***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 Herpes simplex virus type 2 ( HSV-2 ) suppression has been shown to reduce HIV-1 disease progression in non-pregnant women and men , but effects on pregnant and postpartum women have not been described . Methods We analyzed data from a cohort of Kenyan women participating in a r and omized clinical trial of HSV-2 suppression . Pregnant HIV-1-seropositive , HSV-2-seropositive women who were not eligible for antiretroviral therapy ( WHO stage 1–2 , CD4>250 cells/µl ) were r and omized to either 500 mg valacyclovir or placebo twice daily from 34 weeks gestation through 12 months postpartum . Women received zidovudine and single-dose nevirapine for prevention of mother-to-child HIV-1 transmission . HIV-1 progression markers , including CD4 count and plasma HIV-1 RNA levels , were measured serially . Multivariate linear regression was used to compare progression markers between study arms . Results Of 148 women r and omized , 136 ( 92 % ) completed 12 months of postpartum follow-up .  While adjusted mean CD4 count at 12 months ( 565 cells/µl placebo arm , 638 cells/µl valacyclovir arm ) increased from antenatal levels in both arms , the mean CD4 count increase was 73 cells/µl higher in the valacyclovir arm than placebo arm ( p = 0.03 ) . Mean increase in CD4 count was 154 cells/µl in the valacyclovir arm , almost double the increase of 78 cells/µl in the placebo arm . At 12 months , adjusted HIV-1 RNA levels in the placebo arm increased by 0.66 log10 copies/ml from baseline , and increased by only 0.21 log10 copies/ml in the valacyclovir arm ( 0.40 log10 copies/ml difference , p = 0.001 ) . Conclusion Women r and omized to valacyclovir suppressive therapy during pregnancy and postpartum had greater increases in CD4 counts and smaller increases in plasma HIV-1 RNA levels than women in the placebo arm . Valacyclovir suppression during pregnancy and breastfeeding may improve outcomes and delay antiretroviral therapy for HIV-1/HSV-2 co-infected women A r and omized cross-over trial of herpes simplex virus type 2 (HSV-2)-suppressive therapy ( valacyclovir , 500 mg twice daily , or placebo for 8 weeks , a 2-week washout period , then the alternative therapy for 8 weeks ) was conducted among 20 Peruvian women coinfected with HSV-2 and human immunodeficiency virus type 1 ( HIV-1 ) who were not on antiretroviral therapy .  Plasma sample s ( obtained weekly ) and endocervical swab specimens ( obtained thrice weekly ) were collected for HIV-1 RNA polymerase chain reaction . Plasma HIV-1 level was significantly lower during the valacyclovir arm , compared with the placebo arm ( -0.26 log10 copies/mL , a 45 % decrease [ P < .001 ] ) , as was cervical HIV-1 level ( -0.35 log10 copies/swab , a 55 % decrease [ P < .001 ] ) . Suppressive HSV-2 therapy has the potential to reduce HIV-1 infectiousness and slow HIV-1 disease progression 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 OBJECTIVES This study examines the impact of an intervention to promote dual- method contraceptive use among HIV concordant and discordant couples already using condoms for HIV prevention . METHODS A three-armed r and omized , controlled trial was conducted at a voluntary HIV testing and counseling clinic in Lusaka , Zambia ; 251 couples were r and omized . Control couples received family planning education and referral to an outside clinic for nonbarrier contraceptives , intervention 1 couples received education and offer of contraceptives at the research clinic , and intervention 2 couples received intervention 1 plus a presentation design ed to reduce outside pressures to conceive . RESULTS There was a 3-fold higher contraceptive initiation rate in both intervention arms compared with the control arm . The interventions had no impact on incident pregnancy , largely due to high levels of contraceptive discontinuation and user failure .  HIV-positive women who initially selected injectable contraception were less likely to ab and on the method and significantly less likely to conceive than other study participants . CONCLUSIONS Improving access to nonbarrier contraceptives among couples already using condoms for HIV prevention increased dual- method use . Selection of longer-acting injectable contraception was associated with lower pregnancy rates among HIV-positive women . Further research is needed to identify ways to help couples in this population continue to correctly use nonbarrier contraceptives BACKGROUND Epidemiologic data suggest that infection with herpes simplex virus type 2 ( HSV-2 ) is associated with increased genital shedding of human immunodeficiency virus type 1 ( HIV-1 ) RNA and HIV-1 transmissibility . METHODS We conducted a r and omized , double-blind , placebo-controlled trial of HSV suppressive therapy with valacyclovir ( at a dose of 500 mg twice daily ) in Burkina Faso among women who were seropositive for HIV-1 and HSV-2 ; all were ineligible for highly active antiretroviral therapy . The patients were followed for 24 weeks ( 12 weeks before and 12 weeks after r and omization ) . Regression models were used to assess the effect of valacyclovir on the presence and quantity of genital and plasma HIV-1 RNA and genital HSV-2 DNA during treatment , adjusting for baseline values , and to evaluate