***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 Human re source limitations are a challenge to the delivery of antiretroviral therapy ( ART ) in low-re source setting s. We conducted a cluster r and omized trial to assess the effect of community-based peer health workers ( PHW ) on AIDS care of adults in Rakai , Ug and a. Methodology /Principal Findings 15 AIDS clinics were r and omized 2∶1 to receive the PHW intervention ( n = 10 ) or control ( n = 5 ) . PHW tasks included clinic and home-based provision of counseling , clinical , adherence to ART , and social support . Primary outcomes were adherence and cumulative risk of virologic failure ( > 400 copies/mL ) . Secondary outcomes were virologic failure at each 24 week time point up to 192 weeks of ART . Analysis was by intention to treat . From May 2006 to July 2008 , 1336 patients were followed . 444 ( 33 % ) of these patients were already on ART at the start of the study . No significant differences were found in lack of adherence ( < 95 % pill count adherence risk ratio [ RR ] 0.55 , 95 % confidence interval [ CI ] 0.23–1.35 ; < 100 % adherence RR 1.10 , 95 % CI 0.94–1.30 ) , cumulative risk of virologic failure ( RR 0.81 , 95 % CI 0.61–1.08 ) or in shorter-term virologic outcomes ( 24 week virologic failure RR 0.93 , 95 % CI 0.65–1.32 ; 48 week , RR 0.83 , 95 % CI 0.47–1.48 ; 72 week , RR 0.81 , 95 % CI 0.44–1.49 ) . However , virologic failure rates ≥96 weeks into ART were significantly decreased in the intervention arm compared to the control arm ( 96 week failure RR 0.50 , 95 % CI 0.31–0.81 ; 120 week , RR 0.59 , 95 % CI 0.22–1.60 ; 144 week , RR 0.39 , 95 % CI 0.16–0.95 ; 168 week , RR 0.30 , 95 % CI 0.097–0.92 ; 192 week , RR 0.067 , 95 % CI 0.0065–0.71 ) . Conclusions / Significance A PHW intervention was associated with decreased virologic failure rates occurring 96 weeks and longer into ART , but did not affect cumulative risk of virologic failure , adherence measures , or shorter-term virologic outcomes . PHWs may be an effective intervention to sustain long-term ART in low-re source setting s. Trial Registration Clinical Trials.gov Background Prevention of mother to child HIV transmission ( PMTCT ) programmes have great potential to achieve virtual elimination of perinatal HIV transmission provided that PMTCT recommendations are properly followed . This study assessed mothers and infants adherence to medication regimen for PMTCT and the proportions of exposed infants who were followed up in the PMTCT programme . Methods A prospect i ve cohort study was conducted among 282 HIV-positive mothers attending 15 health facilities in Addis Ababa , Ethiopia . Descriptive statistics , bivariate and mulitivariate logistic regression analyses were done . Results Of 282 mothers enrolled in the cohort , 232 ( 82 % , 95 % CI 77 - 86 % ) initiated medication during pregnancy , 154 ( 64 % ) initiated combined zidovudine ( ZDV ) prophylaxis regimen while 78 ( 33 % ) were initiated lifelong antiretroviral treatment ( ART ) . In total , 171 ( 60 % , 95 % CI 55 - 66 % ) mothers ingested medication during labour . Of the 221 live born infants ( including two sets of twins ) , 191 ( 87 % , 95 % CI 81 - 90 % ) ingested ZDV and single-dose nevirapine ( sdNVP )  at birth . Of the 219 live births ( twin births were counted once ) , 148 ( 68 % , 95 % CI 61 - 73 % ) mother-infant pairs ingested their medication at birth . Medication ingested by mother-infant pairs at birth was significantly and independently associated with place of delivery . Mother-infant pairs attended in health facilities at birth were more likely ( OR 6.7 95 % CI 2.90 - 21.65 ) to ingest their medication than those who were attended at home . Overall , 189 ( 86 % , 95 % CI 80 - 90 % ) infants were brought for first pentavalent vaccine and 115 ( 52 % , 95 % CI 45 - 58 % ) for early infant diagnosis at six-weeks postpartum . Among the infants brought for early diagnosis , 71 ( 32 % , 95 % CI 26 - 39 % ) had documented HIV test results and six ( 8.4 % ) were HIV positive . Conclusions We found a progressive decline in medication adherence across the perinatal period . There