***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 A large , district-wide , home-based HIV counselling and testing ( HBHCT ) programme was implemented in Bushenyi district of Ug and a from 2004 to 2007 . This programme provided free HBHCT services to all consenting adults of Bushenyi district and had a very high uptake and acceptability . We measured population -level changes in knowledge of HIV status , stigma and HIV-risk behaviours before and after HBHCT to assess whether widespread HBHCT had an effect on trends of risky sexual behaviours and on stigma and discrimination towards HIV . Methods Serial cross-sectional surveys were carried out before and after the implementation of  HBHCT programme in Bushenyi district of Ug and a. A total of 1402 r and omly selected adults ( 18 to 49 years ) were interviewed in the baseline survey . After the implementation , a different set of r and omly selected 1562 adults was interviewed using the same question naire . Data was collected on socio-demographic characteristics , sexual behaviour , whether respondents had ever tested for HIV and stigma and discrimination towards HIV/AIDS . Results The proportion of people who had ever tested for HIV increased from 18.6 % to 62 % ( p<0.001 ) . Among people who had ever tested , the proportion of people who shared HIV test result with a sexual partner increased from 41 % to 57 % ( p<0.001 ) . The proportion of persons who wanted infection status of a family member not to be revealed decreased from 68 % to 57 % ( p<0.001 ) . Indicators of risk behaviour also improved ; the proportion of people who exchanged money for sex reduced from 12 % to 4 % ( p<0.001 ) , who used a condom when money was exchanged during a sexual act increased from 39 % to 80 % ( p<0.001 ) and who reported genital ulcer/discharge decreased from 22 % to 10 % ( p<0.001 ) . Conclusion These data suggest that HBHCT rapidly increased the uptake of HCT and may have led to reduction in high-risk behaviours at population level as well as reduction in stigma and discrimination . Because HBCT programmes are cost-effective , they should be considered for implementation in delivery of HIV services especially in areas where access to HCT is low Objective : Effective behavioral HIV prevention is needed for stable HIV-discordant couples at risk for HIV , especially those without access to biomedical prevention . This analysis addressed whether HIV testing and counseling with ongoing counseling and condom distribution lead to reduced unprotected sex in HIV-discordant couples . Methods : Partners in Prevention HSV/HIV Transmission Study was a r and omized trial conducted from 2004 to 2008 assessing whether acyclovir reduced HIV transmission from HSV-2/HIV-1–coinfected persons to HIV-uninfected sex partners . This analysis relied on self-reported behavioral data from 508 HIV-infected South African participants . The exposure was timing of first HIV testing and counseling : 0–7 , 8–14 , 15–30 , or > 30 days before baseline . In each exposure group , predicted probabilities of unprotected sex in the last month were calculated at baseline , month 1 , and month 12 using generalized estimating equations with a logit link and exchangeable correlation matrix . Results : At baseline , participants who knew their HIV status for less time experienced higher predicted probabilities of unprotected sex in the last month : 0–7 days , 0.71 ; 8–14 days , 0.52 ; 15–30 days , 0.49 ; > 30 days , 0.26 . At month 1 , once all participants had been aware of being in HIV-discordant relationships for ≥1 month , predicted probabilities declined : 0–7 days , 0.08 ; 8–14 days , 0.08 ; 15–30 days , 0.15 ; > 30 days , 0.14 . Lower predicted probabilities were sustained through month 12 : 0–7 days , 0.08 ; 8–14 days , 0.11 ; 15–30 days , 0.05 ; > 30 days , 0.19 . Conclusions : Unprotected sex declined after HIV-positive diagnosis and declined further after awareness of HIV discordance . Identifying HIV-discordant couples for behavioral prevention is important for reducing HIV transmission risk Introduction Hope is an essential dimension of successful coping in the context of illnesses such as HIV/AIDS , because positive expectations for the future alleviate emotional distress , enhance quality of life and have been linked to the capacity for behavioural change . The social environment ( e.g. family , peers ) is a regulator of hope for people living with HIV/AIDS ( PLWHA ) . In this regard , the dual aim of this article is ( 1 ) to analyze the influence of a peer adherence support ( PAS ) intervention and the family environment on the state of hope in PLWHA and ( 