***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 . Regular clinic attendance for antiretroviral ( ARV ) drug refills is important for successful clinical outcomes in HIV management . Methods . Clinic attendance for ARV drug refills and medication adherence using a clinic-based pill count in 392 adult patients receiving antiretroviral therapy ( ART ) in a district hospital in Ug and a were prospect ively monitored over a 28-week period . Results . Of the 2267 total scheduled clinic visits , 40 ( 1.8 % ) were missed visits . Among the 392 clients , 361 ( 92 % ) attended all appointments for their refills ( regular attendance ) . Clinic attendance for refills was statistically significantly associated with medication adherence with regular attendant clients having about fourfold greater odds of achieving optimal ( ≥95 % ) medication adherence [ odds ratio ( OR ) = 3.89 , 95 % CI : 1.48 to 10.25 , exact P = .013 ] . In multivariate analysis , clients in age category 35 years and below were less likely to achieve regular clinic attendance . Conclusion . Monitoring of clinic attendance may be an objective and effective measure and could be a useful adjunct to an adherence measure such as pill counting in re source -constrained setting s. Where human re source constraints do not allow pill counts or other time-consuming measures , then monitoring clinic attendance and acting on missed appointments may be an effective proxy measure Objectives : Antiretroviral treatment ( ART ) scale-up in sub-Saharan Africa has made it possible to investigate the maintenance of adherence to HIV medications . We describe here adherence to ART and identify its correlates in the Cameroonian context . Design : Prospect i ve cohort study in 9 rural district hospitals . Methods : A mixed logistic regression model was used to identify factors associated with adherence to ART in 401 patients with data prospect ively collected on adherence . Results : Although 73 % of patients were adherent after the first month on ART , this proportion decreased to 61 % after 24 months . After adjustment for known factors of adherence to ART ( such as knowledge , motivation and side-effects ) , patients who reported willingness to start ART before initiation , those who were satisfied with information provided by their physicians , and those who implemented reminder methods for ART intake { eg , using an alarm clock , mobile phone , or watch [ odds ratio ( 95 % confidence interval ) ] = 2.45 ( 1.58 to 3.79 ) , but also the help of a relative to remind them or other methods } were more likely to be adherent to ART . Conclusions : Besides highlighting some correlates already known to have an impact on adherence to ART , our findings also underline the need to reinforce the counseling component of follow-up through innovative methods . Accordingly , training and implementation research should encourage the use of medication reminder methods , such as mobile phones , to assure adherence over time and improve long-term response to ART Background . Large-scale , government-based antiretroviral therapy ( ART ) programs in rural areas of re source -poor countries remain largely unevaluated . Methods . We conducted a retrospective review of all patients receiving ART ( n = 399 ) to assess survival and retention in care and a prospect i ve evaluation of patients on ART for at least 6 months ( n = 175 ) . We used 3-day self-report to measure  adherence . Results . The probability ( 95 % confidence interval [ CI ] ) of surviving and remaining in care was 0.76 ( 0.72 , 0.81 ) at 1 year . Men and patients with advanced disease were more likely to die or be lost to follow-up . At baseline , 149 ( 85 % ) reported 100 % adherence . Nonadherence was associated with lack of suppression of viral replication ( odds ratio [ OR ] = 4.5 ; 95 % CI : 1.8 , 11.5 ) . Missing a scheduled clinic visit and lack of disclosure of HIV status were associated with nonadherence . Conclusion . Viral suppression was high , but counseling to include HIV disclosure to family and keeping scheduled clinic appointments may improve long-term adherence and treatment outcomes We conducted a prospect i ve cohort study of 496 adults starting antiretroviral treatment ( ART )  to determine the impact of neuropsychiatric symptoms and socioeconomic status on adherence and mortality . Almost 60 % had good adherence based upon pharmacy records . Poor adherence was associated with being divorced , poorer , food insecure , and less educated . Longer travel time to clinic , concealing one 's human immunodeficiency virus ( HIV ) status , and experiencing side effects predicted poor adherence . Over a third of the patients had cognitive impairment and poorer cognitive function was also associated with poor adherence . During follow-up ( mean 275 days ) , 20 % died-usually within 90 days of starting ART . Neuropsychiatric symptoms , advanced HIV , peripheral neuropathy symptoms , food insecurity , and poverty were associated with death . Neuropsychiatric symptoms , advanced HIV , and poverty remained significant independent predictors of death in a multivariate model adjusting for other significant factors . Social , economic , cognitive , and psychiatric problems impact adherence and survival for people receiving ART in rural Zambia Background Access to programmes providing highly active antiretroviral therapy ( HAART ) is recent in Africa . In Senegal , a national initiative was launched in 1998 . The capacity of African patients to adhere to complex antiretroviral treatments ( ARV ) is largely unknown . Methods We assessed adherence and identified the main reasons for treatment interruption in a prospect i ve observational cohort of patients participating in an ARV access programme in Dakar , Senegal . Adherence was estimated each month on the basis of the patients ' stated consumption and on the proportion of the prescribed dose returned unused to the dispensing pharmacy . A total of 158 patients were studied between November 1999 and October 2001 . Results A cross-section analysis showed that the stated level of adherence was high : on average , over the study period , the patients said they had taken 91 % of each monthly dose and that they had taken the full monthly dose during two-thirds of the months studied . Adherence tended to be better among patients who were required to make little or no contribution to the cost of their treatment , through an appropriate pricing structure . Adherence was also better with efavirenz-containing regimens than with indinavir-containing regimens . Conclusion These results show that adherence to HAART can be as high in Africa as that generally observed in industrialized countries , and that the cost and type of drug regimen must be taken into account when design ing ARV access programmes for poor communities Background Participant non-adherence and loss to follow-up can compromise the validity of clinical trial results . An assessment of these issues was made in a 3-year tuberculosis prevention trial among HIV-infected adults in Botswana . Methods and Findings Between 11/2004–07/2006 , 1995 participants were enrolled at eight public health clinics . They returned monthly to receive bottles of medication and were expected to take daily tablets of isoniazid or placebo for three years . Non-adherence was defined as refusing tablet ingestion but agreeing to quarterly physical examinations . Loss to follow-up was defined as not having returned for appointments in ≥60 days . Between 10/2008–04/2009 , survey interviews were conducted with 83 participants identified as lost to follow-up and 127 identified as non-adherent . As a comparison , 252 r and omly selected adherent participants were also surveyed . Multivariate logistic regression analysis was used to identify associations with selected risk factors . Men had higher odds of being non-adherent ( adjusted odds ratio ( AOR ) , 2.24 ; 95 % confidence interval [ 95%CI ] 1.24–4.04 ) and lost to follow-up ( AOR 3.08 ; 95%CI 1.50–6.33 ) . Non-adherent participants had higher odds of reporting difficulties taking the regimen or not knowing if they had difficulties ( AOR 3.40 ; 95%CI 1.75–6.60 ) and lower odds associated with each year of age ( AOR 0.95 ; 95%CI 0.91–0.98 ) , but other variables such as employment , distance from clinic , alcohol use , and underst and ing study requirements were not significantly different than controls . Among participants who were non-adherent or lost to follow-up , 40/210 ( 19.0 % ) reported that they stopped the medication because of work commitments and 33/210 ( 15.7 % ) said they thought they had completed the study . Conclusions Men had higher odds of non-adherence and loss to follow-up than women . Potential interventions that might improve adherence in trial participants may include : targeting health education for men , reducing barriers , clarifying study expectations , educating employers about HIV/AIDS to help reduce stigma in the workplace , and encouraging employers to support employee health . Trial Registration Clinical Trials.gov The anti-retroviral ( ARV ) treatment programme in Nigeria is delivered through selected teaching and mission