is a big gap between mediation initiated during pregnancy and actually ingested by the mother-infant pairs at birth . Follow up for HIV-exposed infants seem not to be organized and is inconsistent . In order to maximize effectiveness of the PMTCT programme , the rate of institutional delivery should be increased , the quality of obstetric services should be improved and missed opportunities to exposed infant follow up should be minimized Background The aim of this study was to describe barriers to accessing and accepting highly active antiretroviral therapy ( HAART ) by HIV-positive mothers in the Ug and an Kabarole District 's Programme for the Prevention of Mother to Child Transmission-Plus ( PMTCT-Plus ) . Methods Our study was a qualitative descriptive exploratory study using thematic analysis . Individual in-depth interviews  ( n = 45 ) were conducted with r and omly selected HIV-positive mothers who attended this programme , and who : ( a ) never enrolled in HAART ( n = 17 ) ; ( b ) enrolled but did not come back to receive HAART ( n = 2 ) ; ( c ) defaulted/interrupted HAART ( n = 14 ) ; and ( d ) are currently adhering to HAART ( n = 12 ) . A focus group was also conducted to verify the results from the interviews . Results Results indicated that economic concerns , particularly transport costs from residences to the clinics , represented the greatest barrier to accessing treatment . In addition , HIV-related stigma and non-disclosure of HIV status to clients ' sexual partners , long waiting times at the clinic and suboptimal provider-patient interactions at the hospital emerged as significant barriers . Conclusions These barriers to antiretroviral treatment of pregnant and post-natal women need to be addressed in order to improve HAART uptake and adherence for this group of the population . This would improve their survival and , at the same time , drastically reduce HIV transmission from mother to child Background Global coverage of prevention of mother-to-child ( PMTCT ) services reached 53 % in 2009 . However the number of pregnant women who test positive for HIV in antenatal clinics and who link into long-term HIV care is not known in many re source -poor countries . We measured the proportion of HIV-positive pregnant women in Mwanza city , Tanzania , who completed the cascade of care from antenatal HIV diagnosis to assessment and engagement in care in adult HIV clinics . Methods Thirty antenatal and maternity ward health workers were interviewed about PMTCT activities . Nine antenatal HIV education sessions were observed . A prospect i ve cohort of 403 HIV-positive women was enrolled by specially-trained clinicians and nurses on admission to delivery and followed for four months post-partum . Information was collected on referral and attendance at adult HIV clinics , eligibility for highly active antiretroviral therapy ( HAART ) and reasons for lack of attendance . Results Overall , 70 % of PMTCT health workers referred HIV-positive pregnant women to the HIV clinic for assessment and care . Antenatal HIV education sessions did not cover on-going care for HIV-infected women . Of 310 cohort participants tested in pregnancy , 51 % had received an HIV clinic referral pre-delivery . Only 32 % of 244 women followed to four months post-partum had attended an HIV clinic and been assessed for HAART eligibility . Non-attendance for HIV care was independently associated with fewer antenatal visits , poor PMTCT prophylaxis compliance , non-disclosure of HIV status , and non-Sukuma ethnicity . Conclusion Most women identified as HIV-positive during pregnancy were not assessed for HAART eligibility during pregnancy or in the first four months post-partum . Initiating HAART at the antenatal clinic , improved counselling and linkages to care between PMTCT and adult HIV treatment services and reducing stigma surrounding disclosure of HIV results would benefit on-going care of HIV-positive pregnant women Objective : There is limited evidence on whether growing mobile phone availability in sub-Saharan Africa can be used to promote high adherence to antiretroviral therapy ( ART ) . This study tested the efficacy of short message service ( SMS ) reminders on adherence to ART among patients attending a rural clinic in Kenya . Design : A r and omized controlled trial of four SMS reminder interventions with 48 weeks of follow-up . Methods : Four hundred and thirty-one adult patients who had initiated ART within 3 months were enrolled and r and omly assigned to a control group or one of the four intervention groups . Participants in the intervention groups received SMS reminders that were either short or long and sent at a daily or weekly frequency .  