***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 : To identify the effects of substance abuse status ( active , former , and never ) on utilization of highly active antiretroviral therapy ( HAART ) , medication adherence , and virologic and immunologic responses to therapy . Design : Prospect i ve cohort study of 764 HIV‐1‐infected patients who attended an urban HIV clinic and participated in a st and ardized interview .  Main Outcome Measures : Past utilization of HAART , self‐reported nonadherence with antiretroviral therapy  , and changes in HIV‐1 RNA level and CD4 + lymphocyte count relative to prior peak and nadir , respectively . Results : Forty‐four percent of active drug users failed to utilize HAART compared with 22 % of former drug users and 18 % of non‐drug users ( p < .001 for both comparisons ) . Among participants who were taking antiretroviral therapy when interviewed , active drug users were more likely to report medication nonadherence ( 34 % vs. 24 % of nonusers and 17 % of former users ) , had a smaller median reduction in HIV‐1 RNA from baseline ( 0.8 log10 copies/ml vs. 1.7 in nonusers and 1.6 in former users ) , and had smaller median increases in CD4 + lymphocyte count from baseline ( 65 cells/mm3 vs. 116 in nonusers and 122 in former users ) ( p < .05 for all comparisons with active users ) . Conclusions : Active drug use was strongly associated with underutilization of HAART , nonadherence , and inferior virologic and immunologic responses to therapy , whereas former drug users and non‐drug users were similar in all outcomes . Effective strategies are needed that integrate HIV‐1 and substance abuse treatments To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results Developing an evidence base for making public health decisions will require using data from evaluation studies with r and omized and nonr and omized design s. Assessing individual studies and using studies in quantitative research syntheses require transparent reporting of the study , with sufficient detail and clarity to readily see differences and similarities among studies in the same area . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement provides guidelines for transparent reporting of r and omized clinical trials . We present the initial version of the Transparent Reporting of Evaluations with Nonr and omized Design s ( TREND ) statement . These guidelines emphasize the reporting of theories used and descriptions of intervention and comparison conditions , research design , and methods of adjusting for possible biases in evaluation studies that use nonr and omized design Directly administered antiretroviral therapy ( DAART ) is one approach to improving adherence to among human immunodeficiency virus (HIV)-infected drug users . We evaluated the essential features of a community-based DAART intervention in a r and omized , controlled trial of DAART versus self-administered therapy .  Of the initial 72 subjects , 78 % were racial minorities , and 32 % were women . Social and medical comorbidities among subjects included homelessness ( 35 % of subjects ) , lack of interpersonal support ( 86 % ) , major depression ( 57 % ) , and alcoholism ( 36 % ) . At baseline , the median CD4 + cell count was 403 cells/mL and the median HIV-1 RNA load was 146,333 copies/mL ( log10 5.31 copies/mL ) . During the prior 6 months , 33 % of subjects had missed a medical appointment , and 47 % had visited an emergency department . Although most subjects ( 67 % ) preferred to take their own medications , 76 % would accept DAART if it were made compulsory . A methadone clinic was the DAART venue acceptable to the fewest subjects ( 36 % ) , and a mobile syringe-exchange program was acceptable to the most subjects ( 83 % ) . Adherence was higher for supervised than for unsupervised medication administration ( P<.0001 ) , a finding that supports use of daily supervision of once-daily regimens . Moreover , DAART should incorporate enhanced elements such as convenience , flexibility , confidentiality , cues and reminders , responsive pharmacy and medical services , and specialized training for staff To evaluate the impact of  injection drug users ( IDUs ) adherence on effectiveness of highly active antiretroviral therapy ( HAART ) , repeated measures of plasma viral load and CD4 + counts before HAART initiation and at last visit in the cohort were studied . Data were collected by means of patient 's face-to-face and self-administered question naires about adherence to HAART during the week prior to the last visit . Of a total of 119 patients treated with HAART , undetectable viral load was obtained for 55 patients ( 46.2 % ) ( G3 ) ; 34 patients ( 28.6 % ) ( G2 ) had a viral load decline > 0.5 log copies/ml but still detectable viral load at last visit in the cohort , while 30 patients ( 25.2 % ) ( G1 ) had no decline or decline ≤ 0.5 log copies/ml . Proportion of 100 % adherent patients was significantly higher in G3 ( 83.6 % ) than in G2 ( 64.7 % ) and G1 ( 56.7 % ) . In spite of differences in virological success and adherence , mean increase in CD4 + counts was similar in G3 ( 123 ± 160 counts/mm3 ) and G2 ( 143 ± 147 ) while no immunological improvement was observed in G1 . For the sub-groups of patients whose limited adherence has implied virological failure but did not impede short-term immunological reconstitution following HAART initiation , decision to switch HAART regimens could be delayed until interventions for improving future adherence have been carried out Objective To assess the temporal association of changes in substance abuse with  antiretroviral therapy use and adherence , HIV-1 RNA suppression , and CD4 cell count changes in patients attending an urban clinic . Design Prospect i ve cohort study . Methods Six-hundred and ninety-five HIV-1-infected individuals , who completed two or more semi-annual st and ardized surveys and in whom antiretroviral therapy was indicated , were included in the analysis . Surveys addressed antiretroviral therapy  use and adherence , and use of illicit drugs and alcohol . Substance abuse was defined as active heroin , cocaine , or heavy alcohol use in the 6 months