om effect of time . At both follow-ups , the rate of disclosure in the intervention group was significantly higher than that of the comparison group ( p < 0.001 ) . Compared to the comparison group at the first follow-up , the intervention group displayed higher levels of active coping ( t = 2.68 , p < 0.05 ) and lower levels of avoidant coping ( t = −2.02 , p < 0.05 ) , and those who attended at least half of the intervention sessions exhibited improved self-esteem ( t = 2.11 , p < 0.05 ) . Group interventions tailored for newly HIV positive pregnant women , implemented in re source -limited setting s , may accelerate the process of adjusting to one 's HIV status , but may not have sustainable benefits over time Objective : The objective of this study is to assess the efficacy of an intervention design ed to promote resilience in young children living with their HIV-positive mothers . Design / methods : HIV-positive women attending clinics in Tshwane , South Africa , and their children , aged 6–10 years , were r and omized to the intervention ( I ) or st and ard care ( S ) . The intervention consisted of 24 weekly group sessions led by community care workers . Mothers and children were in separate groups for 14 sessions , followed by 10 interactive sessions . The primary focus was on parent – child communication and parenting . Assessment s were completed by mothers and children at baseline and 6 , 12 and 18 months . Repeated mixed linear analyses were used to assess change over time . Results : Of 390 mother – child pairs , 84.6 % ( I : 161 and S : 169 ) completed at least two interviews and were included in the analyses . Children 's mean age was 8.4 years and 42 % of mothers had been ill in the prior 3 months . Attendance in groups was variable : only 45.7 % attended more than 16 sessions . Intervention mothers reported significant improvements in children 's externalizing behaviours ( ß = –2.8 , P = 0.002 ) , communication ( ß = 4.3 , P = 0.025 ) and daily living skills ( ß = 5.9 , P = 0.024 ) , although improvement in internalizing behaviours and socialization was not significant ( P = 0.061 and 0.052 , respectively ) . Intervention children reported a temporary increase in anxiety but did not report differences in depression or emotional intelligence . Conclusion : This is the first study demonstrating benefits of an intervention design ed to promote resilience among young children of HIV-positive mothers . The intervention was specifically design ed for an African context and has the potential to benefit large numbers of children , if it can be widely implemented Concerns that st and ard didactic adherence counselling may be inadequate to maximise antiretroviral therapy ( ART ) adherence led us to evaluate more intensive individualised motivational adherence counselling . We r and omised 297 HIV-positive ART-naïve patients in Durban , South Africa , to receive either didactic counselling , prior to ART initiation ( n = 150 ) , or an intensive motivational adherence intervention after initiating ART ( n = 147 ) . Study arms were similar for age ( mean 35.8 years ) , sex ( 43.1 % male ) , CD4 + cell count ( median 121.5 cells/μl ) and viral load ( median 119,000 copies/ml ) . Virologic suppression at 9 months was achieved in 89.8 % of didactic and 87.9 % of motivational counselling participants ( risk ratio [ RR ] 0.98 , 95 % confidence interval [ CI ] 0.90–1.07 , p = 0.62 ) . 82.9 % of didactic and 79.5 % of motivational counselling participants achieved > 95 % adherence by pill count at 6 months ( RR 0.96 , 95 % CI 0.85–1.09 , p = 0.51 ) . Participants receiving intensive motivational counselling did not achieve higher treatment adherence or virological suppression than those receiving routinely provided didactic adherence counselling . These data are reassuring that less re source intensive didactic counselling was adequate for excellent treatment outcomes in this setting .ResumenLa inquietud de que la terapia didáctica de adherencia estándar pudiera ser inadecuada para maximizar la adherencia al tratamiento antiretroviral ( ART ) , nos llevó a evaluar la terapia motivacional individualizada . Aleatorizamos 297 pacientes HIV-positivos sin ART previo en Durban , Sudáfrica , para recibir , ya sea terapia didáctica antes del inicio del ART ( n = 150 ) , o terapia motivacional intensiva después de iniciado el ART ( n = 147 ) . Los brazos del estudio fueron similares en edad ( promedio 35.8 años ) , sexo ( 43.1 % hombres ) , recuento de células CD4 + ( mediana 121.5 células/μl ) y carga viral ( mediana 119,000 copias/ml ) . La supresión virológica a los nueves meses se logró en el 89.8 % de los participantes que recibieron terapia didáctica y en 87.9 % de aquellos en terapia motivacional ( riesgo relativo [ RR ] 0.98 , 95 % intervalo de confianza [ CI ] 0.90–1.07 , p = 0.62 ) . 