***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: Background The 2015 WHO recommendation of antiretroviral therapy ( ART ) for all immediately following HIV diagnosis is partially based on the anticipated impact on HIV incidence in the surrounding population . We investigated this approach in a cluster-r and omised trial in a high HIV prevalence setting in rural KwaZulu-Natal . We present findings from the first phase of the trial and report on uptake of  home-based HIV testing  , linkage to care , uptake of ART , and community attitudes about ART . Methods and Findings Between 9 March 2012 and 22 May 2014 , five clusters in the intervention arm ( immediate ART offered to all HIV-positive adults ) and five clusters in the control arm  ( ART offered according to national guidelines , i.e. , CD4 count ≤ 350 cells/μl ) contributed to the first phase of the trial . Households were visited every 6 mo . Following informed consent and administration of a study question naire , each resident adult ( ≥16 y ) was asked for a finger-prick blood sample , which was used to estimate HIV prevalence , and offered a rapid HIV test using a serial HIV testing algorithm . All HIV-positive adults were referred to the trial clinic in their cluster . Those not linked to care 3 mo after identification were contacted by a linkage-to-care team . Study procedures were not blinded . In all , 12,894 adults were registered as eligible for participation ( 5,790 in intervention arm ; 7,104 in control arm ) , of whom 9,927 ( 77.0 % ) were contacted at least once during household visits . HIV status was ever ascertained for a total of 8,233/9,927 ( 82.9 % ) , including 2,569 ascertained as HIV-positive ( 942 tested HIV-positive and 1,627 reported a known HIV-positive status ) . Of the 1,177 HIV-positive individuals not previously in care and followed for at least 6 mo in the trial , 559 ( 47.5 % ) visited their cluster trial clinic within 6 mo . In the intervention arm , 89 % ( 194/218 ) initiated ART within 3 mo of their first clinic visit . In the control arm , 42.3 % ( 83/196 ) had a CD4 count ≤ 350 cells/μl at first visit , of whom 92.8 % initiated ART within 3 mo . Regarding attitudes about ART , 93 % ( 8,802/9,460 ) of participants agreed with the statement that they would want to start ART as soon as possible if HIV-positive . Estimated baseline HIV prevalence was 30.5 % ( 2,028/6,656 ) ( 95 % CI 25.0 % , 37.0 % ) . HIV prevalence , uptake of home-based HIV testing , linkage to care within 6 mo , and initiation of ART within 3 mo in those with CD4 count ≤ 350 cells/μl did not differ significantly between the intervention and control clusters . Selection bias related to noncontact could not be entirely excluded . Conclusions Home-based HIV testing  was well received in this rural population , although men were less easily contactable at home ; immediate ART was acceptable , with good viral suppression and retention . However , only about half of HIV-positive people accessed care within 6 mo of being identified , with nearly two-thirds accessing care by 12 mo . The observed delay in linkage to care would limit the individual and public health ART benefits of universal testing and treatment in this population . Trial registration Clinical Trials.gov Importance Home-based HIV testing is a frequently used strategy to increase awareness of HIV status in sub-Saharan Africa . However , with referral to health facilities , less than half of those who test HIV positive link to care and initiate antiretroviral therapy ( ART ) . Objective To determine whether offering same-day home-based ART to patients with HIV improves linkage to care and viral suppression in a rural , high-prevalence setting in sub-Saharan Africa . Design , Setting , and Participants Open-label , 2-group , r and omized clinical trial ( February 22 , 2016-September 17 , 2017 ) , involving 6 health care facilities in northern Lesotho . During home-based HIV testing in 6655 households from 60 rural villages and 17 urban areas , 278 individuals aged 18 years or older who tested HIV positive and were ART naive from 268 households consented and enrolled . Individuals from