***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: Abstract Objective : To determine the uptake and acceptability of different methods of a universal offer of voluntary HIV testing to pregnant women . Design : R and omised controlled trial involving four combinations of written and verbal communication , followed by the direct offer of a test . The control group received no information and no direct offer of a test , although testing was available on request . Setting : Hospital antenatal clinic covering most of the population of the city of Edinburgh . Subjects : 3024 pregnant women booking at the clinic over a 10 month period . Main outcome measures : Uptake of HIV testing and women 's knowledge , satisfaction , and anxiety . Results : Uptake rates were 6 % for those in the control group and 35 % for those directly offered the test . Neither the style of leaflet nor the length of discussion had an effect on uptake . Significant independent predictors of uptake were a direct test offer ; the midwife seen ; and being unmarried , previously tested , and younger age . Knowledge of the specific benefits of testing increased with the amount of information given , but neither satisfaction nor anxiety was affected by the type of offer . Conclusions : The universal offer of HIV testing is not intrusive and is acceptable to pregnant women . A policy of offering the HIV test to all women result ed in higher uptake and did not increase anxiety or dissatisfaction . Uptake depends more on the midwife than the method of offering the test . Low uptake rates and inadequate detection of HIV infection point to the need to assess a more routine approach to testing . Key messages HIV testing in pregnancy is beneficial , but uptake rates are not high Offering the test to women attending antenatal clinics increases uptake without increasing anxiety or dissatisfaction The extent of information given is not important in terms of whether women take the test and whether they find the procedure acceptable Uptake depends more on the midwife than the method of offering the test Low uptake rates and inadequate detection of HIV infection point to the need to assess a more routine approach to Introduction The results of the Voluntary HIV-1 Counselling and Testing Efficacy Study support the efficacy and cost-effectiveness of HIV voluntary counselling and testing ( VCT ) for reducing risk behaviors in three developing countries . Methods This report explores the social consequences of HIV VCT by examining the incidence of positive and negative life events at the first follow-up ( an average of 7.3 months after recruitment ) . The incidence of positive and negative life events was compared between : ( i ) those who were r and omly assigned to HIV VCT versus health information ( HI ) ; ( ii ) those who tested seronegative and those who tested seropositive ; and ( iii ) those who disclosed their serostatus and those who did not . Results The occurrence of most negative life events was rare ( 0–4 % ) ; positive life events were more common ( 17–39 % ) . With few exceptions , those assigned to HIV VCT were no more likely to experience negative life events than those who were assigned to HI . For individuals , positive serostatus was associated with increased support from health professionals , the break-up of a marriage and being neglected or disowned by their family . Serodiscordant couples with an HIV-positive woman were most likely to report the break-up of a marriage ( 20 versus 0–7 % for other groups ) and the break-up of a sexual relationship ( 45 versus 22–38 % for other groups ) . Disclosure was associated with strengthening of a sexual relationship except for HIV-seropositive women . Conclusion These findings , in combination with findings supporting the efficacy and cost-effectiveness of HIV VCT , support the dissemination of HIV VCT with appropriate support services in developing countries OBJECTIVE To determine the magnitude of the contribution of infant feeding practice s on the risk of mother to child transmission ( MTCT ) of the HIV-1 infection . METHODOLOGY Prospect i ve data from birth until 24 months of age on 236 infants born to HIV-positive mothers in Harare , Zimbabwe was analysed for this study . However , because only a small proportion of infants ( 2.1 % ) were HIV-1 polymerase chain reaction ( PCR ) tested shortly after birth , the PCR results for infants at birth were not incorporated into our analyses . The contribution of infant feeding practice s on the risk of MTCT of HIV-1 was assessed using Cox Proportional Hazards Regression Models . RESULTS The incidence of HIV-1 through MTCT was greatest among breastfed ( 8.33 per 100 child-months ) and mixed fed ( 8.64 per 100 child-months ) infants by 3 months . After adjustment for maternal age , marital status , education and infant antibody HIV-1 status , the cumulative relative risk of MTCT of HIV-1 was 4.19 ( 95 % confidence interval ( CI ) 3.44 , 5.09 ) among breastfed and 1.10 ( 95 % CI 0.97 , 1 . 