***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: This r and omized behavioral trial examined whether youth living with HIV ( YLH ) receiving cell-phone support with study funded phone plans , demonstrated improved adherence and viral control during the 24 week intervention and 24 weeks post-intervention compared to controls . Monday through Friday phone calls confirmed medications were taken , provided problem-solving support , and referred to services to address adherence barriers . Of 37 participants ( ages 15–24 ) , 62 % were male and 70 % were African American .  Self-reported adherence was significantly higher in the intervention group compared to the control at 24 and 48 weeks for the past month ( P = 0.007 ) and log 10 HIV VL was significantly lower at both 24 weeks ( 2.82 versus 4.52 P = 0.002 ) and 48 weeks ( 3.23 versus 4.23 P = 0.043 ) . Adherence and viral load showed medium to large effect sizes across the 48 week study . This is the first study to demonstrate sustained clinical ly significant reductions in HIV VL using youth friendly technology . ResumenEste ensayo de comportamiento aleatorio examinó si los jóvenes que viven con el VIH ( YLH ) reciben apoyo por celular con el estudio financiado de teléfono , se demostró un mejor cumplimiento y control viral durante la intervención de 24 semanas y 24 semanas después de la intervención en comparación con los controles . De Lunes a Viernes las llamadas telefónicas confirmaron los medicamentos , apoyaron la resolución de problemas , y se refirió a los servicios para hacer frente a las barreras de adherencia . De los 37 participantes ( siglos 15–24 ) , el 62 % eran hombres y el 70 % eran afroamericanos . Adherencia auto-reportada fue significativamente mayor en el grupo de intervención en comparación con el control a las 24 y 48 semanas del mes pasado ( P = 0.007 ) y el log 10 VL VIH fue significativamente menor en ambos 24 semanas ( 2.82 versus 4.52 P = 0.002 ) y 48 semanas ( 3.23 versus 4.23 P = 0.043 ) . La adhesión y la carga viral mostraron medianas y gr and es tamaños del efecto en todo el estudio de 48 semanas . Este es el primer estudio que demuestra descensos importantes de la VL VIH utiliz and o tecnología amigable para la juventud HIV-positive adolescents and young adults often experience suboptimal medication adherence , yet few interventions to improve adherence in this group have shown evidence of efficacy . We conducted a r and omized trial of a two-way , personalized daily text messaging intervention to improve adherence to antiretroviral therapy ( ART ) among N = 105 poorly adherent HIV-positive adolescents and young adults , ages 16–29 . Adherence to ART was assessed via self-reported visual analogue scale ( VAS ; 0–100 % ) at 3 and 6-months for mean adherence level and proportion ≥90 % adherent . The average effect estimate over the 6-month intervention period was significant for ≥90 % adherence ( OR = 2.12 , 95 % CI 1.01–4.45 , p < .05 ) and maintained at 12-months ( 6 months post-intervention ) . Satisfaction scores for the intervention were very high . These results suggest both feasibility and initial efficacy of this approach . Given study limitations , additional testing of this intervention as part of a larger clinical trial with objective and /or clinical outcome measures of adherence is warranted Social media technologies have become increasingly useful tools for research -based interventions . However , participants and social media users have expressed ethical concerns with these studies , such as risks and benefits of participation , as well as privacy , confidentiality , and informed consent issues . This study was design ed to follow up with and assess experiences and perceptions of ethics-related issues among a sample of 211 men who have sex with men who participated in the Harnessing Online Peer Education ( HOPE ) Peru study , a r and omized controlled HIV prevention intervention conducted in Peru . We found that after adjusting for age , highest educational attainment , race , sexual orientation , and prior HIV research experience , participants in the intervention group were more likely than those in the control group to have safe sex ( p = 0.0051 ) and get tested for HIV regularly ( p = 0.0051 ) . As a result of their participation , those in the intervention group