82.9 % de los participantes bajo terapia didáctica y 79.5 % de los tratados con terapia motivacional alcanzaron > 95 % de adherencia por cuenta de píldoras a los seis meses ( RR 0.96 , 95 % CI 0.85–1.09 , p = 0.51 ) . Los participantes que recibieron terapia motivacional intensiva no mostraron una mayor adherencia al tratamiento o supresión virológica que aquellos bajo terapia didáctica rutinaria . Estos result ados son tranquilizadores ya que muestran que la menos costosa terapia didáctica es adecuada en este escenario Throughout Africa , Peer Mentors who are women living with HIV ( WLH ) are supporting pregnant WLH at antenatal and primary healthcare clinics ( McColl in BMJ 344:e1590 , 2012 ) . We evaluate a program using this intervention strategy at 1.5 months post-birth . In a cluster r and omized controlled trial in KwaZulu-Natal , South Africa , eight clinics were r and omized for their WLH to receive either : st and ard care ( SC  ) , based on national guidelines to prevent mother-to-child transmission ( 4 clinics ; n = 656 WLH ) ; or an enhanced intervention ( EI ; 4 clinics ; n = 544 WLH ) . The EI consisted of four antenatal and four postnatal small group sessions led by Peer Mentors , in addition to SC . WLH were recruited during pregnancy and 70 % were reassessed at 1.5 months post-birth . EI ’s effect was ascertained on 16 measures of maternal and infant well-being using r and om effects regressions to control for clinic clustering . A binomial test for correlated outcomes evaluated EI ’s overall effectiveness . Among EI WLH reassessed , 87 % attended at least one intervention session ( mean 4.1 , SD 2.0 ) . Significant overall benefits were found in EI compared to SC using the binomial test . However , it is important to note that EI WLH were significantly less likely to adhere to ARV during pregnancy compared to SC . Secondarily , compared to SC , EI WLH were more likely to ask partners to test for HIV , better protected their infants from HIV transmission , and were less likely to have depressed mood and stunted infants . Adherence to clinic intervention groups was low , yet , there were benefits for maternal and infant health at 1.5 months post-birth ABSTRACT Experimental studies to test interventions for people living with HIV in low- and middle-income countries are essential to ensure appropriate and effective clinical care . The implication s of study participation on outcome data in such population s have been discussed theoretically , but rarely empirically examined . We aim ed to explore the effects of participating in a r and omised controlled trial conducted in an HIV clinic in Mombasa , Kenya . We report qualitative data from the Treatment Outcomes in Palliative Care trial , which evaluated the impact of a nurse-led palliative care intervention for HIV positive adults on antiretroviral therapy compared to st and ard care . Participants in both arms attended five monthly quantitative data collection appointments . Post-trial exit , 10 control and 20 intervention patients participated in semi-structured qualitative interviews , analysed using thematic analysis . We found benefit attributed to the compassion of the research team , social support , communication , completion of patient reported outcome measures ( PROMs ) and material support ( transport reimbursement ) . Being treated with compassion and receiving social support enabled participants to build positive relationships with the research team , which improved mental health and well-being . Open and non-judgmental communication made participants feel accepted . Participants described how repeated completion of the PROMs was a prompt for reflection , through which they began to help themselves and self-care . Participant reimbursements relieved financial hardship and enabled them to fulfil their social responsibilities , enhancing self-worth . These findings emphasise the importance of compassion , support and effective communication in the clinical encounter , particularly in stigmatised and isolated population s , and the potential of the integration of simple PROMs to improve patient outcomes . Participation in research has unexpected positive benefits for participants , which should be taken into account when design ing research in similar population s. Research ers should be aware of the effects of financial reimbursement and contact with research ers in isolated and impoverished communities Context : The US Centers for Disease Control and Prevention ( CDC ) strongly recommend comprehensive risk counceling and services for people living with HIV ( PLH ) ; yet , there are no evidence -based counseling protocol s. Objective : To examine the effect of a 15-session , individually delivered , cognitive behavioral intervention on a diverse sample of PLH at risk of transmitting to others . Design : This was a multisite , 2-group , r and omized , controlled trial . Participants : Nine hundred thirty-six HIV-infected participants considered to be at risk of transmitting HIV of 3818 persons screened were r and omized into the trial . Participants were recruited in Los Angeles , Milwaukee , New York , and San Francisco . Intervention : Fifteen 90-minute individually delivered intervention sessions were divided into 3 modules : stress , coping , and adjustment ; safer behaviors ; and health behaviors . The control group received no intervention until the trial was completed . Both groups completed follow-up assessment s at 5 , 10 , 15 , 20 , and 25 months after r and omization . Main Outcome Measure : Transmission risk , as measured by the number of unprotected sexual risk acts with persons of HIV-negative or unknown status , 
    Output:
    
The available evidence suggests that psychosocial support interventions may improve self-esteem , coping and social support , and reduce depression , stress , and perceived stigma .
Most studies placed greater emphasis on instrumental health outcomes to prevent HIV transmission than on the intrinsic well-being and SRH of women living with HIV .