2 ) to investigate the interrelationship between the two determinants . Methods The Effective AIDS Treatment and Support in the Free State study is a prospect i ve r and omized controlled trial . Participants were recruited from 12 public antiretroviral treatment ( ART ) clinics across five districts in the Free State Province of South Africa . Each of these patients was assigned to one of the following groups : a control group receiving st and ard care , a group receiving additional biweekly PAS or a group receiving PAS and nutritional support . Latent cross-lagged modelling ( Mplus ) was used to analyse the impact of  PAS  and the family environment on the level of hope in PLWHA . Results The results of the study indicate that neither  PAS  nor the family environment has a direct effect on the level of hope in PLWHA . Subsequent analysis reveals a positive significant interaction between family functioning and PAS  at the second follow-up , indicating that better family functioning increases the positive effect of PAS  on the state of hope in PLWHA . Conclusions The interplay between well-functioning families and external PAS generates higher levels of hope , which is an essential dimension in the success of lifelong treatment . This study provides additional insight into the important role played by family dynamics in HIV/AIDS care , and it underscores the need for PAS interventions that are sensitive to the context s in which they are implemented Background Among people living with HIV ( PLHIV ) on antiretroviral therapy ( ART ) , it is important to determine how quality of life ( QOL ) may be improved and HIV-related stigma can be lessened over time . This study assessed the effect of peer support on QOL and internal stigma during the first year after initiating ART among a cohort of PLHIV in north-eastern Vietnam . Methods A sub- sample study of a r and omised controlled trial was implemented between October 2008 and November 2010 in Quang Ninh , Vietnam . In the intervention group , participants ( n = 119 ) received adherence support from trained peer supporters who visited participants ’ houses biweekly during the first two months , thereafter weekly . In the control group , participants ( n = 109 )  were treated according to st and ard guidelines , including adherence counselling , monthly health check and drug refills . Basic demographics were measured at baseline . QOL and internal stigma were measured using a Vietnamese version of the WHOQOL-HIVBREF and Internal AIDS-related Stigma Scale instruments at baseline and 12 months . T-tests were used to detect the differences between mean values , multilevel linear regressions to determine factors influencing QOL . Results Overall , QOL improved significantly in the intervention group compared to the control group . Among participants initiating ART at clinical stages 3 and 4 , education at high school level or above and having experiences of a family member dying from HIV were also associated with higher reported QOL . Among participants at clinical stage 1 and 2 , there was no significant effect of peer support , whereas having children was associated with an increased QOL . Viral hepatitis was associated with a decreased QOL in both groups . Lower perceived stigma correlated significantly but weakly with improved QOL , however , there was no significant relation to peer support . Conclusion The peer support intervention  improved QOL after 12 months among ART patients presenting at clinical stages 3 and 4 at baseline , but it had no impact on QOL among ART patients enrolled at clinical stages 1 and 2 . The intervention did not have an effect on Internal AIDS-related stigma . To improve QOL for PLHIV on ART , measures to support adherence should be context ualized in accordance with individual clinical and social needs An extensive multi-disciplinary literature examines the effects of learning one 's HIV status on subsequent risky sexual behaviors . However , many of these studies rely on non-experimental design s ; use self-reported outcome measures , or both . This study investigates the effects of a r and omly assigned home based HIV testing and counseling ( HTC ) intervention on risky sexual behaviors and schooling investments among school-age females in Malawi . The study finds no overall effects on HIV , Herpes Simplex Virus ( HSV-2 ) , or achievement test scores at follow-up . However , among the small group of individuals who tested positive for HIV , a large increase in the probability of contracting HSV-2 is found , with this effect stronger among those surprised by their test results . Similarly , those