benefited more positively than participants in the control group in improving HIV care ( p = 0.0077 ) and learning where to receive sexual health services ( p = 0.0021 ) . Participants in the intervention group expressed higher levels of comfort than those in the control group in joining and seeing other people in the Facebook group ( p = 0.039 ) , seeing other people ’s posts ( p = 0.038 ) and having other group members talk to them online ( p = 0.040 ) . We discuss the implication s of these results as they relate to social media-based HIV research & NA ; Patient engagement in care and adherence to medication are critical to achieving the full benefits of antiretroviral therapy ( ART ) among people with HIV infection . A r and omized controlled trial in Kenya , WelTelKenya1 , showed that an interactive mobile phone text‐messaging intervention can improve adherence and viral load suppression . We conducted a pilot study to adapt the WelTel intervention for HIV‐infected clients ( n = 25 ) at an HIV clinic in Vancouver , British Columbia . Between April and June 2012 , we recruited five participants from five groups : youth ( 14–24 years ) , mature ( ≥50 years ) , English as a second language , remote ( ≥3 hours travel time to clinic ) , and nonsuppressed ( CD4 + T cell count < 200 cells/mm3 and viral load ≥250 copies/mL on two consecutive occasions ) . Participants described the intervention as a useful way to communicate with health care providers , thus increasing the ability to access services , report side effects , and attend appointments Objective : To explore the effects of four types of short message service ( SMS ) plus real-time adherence monitoring on antiretroviral therapy ( ART ) adherence : daily reminders , weekly reminders , reminders triggered after a late or missed dose ( delivered to patients ) , and notifications triggered by sustained adherence lapses ( delivered to patient-nominated social supporters ) . Design : Pilot r and omized controlled trial . Methods : Sixty-three individuals initiating ART received a real-time adherence monitor  and were r and omized ( 1 : 1 : 1 ) : ( 1 ) Scheduled SMS reminders ( daily for 1 month , weekly for 2 months ) , then SMS reminders triggered by a late or missed dose ( no monitoring signal within 2 h of expected dosing ) ; SMS notifications to social supporters for sustained adherence lapses ( no monitoring signal for > 48 h ) added after 3 months . ( 2 ) Triggered SMS reminders starting at enrolment ; SMS notifications to social supporters added after 3 months . ( 3 ) Control : No SMS .  HIV RNA was determined at 9 months . Percentage adherence and adherence lapses were compared by linear generalized estimating equations and Poisson regression , respectively . Results : Median age was 31 years , 65 % were women , and median enrolment CD4 + cell count was 322 cells/&mgr;l 97 % took once daily tenofovir/emtricitabine/efavirenz . Compared to control , adherence was 11.1 % higher ( P = 0.04 ) and more than 48-h lapses were less frequent ( IRR 0.6 , P = 0.02 ) in the scheduled SMS arm . Adherence and more than 48-h lapses were similar in the triggered SMS arm and control . No differences in HIV RNA were seen . Conclusion : Scheduled SMS reminders improved ART in the context of real-time monitoring . Larger studies are needed to determine the impact of triggered reminders and role of social supporters in improving adherence Adherence to antiretroviral therapy ( ART ) represents one of the strongest predictors of progression to AIDS , yet it is difficult for most patients to sustain high levels of adherence . This study compares the efficacy of a personalized cell phone reminder system ( ARemind ) in enhancing adherence to ART versus a beeper .  Twenty-three HIV-infected subjects on ART with self-reported adherence less than 85 % were r and omized to a cellular phone ( CP ) or beeper ( BP ) . CP subjects received personalized text messages daily ; in contrast , BP subjects received a reminder beep at the time of dosing . Interviews were scheduled at weeks 3 and 6 . Adherence to ART was measured by self-report ( SR , 7-day recall ) , pill count ( PC , past 30 days at baseline , then past 3 weeks ) , Medication Event Monitoring System ( MEMS ; cumulatively at 3 and 6 weeks ) , and via a composite adherence score constructed by combining MEMS , pill count , and self report . A mixed effects model adjusting for baseline adherence was used to compare adherence rates between the intervention groups at 3 and 6 weeks . Nineteen subjects completed all visits , 10 men and 9 females . The mean age was 42.7 ± 6.5 years , 37 % of subjects were Caucasian and 89 % acquired HIV heterosexually .  