***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: Introduction Linkage from HIV testing and counselling ( HTC ) to initiation of antiretroviral therapy ( ART ) is suboptimal in many national programmes in sub-Saharan Africa , leading to delayed initiation of ART and increased risk of death . Reasons for failure of linkage are poorly understood . Methods Semi-structured qualitative interviews were undertaken with health providers and HIV-positive primary care patients as part of a prospect i ve cohort study at primary health centres in Blantyre , Malawi . Patients successful and unsuccessful in linking to ART were included . Results Progression through the HIV care pathway was strongly influenced by socio-cultural norms , particularly around the perceived need to regain respect lost during a period of visibly declining health . Capacity to call upon the support of networks of families , friends and employers was a key determinant of successful progression . Over-busy clinics , non-functioning laboratories and unsuitable tools used for ART eligibility assessment ( WHO clinical staging system and central ized CD4 count measurement ) were important health systems determinants of drop-out . Conclusions Key interventions that could rapidly improve linkage include guarantee of same-day , same-clinic ART eligibility assessment s ; utilization of the support offered by peer-groups and community health workers ; and integration of HTC and ART programmes Background Poor rates of linkage from HIV diagnosis to ART initiation are a major barrier to universal coverage of ART in sub-Saharan Africa , with reasons for failure poorly understood . In the first study of this kind at primary care level , we investigated the pathway to care in the Malawian National Programme , one of the strongest in Africa . Methods and Findings A prospect i ve cohort study was undertaken at two primary care clinics in Blantyre , Malawi . Newly diagnosed HIV-positive adults ( > 15 years ) were followed for 6-months to assess completion of eligibility assessment s , initiation of ART and death .  Two hundred and eighty participants were followed for 82.6 patient-years . ART eligibility assessment s were problematic : only 134 ( 47.9 % ) received same day WHO staging and 121 ( 53.2 % ) completed assessment s by 6-months . Completion of CD4 measurement ( stage 1/2 only ) was 81/153 ( 52.9 % ) . By 6-months , 87/280 ( 31.1 % ) had initiated ART with higher uptake in participants who were ART eligible ( 68/91 , 74.7 % ) , and among participants who received same-day staging ( 52/134 [ 38.8 % ] vs. 35/146 [ 24.0 % ] p = 0.007 ) . Non-completion of ART eligibility assessment s ( adjusted hazard ratio : 0.11 , 95 % CI : 0.06–0.21 ) was associated with failure to initiate ART . Retention in pre-ART care for non-ART initiators was low ( 55/193 [ 28.5 % ] ) . Of the 15 ( 5.4 % ) deaths , 11 ( 73.3 % ) occurred after ART initiation . Conclusions Although uptake of ART was high and prompt for patients with known eligibility , there was frequent failure to complete eligibility assessment and poor retention in pre-ART care . HIV care programmes should urgently evaluate the way patients are linked to ART . In particular , there is a critical need for simplified , same-day ART eligibility assessment s , reduced requirements for hospital visits , and active defaulter follow-up Objective : We evaluated the effectiveness of short-term cash and food assistance to improve adherence to antiretroviral therapy ( ART ) and retention in care among people living with HIV in Tanzania . Methods : At three clinics , 805 participants were r and omized to three groups in a 3 : 3 : 1 ratio , stratified by site : nutrition assessment and counseling ( NAC ) and cash transfers ( ∼$11/month , n = 347 ) , NAC and food baskets ( n = 345 ) , and NAC-only ( comparison group , n = 113 , clinical trials.gov NCT01957917 ) . Eligible people living with HIV were at least 18 years , initiated ART 90 days or less prior , and food insecure .  Cash or food was provided for 6 or less consecutive months , conditional on visit attendance . The primary outcome was medication possession ratio ( MPR ≥ 95 % ) at 6 months . Secondary outcomes were appointment attendance and loss to follow-up ( LTFU ) at 6 and 12 months . Results : The primary intent-to-treat analysis included 800 participants . Achievement of MPR ≥ 95 % at 6 months was higher in the NAC + cash group compared with NAC-only ( 85.0 vs. 63.4 % ) , a 21.6 percentage point difference [ 95 % confidence interval ( CI ) : 9.8 , 33.4 , P < 0.01 ] . MPR ≥ 95 % was also significantly higher in the NAC + food group vs. NAC-only ( difference = 15.8 , 95 % CI : 3.8 , 27.9 , P < 0.01 ) . When directly compared , MPR ≥ 95 % was similar in the NAC + cash and NAC + food groups ( difference = 5.7 , 95 % CI : −1.2 , 12.7 , P = 0.15 ) . Compared with NAC-only , appointment attendance and LTFU were significantly higher in both the NAC + cash and NAC + food groups at 6 months . At 12 months , the effect of NAC + cash , but not NAC + food , on MPR ≥ 95 % and retention was sustained . Conclusion : Short-term conditional cash and food assistance  improves ART possession and appointment attendance and reduces LTFU among food-insecure ART initiates in Tanzania 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 ABSTRACT BACKGROUND Antiretroviral therapy ( ART ) adherence is key to successful treatment of HIV infection and alcohol is a known barrier to adherence . Beyond intoxication , ART adherence is impacted by beliefs that mixing alcohol and medications is toxic . PURPOSE To examine prospect i ve relationships of factors contributing to intentional medication non-adherence when drinking . METHODS People who both receive ART and drink alcohol ( N = 178 ) were enrolled in a 12-month prospect i ve cohort study that monitored beliefs about the hazards of mixing ART with alcohol ( interactive toxicity beliefs ) , alcohol consumption using electronic daily diaries , ART adherence assessed by both unannounced pill counts and self-report , and chart- abstract ed HIV viral load . RESULTS Participants who reported skipping or stopping their ART when drinking ( N = 90 , 51 % ) demonstrated significantly poorer ART adherence , were less likely to be viral suppressed , and more likely to have CD4 counts under 200/cc3 . Day-level analyses showed that participants who endorsed interactive toxicity beliefs were significantly more likely to miss medications on drinking days . CONCLUSIONS Confirming earlier cross-sectional studies , the current findings from a prospect i ve cohort show that a substantial number of people intentionally skip or stop their medications when drinking . Interventions are needed to correct alcohol-related interactive toxicity misinformation and promote adherence among alcohol drinkers 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 
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Developing an explanatory model , which we labeled the Transdisciplinary Model of Health Decision-Making , we posited that context ual factors determine the costs and benefits of ART ; patients perceive this context ( through cognitive and emotional appraisal s ) and form an intention whether or not to start ; and these intentions may ( or may not ) be translated into actions .
Reasons for not starting ART included consistent themes across studies .