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lti
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ntervention
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nce t
he
qua
lity o
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rism
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nfo
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T
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ticle
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to
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y:
R
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eiv
ed
Sep
17
,
2
0
2
3
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ev
is
ed
Dec
29
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0
2
3
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ted
Feb
21
,
2
0
2
4
Hu
m
a
n
imm
u
n
o
d
e
ficie
n
c
y
v
iru
s
(
HIV
)
a
n
d
a
c
q
u
ired
imm
u
n
o
d
e
ficie
n
c
y
sy
n
d
r
o
m
e
(AID
S
)
a
re
stil
l
c
h
a
ll
e
n
g
e
s
wo
r
ld
wid
e
.
Im
p
r
o
v
e
m
e
n
t
in
q
u
a
l
it
y
o
f
li
fe
(Qo
L)
is
c
ru
c
ial
fo
r
HIV
-
in
fe
c
ted
p
e
o
p
le.
T
h
e
Qo
L
o
f
HI
V
-
in
fe
c
ted
p
a
ti
e
n
ts
h
a
s
b
e
e
n
imp
r
o
v
e
d
b
y
th
e
u
se
o
f
m
u
lt
il
e
v
e
l
i
n
terv
e
n
t
io
n
s
in
v
a
ri
o
u
s
c
ircu
m
sta
n
c
e
s.
Th
is
stu
d
y
e
v
a
l
u
a
t
e
s
th
e
e
v
id
e
n
c
e
f
o
r
i
n
terv
e
n
ti
o
n
s t
h
a
t
targ
e
t
th
e
q
u
a
li
ty
o
f
li
fe
o
f
p
e
rso
n
s
wit
h
HIV
.
A
sy
ste
m
a
ti
c
re
v
iew
wa
s
p
e
rfo
rm
e
d
a
c
c
o
rd
in
g
to
th
e
P
RIS
M
A
g
u
id
e
l
in
e
s.
S
c
ien
c
e
Dire
c
t,
t
h
e
Co
c
h
ra
n
e
Li
b
ra
ry
d
a
tab
a
se
,
a
n
d
P
u
b
m
e
d
we
re
a
ls
o
se
a
rc
h
e
d
.
Th
re
e
in
d
e
p
e
n
d
e
n
t
re
v
iew
e
rs
e
x
trac
ted
th
e
d
a
ta.
S
e
a
rc
h
e
s
we
re
c
o
n
d
u
c
ted
f
o
r
a
rti
c
les
p
u
b
li
sh
e
d
f
ro
m
2
0
1
3
to
2
0
2
3
.
S
e
a
rc
h
in
g
p
r
o
c
e
d
u
re
s
a
n
d
d
a
ta
a
b
stra
c
ti
o
n
tec
h
n
i
q
u
e
s
we
re
sta
n
d
a
rd
ize
d
.
Th
e
2
7
re
se
a
rc
h
e
x
a
m
in
e
d
th
e
e
ffe
c
ts
o
f
in
terv
e
n
ti
o
n
s
o
n
HIV
-
in
fe
c
ted
p
e
o
p
le'
s
q
u
a
li
ty
o
f
li
fe
.
Ch
in
a
is
th
e
m
o
st
fre
q
u
e
n
tl
y
m
e
n
ti
o
n
e
d
c
o
u
n
tr
y
i
n
th
e
2
7
stu
d
ies
,
a
p
p
e
a
rin
g
a
s
th
e
se
tt
i
n
g
in
8
(2
9
.
6
%
).
F
o
ll
o
win
g
S
o
u
t
h
Afric
a
(1
4
.
8
%
),
Ne
w
Y
o
rk
(1
1
.
1
1
%
)
a
n
d
Ke
n
y
a
(7
.
4
%
)
we
r
e
th
e
n
e
x
t
m
o
st
o
fte
n
m
e
n
ti
o
n
e
d
c
o
u
n
tri
e
s.