the same household were r and omized into the same group . Interventions Participants were r and omly assigned to be offered same-day home-based ART initiation ( n = 138 ) and subsequent follow-up intervals of 1.5 , 3 , 6 , 9 , and 12 months after treatment initiation at the health facility or to receive usual care ( n = 140 ) with referral to the nearest health facility for preparatory counseling followed by ART initiation and monthly follow-up visits thereafter . Main Outcomes and Measures Primary end points were rates of linkage to care within 3 months ( presenting at the health facility within 90 days after the home visit ) and viral suppression at 12 months , defined as a viral load of less than 100 copies/mL from 11 through 14 months after enrollment . Results Among 278 r and omized individuals ( median age , 39 years [ interquartile range , 28.0 - 52.0 ] ; 180 women [ 65.7 % ] ) , 274 ( 98.6 % ) were included in the analysis ( 137 in the same-day group and 137 in the usual care group ) . In the same-day group , 134 ( 97.8 % ) indicated readiness to start ART that day and 2 ( 1.5 % ) within the next few days and were given a 1-month supply of ART . At 3 months , 68.6 % ( 94 ) in same-day group vs 43.1 % ( 59 ) in usual care group had linked to care ( absolute difference , 25.6 % ; 95 % CI , 13.8 % to 36.3 % ; P < .001 ) . At 12 months , 50.4 % ( 69 ) in the same-day group vs 34.3 % ( 47 ) in usual care group achieved viral suppression ( absolute difference , 16.0 % ; 4.4%-27.2 % ; P = .007 ) . Two deaths ( 1.5 % ) were reported in the same-day group , none in usual care group . Conclusions and Relevance Among adults in rural Lesotho , a setting of high HIV prevalence , offering same-day home-based ART initiation to individuals who tested positive during home-based HIV testing , compared with usual care and st and ard clinic referral , significantly increased linkage to care at 3 months and HIV viral suppression at 12 months . These findings support the practice of offering same-day ART initiation during home-based HIV testing . Trial Registration clinical trials.gov Identifier : Background Attrition during the period from HIV testing to antiretroviral therapy ( ART ) initiation is high worldwide . We assessed whether same-day HIV testing and ART initiation  improves retention and virologic suppression . Methods and findings We conducted an unblinded , r and omized trial of st and ard ART initiation versus same-day HIV testing and ART initiation among eligible adults ≥18 years old with World Health Organization Stage 1 or 2 disease and CD4 count ≤500 cells/mm3 . The study was conducted among out patients at the Haitian Group for the Study of Kaposi ’s Sarcoma and Opportunistic infections ( GHESKIO ) Clinic in Port-au-Prince , Haiti . Participants were r and omly assigned ( 1:1 ) to st and ard ART initiation or same-day HIV testing and ART initiation . The st and ard group initiated ART 3 weeks after HIV testing , and the same-day group initiated ART on the day of testing . The primary study endpoint was retention in care 12 months after HIV testing with HIV-1 RNA < 50 copies/ml . We assessed the impact of treatment arm with a modified intention-to-treat analysis , using multivariable logistic regression controlling for potential confounders . Between August 2013 and October 2015 , 762 participants were enrolled ; 59 participants transferred to other clinics during the study period , and were excluded as per protocol , leaving 356 in the st and ard and 347 in the same-day ART groups . In the st and ard ART group , 156 ( 44 % ) participants were retained in care with 12-month HIV-1 RNA < 50 copies , and 184 ( 52 % ) had < 1,000 copies/ml ; 20 participants ( 6 % ) died . In the same-day ART group , 184 ( 53 % ) participants were retained with HIV-1 RNA < 50 copies/ml , and 212 ( 61 % ) had < 1,000 copies/ml ; 10 ( 3 % ) participants died . The unadjusted risk ratio ( RR ) of being retained at 12 months with HIV-1 RNA < 50 copies/ml was 1.21 ( 95 % CI : 1.04 , 1.38 ; p = 0.015 ) for the same-day ART group compared to the st and ard ART group , and the unadjusted RR for being retained with HIV-1 RNA < 1,000 