***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 : Determine the effectiveness of strategies to increase linkage to care  after testing HIV positive at mobile HIV testing in South Africa . Design : Unmasked r and omized controlled trial . Methods : Recruitment of adults testing HIV positive and not currently in HIV care occurred at 7 mobile HIV counseling and testing units in urban , periurban , and rural South Africa with those consenting r and omized 1:1:1:1 into 1 of 4 arms . Three strategies were compared with st and ard of care ( SOC ) : point-of-care CD4 count testing ( POC CD4 ) , POC CD4 plus longitudinal strengths-based counseling ( care facilitation ; CF ) , and POC CD4 plus transport reimbursement ( transport ) . Participants were followed up telephonically and through clinic records and analyzed with an intention-to-treat analysis . Results : From March 2013 to October 2014 , 2558 participants were enrolled , of whom 160 were excluded postr and omization . Compared with the SOC arm where 298 ( 50 % ) reported having entered care , linkage to care was 319 ( 52 % ) for POC CD4 , hazard ratio ( HR ) 1.0 [ 95 % confidence interval ( CI ) : 0.89 to 1.2 , P = 0.6 ] ; 331 ( 55 % ) for CF , HR : 1.1 ( 95 % CI : 0.84 to 1.3 , P = 0.2 ) ; and 291 ( 49 % ) for transport , HR 0.97 ( 95 % CI : 0.83 to 1.1 , P = 0.7 ) . Linkage to care verified with clinical records that occurred for 172 ( 29 % ) in the SOC arm ; 187 ( 31 % ) in the POC CD4 arm , HR : 1.0 ( 95 % CI : 0.86 to 1.3 , P = 0.6 ) ; 225 ( 38 % ) in the CF arm , HR : 1.4 ( 95 % CI : 1.1 to 1.7 , P = 0.001 ) ; and 180 ( 31 % ) in the transport arm , HR : 1.1 ( 95 % CI : 0.88 to 1.3 , P = 0.5 ) . Conclusions : CF improved verified linkage to care from 29 % to 38 % Abstract Introduction The aim of this study was to determine whether counselling provided subsequent to HIV testing and referral for care increases linkage to care among HIV‐positive persons identified through home‐based HIV counselling and testing ( HBHCT ) in Masaka , Ug and a. Methods The study was an open‐label cluster‐r and omized trial . 28 rural communities were r and omly allocated ( 1:1 ) to intervention ( HBHCT , referral and counselling at one and two months ) or control ( HBHCT and referral only ) . HIV‐positive care‐naïve adults ( ≥18 years ) were enrolled . To conceal participants ’ HIV status , one HIV‐negative person was recruited for every three HIV‐positive participants . Primary outcomes were linkage to care ( clinic‐verified registration for care ) status at six months , and time to linkage . Primary analyses were intention‐to‐treat using r and om effects logistic regression or Cox regression with shared frailty , as appropriate . Results Three hundred and two(intervention , n = 149 ; control , n = 153 ) HIV‐positive participants were enrolled . Except for travel time to the nearest HIV clinic , baseline participant characteristics were generally balanced between trial arms . Retention was similar across trial arms ( 92 % overall ) . One hundred and twenty‐seven ( 42.1 % ) participants linked to care : 76 ( 51.0 % ) in the intervention arm versus 51 ( 33.3 % ) in the control arm [ odds ratio = 2.18 , 95 % confidence interval ( CI ) = 1.26–3.78 ; p = 0.008 ) ] . There was evidence of interaction between trial arm and follow‐up time ( p = 0.009 ) . The probability of linkage to care , did not differ between arms in the first two months of follow‐up , but was subsequently higher in the intervention arm versus the control arm [ hazard ratio = 4.87 , 95 % CI = 1.79–13.27 , p = 0.002 ] . Conclusions Counselling substantially increases linkage to care among HIV‐positive adults identified through HBHCT and may enhance efforts to increase antiretroviral therapy coverage in sub‐Saharan Africa Importance Home-based HIV testing is a frequently used strategy to increase awareness of HIV status in sub-Saharan Africa . However , with referral to health facilities , less than half of those who test HIV positive link to care and initiate antiretroviral therapy ( ART ) . Objective To determine whether offering same-day home-based ART to patients with HIV improves linkage to care and viral suppression in a rural , high-prevalence setting in sub-Saharan Africa . Design , Setting , and Participants Open-label , 2-group , r and omized clinical trial ( February 22 , 2016-September 17 , 2017 ) , involving 6 health care facilities in northern Lesotho . During home-based HIV testing in 6655 households from 60 rural villages and 17 urban areas , 278 individuals aged 18 years or older who tested HIV positive and were ART naive from 268 households consented and enrolled . Individuals from the same household were r and omized into the same group . Interventions Participants were r and omly assigned to be offered same-day home-based ART initiation ( n = 138 ) and subsequent follow-up intervals of 1.5 , 3 , 6 , 9 , and 12 months after treatment initiation at the health facility or to receive usual care ( n = 140 ) with referral to the nearest health facility for preparatory counseling followed by ART initiation and monthly follow-up visits thereafter . Main Outcomes and Measures Primary end points were rates of linkage to care within 3 months ( presenting at the health facility within 90 days after the home visit ) and viral suppression at 12 months , defined as a viral load of less than 100 copies/mL from 11 through 14 months after enrollment . Results Among 278 r and omized individuals ( median age , 39 years [ interquartile range , 28.0 - 52.0 ] ; 180 women [ 65.7 % ] ) , 274 ( 98.6 % ) were included in the analysis ( 137 in the same-day group and 137 in the usual care group ) . In the same-day group , 134 ( 97.8 % ) indicated readiness to start ART that day and 2 ( 1.5 % ) within the next few days and were given a 1-month supply of ART . At 3 months , 68.6 % ( 94 ) in same-day group vs 43.1 % ( 59 ) in usual care group had linked to care ( absolute difference , 25.6 % ; 95 % CI , 13.8 % to 36.3 % ; P < .001 ) . At 12 months , 50.4 % ( 69 ) in the same-day group vs 34.3 % ( 47 ) in usual care group achieved viral suppression ( absolute difference , 16.0 % ; 4.4%-27.2 % ; P = .007 ) . Two deaths ( 1.5 % ) were reported in the same-day group , none in usual care group . Conclusions and Relevance Among adults in rural Lesotho , a setting of high HIV prevalence , offering same-day home-based ART initiation to individuals who tested positive during home-based HIV testing , compared with usual care and st and ard clinic referral , significantly increased linkage to care at 3 months and HIV viral suppression at 12 months . These findings support the practice of offering same-day ART initiation during home-based HIV testing . Trial Registration clinical trials.gov Identifier : BACKGROUND HIV disease staging with referral laboratory-based CD4 cell count testing is a key barrier to the initiation of antiretroviral treatment ( ART ) . Point-of-care CD4 cell counts can improve linkage to HIV care among people living with HIV , but its effect has not been assessed with a r and omised controlled trial in the context of home-based HIV counselling and testing ( HBCT ) . METHODS We did a two-arm , cluster-r and omised , controlled efficacy trial in two districts of western Kenya with ongoing HBCT . Housing compounds were r and omly assigned ( 1:1 ) to  point-of-care CD4 cell counts ( 366 compounds with 417 participants ) or st and ard-of-care ( 318 compounds with 353 participants ) CD4 cell counts done at one of three referral laboratories serving the study catchment area . In each compound , we enrolled people with HIV not engaged in care in the previous 6 months . All participants received post-test counselling and referral for HIV care . Point-of-care test participants received additional counselling on the result , including ART eligibility if CD4 was less than 350 cells per μL , the cutoff in Kenyan guidelines . Participants were interviewed 6 months after enrolment to ascertain whether they sought HIV care , verified through chart review s at 23 local clinics . The prevalence of loss to follow-up at 6 months ( LTFU ) was listed as the main outcome in the study protocol . We analysed linkage to care at 6 months ( defined as 1-LTFU ) as the primary outcome . All analyses were by intention to treat . This trial is registered at Clinical Trials.gov , number NCT02515149 . FINDINGS We enrolled 770 participants between July 1 , 2013 , and Feb 28 , 2014 . 692 ( 90 % ) had verified linkage to care status and 78 ( 10 % ) were lost to follow-up . Of 371 participants in the point-of-care group , 215 ( 58 % ) had linked to care within 6 months versus 108 ( 34 % ) of 321 in the st and ard-of-care group ( Cox proportional multivariable hazard ratio [ HR ] 2·14 , 95 % CI 1·67 - 2·74 ; log rank p<0·0001 ) . INTERPRETATION Point-of-care CD4 cell counts in a re source -limited HBCT setting doubled linkage to care and thereby improved ART initiation . Given the substantial economic and logistic hindrances to providing ART for all people with HIV in re source -limited setting s in the near term , point of care CD4 cell counts might have a role in prioritising care and improving linkage to care . FUNDING US Centers for Disease Control and Prevention Background Provision of HIV prevention and sexual and reproductive health services in Zambia is largely characterized by discrete service provision with weak client referral and linkage . The literature reveals gaps in the continuity of care for HIV and sexual and reproductive health . This study assessed whether improved service delivery models increased the uptake and cost-effectiveness of HIV and sexual and reproductive health services . Methods Adult clients 18 + years of age accessing family planning ( females ) , HIV testing and counseling ( females and males ) , and male circumcision services ( males ) were recruited , enrolled and individually r and omized to one of three study arms : 1 ) the st and ard model of service provision at the entry point ( N = 1319 ) ; 2 ) an enhanced counseling and referral to add-on service with follow-up ( N = 1323 ) ; and 3 ) the components of study arm two , with the additional offer of an escort ( N = 1321 ) . Interviews were conducted with the same clients at baseline , six weeks and six months . Uptake of services for HIV , family planning , male circumcision , and cervical cancer screening at six weeks and six months were the primary endpoints . Pairwise chi-square and multivariable logistic regression statistical tests assessed differences across study arms , which were also assessed for incremental cost-efficiency and cost-effectiveness . Results A total of 3963 clients , 1920 males and 2043 females , were enrolled ; 82 % of participants at six weeks were tracked and 81 % at six months ; follow-up rates did not vary significantly by study arm . The odds of clients accessing HIV testing and counseling , cervical cancer screening services among females , and circumcision services among males varied significantly by study arm at six weeks and six months ; less consistent findings were observed for HIV care and treatment . Client uptake of family planning services did not vary significantly by study arm . Integrated services were found to be more efficiently provided than vertical service provision ; the cost-effectiveness for HIV/AIDS and cervical cancer was high in the enhanced service models . Conclusions Study results provide evidence for increasing the linkages and integration of a selection of HIV and sexual and reproductive health services . The study provided cost-effective service delivery models that enhanced the likelihood of clients accessing some additional needed health services . Trial registration IS RCT N84228514 Retrospectively registered . The study was retrospectively registered in the IS RCT N clinical trials registry on 06 October 2015 . The first recruitment of participants occurred on 17 December 2013 Background Concerning gaps in the HIV care continuum compromise individual and population health . We evaluated a combination intervention strategy ( CIS ) targeting prevalent barriers to timely linkage and sustained ret 
    Output:
    
Increases in linkage were reported by supply-side and counseling interventions .
Mobile testing and economic incentives  did not increase linkage .