F
o
r
a
n
a
ly
sis
p
u
rp
o
se
s,
th
e
in
te
rv
e
n
ti
o
n
s
u
se
d
i
n
th
e
2
7
re
v
iew
e
d
stu
d
ies
we
re
c
las
sified
in
t
o
t
h
re
e
m
a
in
c
a
teg
o
ries
:
in
d
i
v
id
u
a
l
i
n
terv
e
n
ti
o
n
,
fa
m
il
y
-
c
o
m
m
u
n
it
y
i
n
terv
e
n
t
io
n
,
a
n
d
h
e
a
lt
h
se
rv
ice
in
terv
e
n
t
io
n
.
S
ig
n
ifi
c
a
n
t
in
ter
v
e
n
ti
o
n
in
n
o
v
a
ti
o
n
s
i
n
q
u
a
li
ty
-
of
-
li
f
e
re
se
a
rc
h
c
o
m
b
in
i
n
g
se
v
e
ra
l
in
terv
e
n
ti
o
n
s,
in
c
lu
d
in
g
in
d
iv
id
u
a
l,
fa
m
il
y
,
c
o
m
m
u
n
it
y
,
a
n
d
h
e
a
lt
h
sy
ste
m
in
terv
e
n
ti
o
n
,
sh
o
w t
h
e
m
o
st
p
r
o
m
isin
g
re
su
lt
s.
K
ey
w
o
r
d
s
:
HI
V
Mu
ltil
ev
el
in
ter
v
en
tio
n
Sy
s
tem
atic
R
ev
iew
Qu
ality
o
f
life
Peo
p
le
liv
in
g
with
HI
V
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Gu
s
ti Ay
u
Kr
is
m
a
Yu
n
tar
i
Facu
lty
o
f
Me
d
icin
e,
Ud
ay
an
a
Un
iv
er
s
ity
B
ali,
I
n
d
o
n
esia
E
m
ail: k
r
is
m
ay
u
n
tar
i@
g
m
ail.
co
m
1.
I
NT
RO
D
UCT
I
O
N
Hu
m
an
im
m
u
n
o
d
ef
icien
cy
v
ir
u
s
(
HI
V
)
a
n
d
ac
q
u
i
r
ed
im
m
u
n
o
d
ef
icien
c
y
s
y
n
d
r
o
m
e
(
AI
D
S)
ar
e
s
till
ch
allen
g
es
wo
r
ld
wid
e.
T
h
is
v
ir
u
s
attac
k
s
th
e
im
m
u
n
e
s
y
s
tem
,
wh
ich
ca
u
s
es
a
d
ec
r
ea
s
e
in
im
m
u
n
ity
f
o
r
s
u
f
f
er
er
s
s
o
th
at
th
ey
ar
e
s
u
s
c
ep
tib
le
to
in
f
ec
tio
u
s
d
is
ea
s
es
an
d
m
alig
n
a
n
cies
th
at
ca
n
ca
u
s
e
d
ea
th
.
B
ased
o
n
d
ata
f
r
o
m
UNAI
DS
2
0
1
9
,
th
e
r
e
ar
e
3
7
.
8
m
illi
o
n
p
e
o
p
le
in
f
ec
ted
with
HI
V
in
th
e
w
o
r
ld
,
an
d
So
u
th
ea
s
t
Asi
a
r
an
k
s
s
ec
o
n
d
in
th
e
wo
r
ld
f
o
r
th
e
n
u
m
b
e
r
o
f
p
o
p
u
latio
n
s
with
HI
V
[
1
]
.
Peo
p
le
liv
in
g
with
HI
V
/AI
DS
(
PLWHA)
f
ac
e
p
h
y
s
ical
an
d
e
co
n
o
m
ic
h
ea
lth
p
r
o
b
lem
s
an
d
s
ev
er
e
s
o
cial
p
r
o
b
lem
s
s
u
ch
a
s
r
ejec
tio
n
,
n
e
g
lect,
cr
iticis
m
,
an
d
s
tig
m
a.
HI
V
/AI
DS
will
n
eg
ativ
ely
af
f
ec
t
th
ei
r
q
u
ality
o
f
life
.
Hea
lth
s
tatu
s
an
d
q
u
ality
o
f
life
ar
e
cr
itical
in
d
icato
r
s
to
ass
ess
p
atien
t
ad
h
er
en
ce
an
d
t
h
e
s
u
cc
ess
o
f
tr
ea
tm
en
t
i
n
te
r
v
en
tio
n
s
[
2
]
,
[
3
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
3
,
No
.