surprised by HIV-negative test results see a significant improvement in achievement test scores , consistent with increased returns to investments in human capital . The finding of increased HSV-2 prevalence among HIV-positive individuals suggests that the conventional wisdom that those who learn they are HIV-positive will adopt safer sexual practice s should be treated with caution This paper evaluates an experiment in which individuals in rural Malawi were r and omly assigned monetary incentives to learn their HIV results after being tested . Distance to the HIV results centers was also r and omly assigned . Without any incentive , 34 percent of the participants learned their HIV results . However , even the smallest incentive doubled that share . Using the r and omly assigned incentives and distance from results centers as instruments for the knowledge of HIV status , sexually active HIV-positive individuals who learned their results are three times more likely to purchase condoms two months later than sexually active HIV-positive individuals who did not learn their results ; however , HIV-positive individuals who learned their results purchase only two additional condoms than those who did not . There is no significant effect of learning HIV-negative status on the purchase of condoms OBJECTIVE Antiretroviral therapy ( ART ) significantly decreases HIV-associated morbidity , mortality , and HIV transmission through HIV viral load suppression . In high HIV prevalence setting s , outreach strategies are needed to find asymptomatic HIV positive persons , link them to HIV care and ART , and achieve viral suppression . METHODS We conducted a prospect i ve intervention study in two rural communities in KwaZulu-Natal , South Africa , and Mbabara district , Ug and a. The intervention included home HIV testing and counseling ( HTC ) , point-of-care CD4 count testing for HIV positive persons , referral to care , and one month then quarterly lay counselor follow-up visits . The outcomes at 12 months were linkage to care , and ART initiation and viral suppression among HIV positive persons eligible for ART ( CD4≤350 cells/μL ) . FINDINGS 3,393 adults were tested for HIV ( 96 % coverage ) , of whom 635 ( 19 % ) were HIV positive . At baseline , 36 % of HIV positive persons were newly identified ( 64 % were previously known to be HIV positive ) and 40 % were taking ART . By month 12 , 619 ( 97 % ) of HIV positive persons visited an HIV clinic , and of 123 ART eligible participants , 94 ( 76 % ) initiated ART by 12 months . Of the 77 participants on ART by month 9 , 59 ( 77 % ) achieved viral suppression by month 12 . Among all HIV positive persons , the proportion with viral suppression ( < 1,000 copies/mL ) increased from 50 % to 65 % ( p=<0.001 ) at 12 months . INTERPRETATION Community-based HTC in rural South Africa and Ug and a achieved high testing coverage and linkage to care . Among those eligible for ART , a high proportion initiated ART and achieved viral suppression , indicating high adherence . Implementation of this HTC approach by existing community health workers in Africa should be evaluated to determine effectiveness and costs Home-based voluntary HIV counselling and testing ( HB-VCT ) has been reported to have a high uptake , but it has not been rigorously evaluated . We design ed a model for HB-VCT appropriate for wider scale-up , and investigated the acceptance of home-based counselling and testing , equity in uptake and negative life events with a cluster-r and omized trial . Thirty six rural clusters in southern Zambia were pair-matched based on baseline data and r and omly assigned to the intervention or the control arm . Both arms had access to st and ard HIV testing services . Adults in the intervention clusters were offered HB-VCT by local lay counsellors . Effects were first analysed among those participating in the baseline and post-intervention surveys and then as intention-to-treat analysis . The study was registered with www.controlled-trials.com , number IS RCT N53353725 . A total of 836 and 858 adults were assigned to the intervention and control clusters , respectively . In the intervention arm , counselling was accepted by 85 % and 66 % were tested ( n = 686 ) . Among counselled respondents who were cohabiting with the partner , 62 % were counselled together with the partner . At follow-up eight months later , the proportion of adults reporting to have been tested the year prior 
    Output:
    
Home-based HCT is protective against intimate partner violence , stigmatizing behavior , having multiple sexual partners , and having casual sexual partners .