copies was 1.18 ( 95 % CI : 1.04 , 1.31 ; p = 0.012 ) . The main limitation of this study is that it was conducted at a single urban clinic , and the generalizability to other setting s is uncertain . Conclusions Same-day HIV testing and ART initiation is feasible and beneficial in this setting , as it improves retention in care with virologic suppression among patients with early clinical HIV disease . Trial registration This study is registered with Clinical Trials.gov number BACKGROUND In sub-Saharan Africa , the burden of human immunodeficiency virus (HIV)-associated tuberculosis is high . We conducted a trial with a 2-by-2 factorial design to assess the benefits of early antiretroviral therapy ( ART ) , 6-month isoniazid preventive therapy ( IPT ) , or both among HIV-infected adults with high CD4 + cell counts in Ivory Coast . METHODS We included participants who had HIV type 1 infection and a CD4 + count of less than 800 cells per cubic millimeter and who met no criteria for starting ART according to World Health Organization ( WHO ) guidelines . Participants were r and omly assigned to one of four treatment groups : deferred ART ( ART initiation according to WHO criteria ) , deferred ART plus IPT , early ART ( immediate ART initiation ) , or early ART plus IPT . The primary end point was a composite of diseases included in the case definition of the acquired immunodeficiency syndrome ( AIDS ) , non-AIDS-defining cancer , non-AIDS-defining invasive bacterial disease , or death from any cause at 30 months . We used Cox proportional models to compare outcomes between the deferred-ART and early-ART strategies and between the IPT and no-IPT strategies . RESULTS A total of 2056 patients ( 41 % with a baseline CD4 + count of ≥500 cells per cubic millimeter ) were followed for 4757 patient-years . A total of 204 primary end-point events were observed ( 3.8 events per 100 person-years ; 95 % confidence interval [ CI ] , 3.3 to 4.4 ) , including 68 in patients with a baseline CD4 + count of at least 500 cells per cubic millimeter ( 3.2 events per 100 person-years ; 95 % CI , 2.4 to 4.0 ) . Tuberculosis and invasive bacterial diseases accounted for 42 % and 27 % of primary end-point events , respectively . The risk of death or severe HIV-related illness was lower with early ART than with deferred ART ( adjusted hazard ratio , 0.56 ; 95 % CI , 0.41 to 0.76 ; adjusted hazard ratio among patients with a baseline CD4 + count of ≥500 cells per cubic millimeter , 0.56 ; 95 % CI , 0.33 to 0.94 ) and lower with IPT than with no IPT ( adjusted hazard ratio , 0.65 ; 95 % CI , 0.48 to 0.88 ; adjusted hazard ratio among patients with a baseline CD4 + count of ≥500 cells per cubic millimeter , 0.61 ; 95 % CI , 0.36 to 1.01 ) . The 30-month probability of grade 3 or 4 adverse events did not differ significantly among the strategies . CONCLUSIONS In this African country , immediate ART and 6 months of IPT independently led to lower rates of severe illness than did deferred ART and no IPT , both overall and among patients with CD4 + counts of at least 500 cells per cubic millimeter . ( Funded by the French National Agency for Research on AIDS and Viral Hepatitis ; TEMPRANO ANRS 12136 Clinical Trials.gov number , NCT00495651 . ) Background In high HIV prevalence setting s , offering HIV testing may be 
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Previously diagnosed individuals appear more likely to link-to-care than those who reported being newly-diagnosed .
It appears that individuals diagnosed in the community need time before they are ready to link-to-care/initiate ART .
Point-of-care ( POC ) CD4-counts at the time of HTS did not achieve higher proportions linking-to-care or initiating ART .
Similarly , follow-up visits to HIV-positive individuals did not appear to enhance linkage to care overall .
The available evidence suggests that different approaches to community-based HTS including HB-HTS and CLB-HTS , are equally effective in achieving linkage to care and ART initiation among those detected .
Engagement and support for newly diagnosed individuals may be key to achieving all three UNAIDS 90 - 90 - 90 targets .