hospitals at a free/subsidized rate . The government aims to scale up ARV treatment in the country . However , non-adherence to ARV medication can lead to viral resistance , treatment failure , toxicities and waste of financial re sources . This study examined the factors responsible for non-adherence to free/subsidized ARV treatment in south-east Nigeria . The study was cross-sectional and descriptive . Information was collected from 174 patients selected by simple r and om sampling from the register of all patients who had been on anti-retroviral therapy ( ART ) for at least 12 months at the beginning of the study period . Patients were identified during their clinic visits . Information on their socio-demographic profile , ARV treatment and determinants of non-adherence to ARV treatment was obtained from those who gave consent , using pre-tested interviewer-administered question naires . All patients clearly understood the need to take ARV drugs throughout their lives , and what the costs entailed . They understood the need for periodic testing , the probability that complications would develop , cost of transportation to treatment site and the daily treatment regimen . Seventy-five per cent of respondents were not adhering fully to their drug regimen ; the mean number of days that respondents had been off drugs was 3.57 days the preceding month . Reasons for non-adherence included : physical discomfort ( side effects ) ; non-availability of drugs at treatment site ; forgetting to carry drugs during the day ; fear of social rejection ; treatment being a reminder of HIV status ; and selling of own drugs to those unable to enrol in the projects . Being female , under 35 years , single , and having higher educational status were significantly associated with non-adherence . It is important that policy makers and programme managers address the factors responsible for non-adherence when scaling up subsidized ARV treatment in Nigeria and other parts of sub-Saharan Africa The aim of this prospect i ve study ( 20 months ) was to assess HIV patients ' use of Traditional , Complementary and Alternative Medicine ( TCAM ) and its effect on  ARV adherence at three public hospitals in KwaZulu-Natal , South Africa . Seven hundred and thirty-five ( 29.8 % male and 70.2 % female ) patients who consecutively attended three HIV clinics completed assessment s prior to ARV initiation , 519 after 6 months , 557 after 12 and 499 after 20 months on antiretroviral therapy ( ART ) . Results indicate that following initiation of ARV therapy the use of herbal therapies for HIV declined significantly from 36.6 % prior to ARV therapy to 8.0 % after 6 months , 4.1 % after 12 months and 0.6 % after 20 months on ARVs . Faith healing methods ( including spiritual practice s and prayer ) declined from 35.8 % to 22.1 % , 20.8 % and 15.5 % , respectively . In contrast , the use of micronutrients ( vitamins , etc . ) significantly increased from 42.6 % to 78.2 % . The major herbal remedies that were used prior to ART were unnamed traditional medicine , followed by imbiza ( Scilla natalensis planch ) , canova ( immune booster ) , izifozonke ( essential vitamins mixed with herbs ) , African potato ( Hypoxis hemerocallidea ) , stametta ( aloe mixed with vitamins and herbs ) and ingwe ( tonic ) . Herbal remedies were mainly used for pain relief , as immune booster and for stopping diarrhea . As herbal treatment for HIV was associated with reduced ARV adherence , patient 's use of TCAM should be considered in ARV adherence management Background Seventy percent of urban population s in sub-Saharan Africa live in slums . Sustaining HIV patients in these high-risk and highly mobile setting s is a major future challenge . This study seeks to assess program retention and to find determinants for low adherence to  antiretroviral treatment ( ART ) and drop-out from an established HIV/ART program in Kibera , Nairobi , one of Africa 's largest informal urban settlements . Methods and Findings A prospect i ve open cohort study of 800 patients was performed at the African Medical Research Foundation ( AMREF ) clinic in the Kibera slum .  Adherence to ART and drop-out from the ART program were independent outcomes . Two different adherence measures were used : ( 1 )  “ dose adherence ”  ( the proportion of a prescribed dose taken 
    Output:
    
The systematic review of the available evidence does not provide conclusive support for the existence of a clear association between SES and adherence to ART among adult patients infected with HIV/ AIDS in low- and middle-income countries .