preceding survey . The units of analysis were consecutive pairs of surveys ( couplets ) in individual participants . Couplets in which participants denied substance abuse in both surveys were compared to couplets in which participants switched from non-use to substance abuse , and couplets in which participants reported substance abuse in both surveys were compared to couplets where participants switched from substance abuse to non-use . Results Switching from non-use to substance abuse was strongly associated with worsening antiretroviral therapy use and adherence , less frequent HIV-1 RNA suppression , and blunted CD4 cell increases , compared to remaining free of substance abuse . Alternatively , switching from substance abuse to non-use was strongly associated with improvements in antiretroviral therapy use and adherence , and HIV-1 treatment outcomes , compared to persisting with substance abuse . Conclusions This longitudinal study highlights the dynamic nature of substance abuse and its temporal association with the effectiveness of  HIV-1 treatment in patients attending an inner-city clinic Objective : To assess the efficacy of a peer-delivered intervention to promote short-term ( 6-month ) and long-term ( 12-month ) adherence to HAART in a Mozambican clinic population . Design : A 2-arm r and omized controlled trial was conducted between October 2004 and June 2006 . Participants : Of 350 men and women ( ≥18 years ) initiating HAART , 53.7 % were female , and 97 % were on 1 fixed-dose combination pill twice a day . Intervention : Participants were r and omly assigned to receive 6 weeks ( Monday through Friday ; 30 daily visits ) of peer-delivered , modified directly observed therapy ( mDOT ) or st and ard care . Peers provided education about treatment and adherence and sought to identify and mitigate adherence barriers . Outcome : Participants ' self-reported medication adherence was assessed 6 months and 12 months after starting HAART . Adherence was defined as the proportion of prescribed doses taken over the previous 7 days . Statistical analyses were performed using intention-to-treat ( missing = failure ) . Results : Intervention participants , compared to those in st and ard care , showed significantly higher mean medication adherence at 6 months ( 92.7 % vs. 84.9 % , difference 7.8 , 95 % confidence interval [ CI ] : 0.0.02 , 13.0 ) and 12 months ( 94.4 % vs. 87.7 % , difference 6.8 , 95 % CI : 0.9 , 12.9 ) . There were no between-arm differences in chart- abstract ed CD4 counts . Conclusions : A peer-delivered mDOT program may be an effective strategy to promote long-term adherence among persons initiating HAART in re source -poor setting This study 's hypothesis is that human immunodeficiency virus-infected patients in the inner city ( predominantly injection drug users and ethnic minorities ) do not take highly active antiretroviral therapy ( HAART ) as prescribed and that nonadherence leads to virologic failure . A prospect i ve , observational , 3-month study of adherence to HAART was undertaken at an inner-city clinic . There were 40 subjects [ 110 subject-months ] ; 30 were male , 10 were female , 75 % were Hispanic , 23 % were African American , 68 % were injection drug users , and 68 % were receiving triple therapy . At 3 months , adherence , which was determined by use of the  Medication Event Monitoring System  ( Aprex ) was significantly associated with virologic success : lower virus loads were associated with a rate of adherence of > 80 % ( P<.05 ) . Although nonadherence predicted virologic failure , virologic success was not always predicted by adherence : 11 ( 27.5 % ) of 40 subjects with suboptimal adherence rates ( < 90 % ) had complete virologic suppression Background : Directly administered antiretroviral therapy ( DAART ) is a promising intervention for improving HIV outcomes among active drug users , but the elements associated with successful DAART programs remain largely unknown . This study aim ed to assess the impact of colocated medical , case management , and referral to substance abuse services ( DAART-Plus ) among the subjects receiving DAART  as part of a larger r and omized controlled trial comparing DAART with self-administered therapy . Methods : The health services utilization of 72 subjects receiving DAART  was analyzed for its impact on changes in HIV-1 RNA levels at 6 months . The primary outcome was virologic success , defined as achieving an HIV-1 RNA level ≤400 copies/mL or a ≥1.0 log10 reduction in HIV-1 RNA level . A second analysis consisted of linear regression assessing the effect of covariates on log10 HIV-1 RNA reduction from baseline to 6 months . Results : In multivariate analyses , achieving virologic success at 6 months was associated with high medical services utilization [ adjusted odds ratio [ AOR ] = 10.0 ( 1.4 , 73.9 ) ; P = 0.02 ] and with the use of case management services [ AOR = 5.8 ( 1.1 , 30.5 ) ; P = 0.04 ] . Both services result ed in a larger reduction in log10 HIV-1 RNA from baseline ( difference in slopes : −0.9 and −1.0 , respectively ; P = 0.02 for both ) . Referral to off-site substance abuse services treatment did not significantly predict either virologic outcome . Conclusions : Among individuals who receive DAART , the utilization of on-site medical and case management services was independently associated with improved virologic outcomes . These results suggest the potential utility of integrating these services into DAART interventions ( DAART-Plus ) targeting HIV-infected drug users with problematic adherence Objectives To assess adherence to highly active antiretroviral therapies ( H 
    Output:
    
The systematic review identified better HAART outcomes among former DU , those with less severe psychiatric conditions , those receiving opioid substitution therapy and /or psychosocial support .
Patients initiating HAART with lower viral load and higher CD4 counts , and those without co-infections also had better treatment outcomes .
Our findings suggest that HIV+ DU tend to be inappropriately assumed to be less adherent and unlikely to achieve desirable treatment outcomes , when compared to their non-DU cohort