25 ) among mixed fed infants . The overall MTCT rate of HIV-1 in this study was 40.3 % . CONCLUSIONS Breastfed infants had the greatest cumulative relative risk of MTCT of HIV-1 , followed by mixed fed infants , with the highest incidences occurring within the first 3 months Objective : We examined whether HIV-1 testing using a rapid assay increases the proportion of pregnant women obtaining HIV-1 results and the uptake of perinatal HIV-1 interventions . Methods : Pregnant women attending public health clinics in Nairobi were offered voluntary counselling and testing for HIV-1 . Consenting women were r and omly assigned to receive either rapid or conventional HIV-1 testing . Women r and omly assigned to rapid testing were allowed to receive same-day results or to return later . The results for women r and omly assigned to conventional enzyme-linked immunosorbent assay ( ELISA ) testing were available after 7 days . HIV-1-infected women were referred for antiretroviral prophylaxis to prevent mother-to-child transmission of HIV-1 . Results : Among 1282 women offered voluntary HIV-1 testing and counselling , 1249 accepted testing , of whom 627 were r and omly assigned to rapid testing and 622 to conventional testing . The median duration between testing and obtaining results was 0 days for women who received rapid testing compared with 11 days for women who received conventional testing . The percentage receiving HIV-1 results was significantly higher among women who received rapid testing compared with conventional testing . Of 161 HIV-1-seropositive women , only 24 received antiretroviral prophylaxis . The uptake of perinatal HIV-1 interventions did not differ between HIV-1-seropositive women r and omly assigned to rapid testing or conventional ELISA testing . Conclusion : Rapid HIV-1 testing significantly increased the proportion of  women receiving HIV-1 results , which is important for sexual and perinatal HIV-1 prevention . The challenge remains to improve the uptake of perinatal HIV-1 interventions among HIV-1-seropositive women OBJECTIVE The purpose of this study was to assess informed consent to  human immunodeficiency virus  ( HIV ) testing in a perinatal HIV transmission study in a major referral hospital serving a largely Black population in South Africa . METHODS First-time antenatal clinic attenders who were r and omly selected from those enrolled in the perinatal HIV study ( n = 56 ) answered question naires before and after counseling . RESULTS Knowledge of HIV transmission and prevention , high at the outset , was little improved after counseling . The acceptance rate for HIV testing was high . Despite assurances that participation was voluntary , 88 % of the women said they felt compelled to participate in the study . CONCLUSIONS Informed consent in this setting was truly informed but not truly voluntary Summary Background The observation that mother-to-child transmission of HIV-1 can occur through breastfeeding has result ed in policies that recommend avoidance of breastfeeding by HIV-1-infected women in the developed world and under specific circumstances in developing countries . We compared transmission rates in exclusively breastfed , mixedfed , and formula-fed ( never breastfed ) infants to assess whether the pattern of breastfeeding is a critical determinant of early mother-to-child transmission of HIV-1 . Methods We prospect ively assessed infant-feeding practice s of 549 HIV-1-infected women who were part of a vitamin A intervention trial in Durban , South Africa . The proportions of HIV-1-infected infants at 3 months ( estimated by use of Kaplan-Meier life tables ) were compared in the three different feeding groups . HIV-1 infection was defined by a positive RNA-PCR test . Findings At 3 months , 18·8 % ( 95 % CI 12·6–24·9 ) of 156 never-breastfed children were estimated to be HIV-1 infected compared with 21·3 % ( 17·2–25·5 ) of 393 breastfed children ( p=0·5 ) . The estimated proportion ( Kaplan-Meier ) of infants HIV-1 infected by 3 months was significantly lower for those exclusively breastfed to 3 months than in those who received mixed feeding before 3 months ( 14·6 % [ 7·7–21·4 ] vs 24·1 % [ 19·0–29·2 ] , p=0·03 ) . After adjustment for potential confounders ( maternal CD4-cell/CD8-cell ratio , syphilis screening test results , and preterm delivery ) , exclusive breastfeeding carried a significantly lower risk of HIV-1 transmission  than mixed feeding ( hazard ratio 0·52 [ 0·28–0·98 ] ) and a similar risk to no breastfeeding ( 0·85 [ 