4
,
Dec
em
b
er
20
24
:
1
7
5
7
-
1
7
6
8
1758
Acc
o
r
d
in
g
to
th
e
c
u
r
r
en
t
W
HO
d
ef
in
itio
n
,
a
p
er
s
o
n
'
s
v
iew
o
f
th
eir
p
o
s
itio
n
in
r
elatio
n
t
o
t
h
e
cu
ltu
r
e
an
d
v
alu
e
s
y
s
tem
in
wh
ich
th
ey
n
o
w
liv
e
as
well
a
s
th
eir
o
b
jectiv
es,
s
tan
d
ar
d
s
,
ex
p
ec
tatio
n
s
,
an
d
a
m
b
itio
n
s
co
n
s
titu
tes
th
eir
q
u
ality
o
f
life
[
4
]
.
Pre
v
io
u
s
s
tu
d
ies
h
av
e
s
h
o
wn
th
at
HI
V
tr
ea
tm
en
t
n
ee
d
s
to
b
e
d
o
n
e
co
m
p
r
e
h
en
s
iv
ely
,
s
tar
tin
g
f
r
o
m
in
d
iv
id
u
al,
f
am
ily
,
co
m
m
u
n
it
y
,
an
d
p
o
licy
h
o
ld
er
a
p
p
r
o
ac
h
es
[
5
]
.
Ho
we
v
er
,
litt
le
r
esear
ch
h
as
ex
am
i
n
ed
p
o
licy
an
d
m
u
ltil
ev
el
ap
p
r
o
a
ch
es
to
HI
V
ca
r
e.
On
l
y
a
f
e
w
s
tu
d
ies
h
av
e
f
o
c
u
s
ed
o
n
g
o
v
er
n
m
en
t
p
o
licy
in
ter
v
en
tio
n
s
an
d
co
m
m
u
n
it
y
-
b
ased
in
ter
v
en
tio
n
s
[
6
]
.
H
I
V
s
er
v
ices
in
I
n
d
o
n
esia
cu
r
r
en
tly
c
o
n
s
is
t
o
f
p
r
ev
en
tio
n
ef
f
o
r
ts
,
n
ew
ca
s
e
f
in
d
in
g
,
d
ia
g
n
o
s
is
en
f
o
r
ce
m
e
n
t,
o
p
p
o
r
tu
n
is
tic
in
f
ec
tio
n
d
is
co
v
er
y
,
p
r
ev
en
tio
n
,
HI
V
T
B
co
-
in
f
ec
tio
n
m
a
n
ag
e
m
en
t,
ch
r
o
n
ic
ca
r
e,
a
n
tire
tr
o
v
ir
al
(
AR
V)
ad
m
in
is
tr
atio
n
,
m
o
th
er
-
to
-
c
h
ild
HI
V
tr
an
s
m
is
s
io
n
,
an
d
s
ex
u
ally
t
r
an
s
m
itted
in
f
ec
tio
n
s
(
STI
)
co
n
tr
o
l
a
n
d
t
r
ea
tm
en
t
[
7
]
,
[
8
]
.
T
r
ea
tm
en
t
o
f
HI
V
/AI
DS
to
d
ev
elo
p
s
tr
at
eg
ies
with
ap
p
r
o
ac
h
es
f
r
o
m
in
d
iv
id
u
als,
co
m
m
u
n
ities
,
an
d
p
o
licy
m
ak
e
r
s
.
Mu
ltil
ev
el
s
tr
ateg
y
is
a
s
y
s
te
m
th
at
d
escr
ib
es
th
e
in
f
lu
en
ce
o
f
ea
ch
lev
el
th
at
ca
n
b
e
u
s
ed
to
im
p
r
o
v
e
th
e
q
u
ality
o
f
life
o
f
p
eo
p
le
liv
i
n
g
with
HI
V
(
PL
HI
V
)
[
9
]
.