The average adherence to ART was 79 % by SR and 65 % by PC at baseline in both arms ; over 6 weeks adherence increased and remained significantly higher in the ARemind group using multiple measures of adherence . A larger and longer prospect i ve study is needed to confirm these findings and to better underst and optimal reminder messages and user fatigue Background : HIV and AIDS are major public health problems in the world and Africa . In Cameroon , the HIV prevalence is 5.1 % . Cellphones have been found to be useful in the provision of modern health care services using short message services ( SMS ) . This study assessed the effectiveness of SMS in improving the adherence of people living with HIV and AIDS to their treatment and care in Cameroon . Methods : This intervention study used a r and omized controlled trial design . Ninety participants seeking treatment at the Nkwen Baptist Health Center were recruited between August and September 2011 using a purposive sampling method . They were r and omly allocated into the intervention and control groups , each containing 45 participants . In the intervention group , each participant received four SMSs per week at equal intervals for four weeks . The patients were investigated for adherence to ARVs by evaluating the number of times treatment and medication refill appointments were missed . Data were collected using an interviewer-administered question naire before and after intervention and analysed on STATA . Results : The baseline survey indicated that there were 55(61.1 % ) females and 35(38.9 % ) males aged 23 - 62 years ; the mean age was 38.77 ± 1.08 . Most participants were teachers [ 12 ( 13.3 % ) ] , farmers [ 11 ( 12.2 % ) ] , and businessmen [ 24 ( 26.7 % ) ] . Adherence to ARVs was 64.4 % in the intervention group and 44.2 % in the control group ( p = 0.05 ) . 2(4.4 % ) patients in the control group failed to respect their drug refill appointments while all the 45(100 % ) participants in the intervention group respected their drug refill appointments . 54.17 % of married people and 42.9 % of the participants with primary and secondary levels of education missed their treatment . Key reasons for missing treatment were late home coming ( 54 % ) , forgetfulness ( 22.5 % ) , and travelling out of station without medication ( 17.5 % ) . Other factors responsible for non-adherence included involvement in outdoor business ( 60.87 % ) , ARV stock out ( 37.8 % ) , and not belonging to a support group ( 10.23 % ) . Twenty eight ( 62.22 % ) subjects in the intervention group were able to take their treatment regularly and on time . Conclusion : SMS improved adherence to ARVs . Key constraints which affect adhere to ARV medication can be addressed using SMS Background Following male circumcision for HIV prevention , a high proportion of men fail to return for their scheduled seven-day post-operative visit . We evaluated the effect of short message service ( SMS ) text messages on attendance at this important visit . Methodology We enrolled 1200 participants > 18 years old in a two-arm , parallel , r and omized controlled trial at 12 sites in Nyanza province , Kenya . Participants received daily SMS text messages for seven days ( n = 600 ) or usual care ( n = 600 ) . The primary outcome was attendance at the scheduled seven-day post-operative visit . The primary analysis was by intention-to-treat . Principal Findings Of participants receiving SMS , 387/592 ( 65.4 % ) returned , compared to 356/596 ( 59.7 % ) in the control group ( relative risk [ RR ] = 1.09 , 95 % confidence interval [ CI ] 1.00–1.20 ; p = 0.04 ) . Men who paid more than US$ 1.25 to travel to clinic were at higher risk for failure to return compared to those who spent ≤US$1.25 ( adjusted relative risk [ aR 
    Output:
    
Digital innovations were acceptable , feasible and generated impact .
A trend towards the use of internet-based and combined ( internet and mobile ) innovations was noted .