0·51–1·42 ] ) . Interpretations Our findings have important implication s for prevention of HIV-1 infection and infant-feeding policies in developing countries and further research is essential . In the meantime , breastfeeding policies for HIV-1-infected women require urgent review . If our findings are confirmed , exclusive breastfeeding may offer HIV-1-infected women in developing countries an affordable , culturally acceptable , and effective means of reducing mother-to-child transmission of HIV-1 while maintaining the overwhelming benefits of breastfeeding This study compares the effect of group and individual pre-test counselling on uptake of HIV voluntary counselling and testing ( VCT ) by African pregnant women and knowledge about HIV/AIDS in 2 antenatal clinics of BoboDioulasso , Burkina Faso .  Pre-test counselling was offered to 3958 pregnant women , 927 by group counselling and 3031 by individual counselling .  Acceptance of the test improved with individual counselling , which was already high with group counselling ( 93.3 % versus 89.4 % ) . The return rate for results was independent of the pre-test counselling technique . At post-test session , knowledge about HIV/ AIDS was better after group than individual counselling , except for reporting the existence of an asymptomatic stage of HIV infection . At a public health level , group pre-test counselling can be easily integrated into existing sessions of antenatal care counselling , routinely performed by the current clinic staff . Our findings may help programme managers in the field of maternal and child health to choose optimal options of pre-test counselling adapted to local circumstances in re source -poor setting Before any new antenatal screening test is introduced , the opinions of pregnant women should be considered . This is particularly relevant with HIV testing . This qualitative study reports the views of 29 women attending an antenatal clinic in a large maternity hospital in Scotl and where a trial of different ways of offering  HIV testing  on a universal , voluntary basis occurred . Women were in favour of a test offer , although they did not necessarily wish to accept testing for themselves . Generally they were more worried about having an unhealthy baby . There was a commonly held view that routine testing would cause less anxiety because it would eliminate the stigma of saying yes to testing . A move towards the HIV test being recommended to pregnant women as opposed to merely offered is likely to be acceptable , would probably increase uptake rates and should therefore be assessed OBJECTIVE To assess the effect of a change in human immunodeficiency virus ( HIV ) testing policy on HIV testing rates in an urban maternity clinic population . METHODS Since 1995 , our institution has provided pretest counseling and voluntary HIV testing to all pregnant women . After the 1999 Institute of Medicine recommendation of HIV testing with patient notification as a routine component of prenatal care , we conducted a prospect i ve study to determine whether this policy would increase our HIV screening rates . The intervention incorporated HIV testing into the routine battery of tests drawn at antenatal care . Not to be tested required active refusal . The intervention group was comprised of all women receiving an initial antenatal visit in one of our eight maternity clinics between August 1 , 1999 , and July 30 , 2000 . The control group was comprised of all women presenting for prenatal care in the same clinics during the year before the intervention . RESULTS The 3415 women in the intervention group and 3778 controls were similar with respect to most demographic and risk factors . After the intervention , HIV testing increased from 75 % to 88 % ( P < .001 ) . Among all women in both years of the study , women who were in the intervention group , less than 20 years of age , or who had a history of substance abuse , were more likely not to refuse testing . CONCLUSION After implementation of a policy of routine HIV testing with active patient refusal , HIV testing rates increased among pregnant women in our large , urban obstetric clinic population 
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CONCLUSIONS According to research evidence , factors such as whether counselling is presented in a group or individually , different ways to present HIV testing as well as counsellor and organisational factors can influence counselling for HIV testing during pregnancy .
RELEVANCE TO CLINICAL PRACTICE Implementation of the best practice guidelines may lead to the increased uptake of HIV testing in pregnancy in developing countries like South Africa and thus to an increase in the number of women whose status is known when their babies are born