C
u
r
r
en
t
liter
atu
r
e
s
h
o
ws
th
at
q
u
ality
o
f
life
in
PL
HI
V
is
in
f
lu
en
ce
d
b
y
p
h
y
s
ical
well
-
b
ein
g
,
th
e
h
ea
lth
ef
f
ec
ts
o
f
an
tire
tr
o
v
ir
al
th
er
ap
y
(
AR
T
)
,
p
s
y
ch
o
s
o
cial
co
n
d
itio
n
s
,
co
m
o
r
b
id
ities
,
an
d
th
e
lev
el
o
f
s
o
cial
s
u
p
p
o
r
t r
ec
ei
v
ed
.
T
h
u
s
,
ea
ch
i
n
ter
v
en
tio
n
aim
s
to
in
f
lu
en
ce
th
e
p
h
y
s
ical,
p
s
y
c
h
o
lo
g
ical,
a
n
d
m
en
tal
asp
ec
ts
o
f
PL
HI
V
's
well
-
b
ein
g
,
im
p
ac
tin
g
th
eir
q
u
ality
o
f
life
[
1
0
]
.
Sev
er
al
s
tu
d
ies
h
av
e
s
h
o
wn
th
e
r
e
latio
n
s
h
ip
b
etwe
en
AR
T
ad
h
er
en
ce
an
d
q
u
ality
o
f
life
[
1
1
]
,
[
1
2
]
,
th
e
r
elatio
n
s
h
ip
b
etwe
en
q
u
ality
o
f
life
a
n
d
s
o
cial
s
u
p
p
o
r
t
[
1
3
]
–
[
1
5
]
th
e
r
elatio
n
s
h
ip
b
etwe
en
h
ea
lth
ed
u
ca
tio
n
a
n
d
q
u
ality
o
f
life
[
1
6
]
,
th
e
r
elatio
n
s
h
ip
b
et
wee
n
m
o
b
ile
p
h
o
n
e
u
s
e/tec
h
n
o
lo
g
y
an
d
q
u
ality
o
f
life
[
1
7
]
,
[
1
8
]
an
d
p
o
licies
to
l
im
it
s
o
cial
s
tig
m
a
th
at
ar
e
p
o
s
itiv
e
f
o
r
q
u
ality
o
f
life
[
1
9
]
.
HI
V
/AI
DS
as
an
in
f
ec
tio
u
s
d
is
ea
s
e
th
at
af
f
ec
ts
p
h
y
s
ical,
p
s
y
ch
o
lo
g
ical,
an
d
p
s
y
ch
o
s
o
cial
n
ee
d
s
h
o
lis
tic
h
an
d
lin
g
a
n
d
co
m
p
r
e
h
en
s
iv
e
tr
ea
tm
en
t.
A
m
u
ltil
ev
el
s
tr
ateg
y
f
o
r
H
I
V
/AI
DS
m
an
ag
em
en
t
is
ex
p
ec
ted
to
im
p
r
o
v
e
th
e
h
ea
lth
s
tatu
s
o
f
p
atien
ts
with
HI
V
/AI
DS
an
d
p
r
ev
e
n
t
th
e
tr
an
s
m
is
s
io
n
o
f
t
h
e
v
ir
u
s
.
T
h
er
ef
o
r
e,
th
is
s
tu
d
y
aim
s
to
m
o
d
el
a
m
u
l
tilev
el
s
tr
ateg
y
in
ad
d
r
ess
in
g
th
e
ch
allen
g
es o
f
HI
V
/AI
DS in
I
n
d
o
n
esia.
2.
M
E
T
H
O
D
T
h
e
r
esear
ch
s
ea
r
ch
ed
th
e
lite
r
atu
r
e
in
th
e
C
o
ch
r
an
e
L
i
b
r
ar
y
d
atab
ase,
Pu
b
Me
d
,
an
d
Scien
ce
Dir
ec
t
f
r
o
m
2
0
1
3
to
Ma
y
3
0
,
2
0
2
3
.
T
h
e
s
ea
r
ch
s
tr
ateg
y
f
o
cu
s
ed
o
n
f
o
u
r
k
ey
w
o
r
d
s
:
HI
V
,
in
ter
v
en
tio
n
s
,
m
ed
icatio
n
,
an
d
q
u
ality
o
f
life
.
