***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 % 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 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 retention in HIV care in Mozambique . Methods and findings In this cluster-r and omized trial , 10 primary health facilities in the city of Maputo and Inhambane Province were r and omly assigned to provide the CIS or the st and ard of care ( SOC ) . The CIS included point-of-care CD4 testing at the time of diagnosis , accelerated ART initiation , and short message service ( SMS ) health messages and appointment reminders . A pre – post intervention 2- sample design was nested within the CIS arm to assess the effectiveness of CIS+ , an enhanced version of the CIS that additionally included conditional non-cash financial incentives for linkage and retention . The primary outcome was a combined outcome of linkage to care within 1 month and retention at 12 months after diagnosis .  From April 22 , 2013 , to June 30 , 2015 , we enrolled 2,004 out of 5,327 adults ≥18 years of age diagnosed with HIV in the voluntary counseling and testing clinics of participating health facilities : 744 ( 37 % ) in the CIS group , 493 ( 25 % ) in the CIS+ group , and 767 ( 38 % ) in the SOC group . Fifty-seven percent of the CIS group achieved the primary outcome versus 35 % in the SOC group ( relative risk [RR]CIS vs SOC = 1.58 , 95 % CI 1.05–2.39 ) . Eighty-nine percent of the CIS group linked to care on the day of diagnosis versus 16 % of the SOC group ( RRCIS vs SOC = 9.13 , 95 % CI 1.65–50.40 ) . There was no significant benefit of adding financial incentives to the CIS in terms of the combined outcome ( 55 % of the CIS+ group achieved the primary outcome , RRCIS+ vs CIS = 0.96 , 95 % CI 0.81–1.16 ) . Key limitations include the use of existing medical records to assess outcomes , the inability to isolate the effect of each component of the CIS , non-concurrent enrollment of the CIS+ group , and exclusion of many patients newly diagnosed with HIV . Conclusions The CIS showed promise for making much needed gains in the HIV care continuum in our study , particularly in the critical first step of timely linkage to care following diagnosis . Trial registration Clinical Trials.gov Background : An estimated 50 % of people living with HIV ( PLHIV ) globally are unaware of their status . Among those who know their HIV status , many do not receive antiretroviral therapy ( ART ) in a timely manner , fail to remain engaged in care , or do not achieve sustained viral suppression . Barriers across the HIV care continuum prevent PLHIV from achieving the therapeutic and preventive effects of ART . Methods : A systematic literature search was conducted , and 6132 articles , including r and omized controlled trials , observational studies with or without comparators , cross-sectional studies , and descriptive documents , met the inclusion criteria . Of these , 1047 articles were used to generate 36 recommendations to optimize the HIV care continuum for adults and adolescents . Recommendations : Recommendations are provided for interventions to optimize the HIV care environment ; increase HIV testing and linkage to care , treatment coverage , retention in care , and viral suppression ; and monitor the HIV care continuum BACKGROUND Assisted partner services for index patients with HIV infections involves elicitation of information about sex partners and contacting them to ensure that they test for HIV and link to care . Assisted partner services are not widely available in Africa . We aim ed to establish whether or not assisted partner services increase HIV testing , diagnoses , and linkage to care among sex partners of people with HIV infections in Kenya . METHODS In this cluster r and omised controlled trial , we recruited non-pregnant adults aged at least 18 years with newly or recently diagnosed HIV without a recent history of intimate partner violence who had not yet or had only recently linked to HIV care from 18 HIV testing services clinics in Kenya . Consenting sites in Kenya were r and omly assigned ( 1:1 ) by the study statistician ( restricted r and omisation ; balanced distribution in terms of county and proximity to a city ) to immediate versus delayed assisted partner services . Primary outcomes were the number of partners tested for HIV , the number who tested HIV positive , and the number enrolled in HIV care , in those who were interviewed at 6 week follow-up . Participants within each cluster were masked to treatment allocation because participants within each cluster received the same intervention . This trial is registered with Clinical Trials.gov , number NCT01616420 . FINDINGS Between Aug 12 , 2013 , and Aug 31 , 2015 , we r and omly allocated 18 clusters to immediate and delayed HIV assisted partner services ( nine in each group ) , enrolling 1305 participants : 625 ( 48 % ) in the immediate group and 680 ( 52 % ) in the delayed group . 6 weeks after enrolment of index patients , 392 ( 67 % ) of 586 partners had tested for HIV in the immediate group and 85 ( 13 % ) of 680 had tested in the delayed group ( incidence rate ratio 4·8 , 95 % CI 3·7 - 6·4 ) . 136 ( 23 % ) partners had new HIV diagnoses in the immediate group compared with 28 ( 4 % ) in the delayed group ( 5·0 , 3·2 - 7·9 ) and 88 ( 15 % ) versus 19 ( 3 % ) were newly enrolled in care ( 4·4 , 2·6 - 7·4 ) . Assisted partner services did not increase intimate partner violence ( one intimate partner violence event related to partner notification or study procedures occurred in each group ) . INTERPRETATION Assisted partner services are safe and increase HIV testing and case-finding ; implementation at the population level could enhance linkage to care and antiretroviral therapy initiation and substantially decrease HIV transmission . FUNDING National Institutes of Health Background Gaps in the HIV care continuum contribute to poor health outcomes and increase HIV transmission . A combination of interventions targeting multiple steps in the continuum is needed to achieve the full beneficial impact of HIV treatment . Methods and findings Link4Health , a cluster-r and omized controlled trial , evaluated the effectiveness of a combination intervention strategy ( CIS ) versus the st and ard of care ( SOC ) on the primary outcome of linkage to care within 1 month plus retention in care at 12 months after HIV-positive testing . Ten clusters of HIV clinics in Swazil and were r and omized 1:1 to CIS versus SOC  . The CIS included point-of-care CD4 + testing at the time of an HIV-positive test , accelerated antiretroviral therapy ( ART ) initiation for treatment-eligible participants , mobile phone appointment reminders , health educational packages , and noncash financial incentives . Secondary outcomes included each component of the primary outcome , mean time to linkage , assessment for ART eligibility , ART initiation and time to ART initiation , viral suppression defined as HIV-1 RNA < 1,000 copies/mL at 12 months after HIV testing among patients on ART ≥6 months , and loss to follow-up and death at 12 months after HIV testing . A total of 2,197 adults aged ≥18 years , newly tested HIV positive , were enrolled from 19 August 2013 to 21 November 2014 ( 1,096 C 
    Output:
    
Several strategies showed favorable outcomes : comprehensive care , immediate CD4 count testing , immediate ART initiation , and assisted partner services .
Assisted partner services , same day home-based ART initiation , combination intervention strategies and point-of-care CD4 testing significantly improved linkage to care in urban setting s of sub-Saharan African region .
They can be delivered either in a health facility or in the community but should be facilitated by health workers .
There is , however , the need to conduct more linkage-specific studies in the sub-region