Adherence was measured using the medication event monitoring system .  The primary outcome was whether adherence exceeded 90 % during each 12-week period of analysis and the 48-week study period . The secondary outcome was whether there were treatment interruptions lasting at least 48 h. Results : In intention-to-treat analysis , 53 % of participants receiving weekly SMS reminders achieved adherence of at least 90 % during the 48 weeks of the study , compared with 40 % of participants in the control group ( P = 0.03 ) . Participants in groups receiving weekly reminders were also significantly less likely to experience treatment interruptions exceeding 48 h during the 48-week follow-up period than participants in the control group ( 81 vs. 90 % , P = 0.03 ) . Conclusion : These results suggest that SMS reminders may be an important tool to achieve optimal treatment response in re source -limited setting Objective : To compare compliance and infant HIV-1 infection risk at 6 weeks with the Thai-CDC and HIVNET-012 antiretroviral regimens in a field setting . Design : R and omized clinical trial . Setting : Tertiary hospital antenatal clinic in Nairobi , Kenya . Participants : HIV-1 infected women referred from primary care clinics . Interventions : Thai-CDC zidovudine regimen or HIVNET-012 nevirapine regimen . Main outcome measures : Women were considered compliant if they used ⩾ 80 % of the doses . Infants were tested for HIV-1 at 6 weeks . Results : Seventy women were r and omized to Thai-CDC and 69 to HIVNET-012 regimens . More women were compliant with the antenatal ( 86 % ) than the intrapartum ( 44 % ) Thai-CDC regimen doses ( P = 0.001 ) . Ninety-seven per cent took the maternal and 91 % gave the infant dose of the HIVNET-012 regimen ( P = 0.2 ) . Overall , 41 % were compliant with the Thai-CDC regimen and 87 % with the HIVNET-012 regimen ( P < 0.001 ) . Compliance with the Thai-CDC regimen was associated with partner support of antiretroviral use [ odds ratio ( OR ) , 3.0 ; , 95 % confidence interval ( CI ) , 1.0–9.1 ] and knowledge at recruitment that antiretroviral drugs could prevent infant HIV-1 ( OR , 2.9 ; 95 % CI , 1.0–8.1 ) . Compliance with the HIVNET-012 regimen was associated with partner notification ( OR , 8.0 ; 95 % CI , 1.5–50 ) and partner willingness to have HIV-1 testing ( OR , 7.5 ; 95 % CI , 1.4–40 ) . There was a trend for a higher risk of transmission with the HIVNET-012 regimen than with the Thai-CDC regimen ( 22 % versus 9 % ; P = 0.07 ) . Conclusion : Compliance with the Thai-CDC and HIVNET-012 regimens was comparable to that in efficacy trials . Partner involvement , support and education on perinatal HIV-1 prevention may improve compliance and increase the number of infants protected from HIV-1 infection Universal nevirapine ( NVP ) therapy ( provision of the drug without HIV testing ) has been suggested as potentially superior to targeted NVP therapy ( provision of the drug to seropositive patients identified through voluntary 
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Stigma and fear of status disclosure to partners , family or community members ( community-level factors ) were the most frequently cited barriers overall and across time .
The extent of partner/community support was another major factor impeding or facilitating the uptake of PMTCT ARVs , while cultural traditions including preferences for traditional healers and birth attendants were also common .
Key health-systems issues included poor staff-client interactions , staff shortages , service accessibility and non-facility deliveries .