T
h
e
s
ea
r
ch
s
tr
ateg
y
was
as:
s
ea
r
ch
s
tr
ateg
y
HI
V
/
HI
V
I
n
f
ec
tio
n
/h
u
m
an
im
m
u
n
o
d
ef
icien
cy
v
ir
u
s
/p
eo
p
le
liv
in
g
with
HI
V
/PLW
H,
in
ter
v
en
tio
n
s
tr
ateg
y
/s
o
cial,
d
r
u
g
/m
ed
icatio
n
/clin
i
ca
l,
an
d
q
u
ality
o
f
life
/h
ea
lth
-
r
elate
d
q
u
ality
o
f
li
f
e
(
HR
Qo
L
)
.
T
h
e
f
o
llo
win
g
in
clu
s
io
n
cr
iter
ia
wer
e
u
s
ed
t
o
in
clu
d
e
th
e
m
an
u
s
cr
ip
t
in
t
h
e
r
e
v
iew:
o
r
ig
in
al
r
esear
ch
p
ap
er
s
p
u
b
lis
h
ed
in
E
n
g
lis
h
-
l
an
g
u
ag
e
,
p
ee
r
-
r
e
v
iewe
d
jo
u
r
n
als.
T
h
is
r
ev
iew
i
n
clu
d
ed
s
tu
d
ies
wh
o
s
e
r
esear
ch
d
esig
n
was
a
r
an
d
o
m
ize
d
co
n
tr
o
l
tr
ial.
Stu
d
ies
in
v
o
lv
in
g
p
eo
p
le
liv
in
g
with
HI
V
(
PLWH)
ad
o
lescen
ts
an
d
ad
u
lts
wer
e
in
cl
u
d
ed
in
th
is
r
e
v
iew.
T
h
er
e
wer
e
n
o
s
p
ec
if
ic
l
im
itatio
n
s
co
n
ce
r
n
i
n
g
th
e
s
ettin
g
o
f
t
h
e
s
tu
d
ies
to
b
e
in
v
esti
g
ated
.
T
h
u
s
,
s
tu
d
ies
in
h
o
s
p
itals
,
clin
ics,
h
ea
lth
ce
n
ter
s
,
o
r
co
m
m
u
n
ity
s
ettin
g
s
wer
e
also
in
clu
d
ed
.
E
x
clu
s
io
n
cr
iter
ia
f
o
c
u
s
ed
o
n
q
u
ality
o
f
life
ab
o
u
t
s
p
ec
if
ic
co
m
o
r
b
id
ity
/tre
atm
en
t
s
id
e
e
f
f
ec
ts
an
d
e
x
clu
d
e
d
ab
s
tr
ac
ts
p
r
esen
ted
at
co
n
f
e
r
en
ce
s
,
s
em
in
ar
s
,
n
ewsletter
s
,
an
d
ed
ito
r
letter
s
.
PR
I
SM
A
d
iag
r
am
o
f
th
e
s
y
s
tem
atic
r
ev
iew
f
lo
w
o
f
th
is
r
esear
ch
is
s
h
o
wn
in
Fig
u
r
e
1
.
T
h
is
r
esear
ch
ca
teg
o
r
ized
th
e
in
ter
v
en
tio
n
s
b
ased
o
n
a
co
n
ce
p
tu
al
f
r
am
ewo
r
k
.
T
h
e
f
r
am
ewo
r
k
co
n
s
is
ts
o
f
s
ev
er
al
lev
els
th
at
we
d
ev
elo
p
ed
,
n
am
ely
th
e
in
d
iv
id
u
al
lev
el,
f
am
ily
lev
el,
co
m
m
u
n
ity
lev
el,
an
d
h
ea
lth
f
ac
ilit
y
lev
el.
W
e
d
ev
elo
p
ed
th
e
f
r
am
ew
o
r
k
b
ased
o
n
th
eo
r
y
an
d
ad
o
p
ted
T
an
tu
t
Su
s
an
to
'
s
m
o
d
el
o
f
in
ter
v
en
tio
n
s
f
o
r
p
atien
ts
with
HI
V
/AI
DS
[
2
0
]
.