the effect over time . RESULTS A total of 140 women were r and omly assigned to treatment groups ; 136 were included in the analyses . At enrollment , the median CD4 cell count was 446 cells per cubic millimeter , and the mean plasma viral load was 4.44 log10 copies per milliliter . With the use of summary - measures analysis , valacyclovir therapy was found to be associated with a significant decrease in the frequency of genital HIV-1 RNA ( odds ratio , 0.41 ; 95 % confidence interval [ CI ] , 0.21 to 0.80 ) and in the mean quantity of the virus ( log(10 ) copies per milliliter , -0.29 ; 95 % CI , -0.44 to -0.15 ) . However , there was no significant decrease in detection of HIV ( risk ratio , 0.93 ; 95 % CI , 0.81 to 1.07 ) . HSV suppressive therapy also reduced the mean plasma HIV-1 RNA level by 0.53 log(10 ) copy per milliliter ( 95 % CI , -0.72 to -0.35 ) . Repeated- measures analysis showed that these effects became significantly stronger during the 3 months of follow-up . CONCLUSIONS HSV suppressive therapy significantly reduces genital and plasma HIV-1 RNA levels in dually infected women . This finding may have important implication s for HIV control . ( Clinical Trials.gov number , NCT00158509 [ Clinical Trials.gov ] . ) We evaluated a nurse-delivered adherence intervention in a preliminary r and omized controlled trial among 70 HIV-positive out patients initiating antiretroviral therapy ( ART ) in Beijing , China . In both arms , participants received a 30-min educational session , a pillbox , and a referral to a peer support group . In the enhanced arm , participants could choose an electronic reminder device , three sessions of counseling either alone or with a treatment adherence partner , or both reminder and counseling .  Survey assessment s and blood draws occurred at baseline , post-intervention ( 13 weeks ) , and follow-up ( 25 weeks ) . Primary outcomes were 7-day and 30-day adherence assessed by self-report and electronic drug monitoring ( EDM ) , and secondary outcomes were HIV-1 RNA viral load and CD4 count . The intervention was feasible and well received . It led to some improvement in self-reported and EDM-assessed adherence but not the biological outcomes . Providing counseling and facilitating the use of electronic reminders to patients initiating ART merits further investigation as a culturally viable means of promoting adherence in China Objective : To evaluate costs , cost-efficiency and cost-effectiveness of integration of family planning into HIV services . Intervention : Integration of family planning services into HIV care and treatment clinics . Design : A cluster-r and omized trial . Setting : Twelve health facilities in Nyanza , Kenya were r and omized to integrate family planning into HIV care and treatment ; six health facilities were r and omized to ( nonintegrated ) st and ard-of-care with separately delivered family planning and HIV services .  Main outcome measures : We assessed costs , cost-efficiency ( cost per additional use of more effective family planning ) , and cost-effectiveness ( cost per pregnancy averted ) associated with the first year of integration of family planning into HIV care . More effective family planning methods included oral and injectable contraceptives , subdermal implants , intrauterine device , and female and male sterilization . Patients and participants : We collected cost data through interviews with study staff and review of financial records to determine costs of service integration . Results : Integration of services was associated with an average marginal cost of $ 841 per site and $ 48 per female patient . Average overall and marginal costs of integration were associated with personnel costs [ initial ( $ 1003 vs. $ 872 ) and refresher ( $ 498 vs. $ 330 ) training , mentoring ( $ 1175 vs. $ 902 ) and supervision ( $ 1694 vs. $ 1636 ) ] , with fewer re sources required for other fixed ( $ 18 vs. $ 0 ) and recurring expenses ( $ 471 vs. $ 287 ) . Integration was associated with a marginal cost of $ 65 for each additional use of more effective family planning and $ 1368 for each pregnancy averted . Conclusion : Integration of family planning and HIV services is feasible , inexpensive to implement , and cost-efficient in the Kenyan setting , and thus supports current Kenyan integration policy Objective : Due to high rates of undiagnosed and untreated HIV infection in Africa , we compared HIV counseling and testing ( VCT ) uptake among household members of patients receiving antiretroviral therapy . Methods : HIV-infected persons attending an AIDS clinic were r and omized to a home-based or clinic-based antiretroviral therapy program including V 
    Output:
    
Findings indicate good evidence that adherence counseling and sexually transmitted infection treatment can have a high impact on morbidity , whereas risk reduction education , partner HIV testing and counseling , and family planning counseling can prevent transmission of HIV .
More limited evidence was found to support the impact of these interventions on retention in care and quality of life .
This evidence suggests that these prevention interventions , if brought to sufficient scale and coverage , can help support and optimize the impact of core treatment and prevention interventions in RLS .