Usi
n
g
th
e
co
n
ce
p
tu
al
f
r
am
ewo
r
k
,
we
ca
teg
o
r
ized
th
e
in
ter
v
en
tio
n
s
th
at
we
o
b
tain
e
d
th
r
o
u
g
h
a
liter
atu
r
e
r
ev
iew.
W
e
ca
teg
o
r
ized
th
e
in
ter
v
e
n
tio
n
s
b
ased
o
n
th
e
tar
g
et
o
f
th
e
in
ter
v
e
n
tio
n
.
T
h
e
co
n
ce
p
tu
al
f
r
am
ew
o
r
k
an
d
s
tu
d
y
ch
ar
ac
te
r
is
tics
o
f
th
is
r
es
ea
r
ch
ar
e
s
h
o
wn
in
Fig
u
r
e
2
an
d
T
ab
le
1
(
s
ee
ap
p
en
d
ix
)
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
Resul
t
T
h
e
r
esu
lts
s
h
o
wed
th
at
o
f
th
e
1
4
7
8
u
n
iq
u
e
titl
es
d
is
co
v
er
ed
,
9
2
s
tu
d
ies
d
etailed
a
n
d
e
v
alu
ated
an
HI
V
ca
r
e
ca
s
ca
d
e
in
ter
v
e
n
tio
n
an
d
wer
e
s
u
b
jecte
d
to
f
u
ll
-
te
x
t
r
ev
iew,
a
n
d
2
7
m
et
th
e
in
clu
s
io
n
cr
iter
ia.
C
h
in
a
is
th
e
m
o
s
t
f
r
eq
u
en
tly
m
en
tio
n
ed
co
u
n
t
r
y
in
th
e
2
7
s
tu
d
ies,
ap
p
ea
r
in
g
as
th
e
s
ettin
g
in
8
(
2
9
.
6
%).
Fo
llo
win
g
So
u
th
Af
r
ica
(
1
4
.
8
%),
New
Yo
r
k
(
1
1
.
1
1
%)
an
d
Ken
y
a
(
7
.
4
%)
wer
e
th
e
n
ex
t
m
o
s
t
o
f
ten
m
en
tio
n
ed
co
u
n
tr
ies.
C
o
m
p
o
s
itio
n
o
f
i
n
t
er
v
en
tio
n
s
f
o
r
a
n
aly
s
is
p
u
r
p
o
s
es,
th
e
in
ter
v
en
tio
n
s
u
s
ed
i
n
th
e
2
7
r
ev
iewe
d
s
tu
d
ies
wer
e
clas
s
if
ied
in
to
th
r
ee
m
ain
ca
teg
o
r
ies:
in
d
iv
id
u
al
in
ter
v
en
tio
n
(
7
)
,
f
am
ily
-
co
m
m
u
n
ity
in
ter
v
e
n
tio
n
(
6
)
,
an
d
h
ea
lth
s
er
v
ice
in
ter
v
e
n
tio
n
(
1
4
)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
A
s
ystema
tic
r
ev
ie
w
o
f m
u
lti
-
leve
l in
terven
tio
n
to
en
h
a
n
ce
t
h
e
q
u
a
lity
o
f …
(
Gu
s
ti A
yu
K
r
is
ma
Yu
n
ta
r
i)
1759
Fig
u
r
e
1
.
PR
I
SMA
d
iag
r
am
Fig
u
r
e
2
.
C
o
n
ce
p
tu
al
f
r
a
m
ewo
r
k
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
3
,
No
.
4
,
Dec
em
b
er
20
24
:
1
7
5
7
-
1
7
6
8
1760
3
.
1
.
1
.
I
nd
iv
idu
a
l int
er
v
ent
io
n
I
n
d
iv
id
u
al
in
ter
v
en
tio
n
s
t
h
at
ca
n
b
e
d
o
n
e
to
im
p
r
o
v
e
t
h
e
q
u
ality
o
f
life
i
n
clu
d
e
e
d
u
ca
tio
n
al
in
ter
v
en
tio
n
[
2
1
]
,
em
p
o
wer
m
en
t
p
r
o
g
r
am
[
2
2
]
,
y
o
g
a
[
2
3
]
,
tr
an
s
ce
n
d
en
tal
m
ed
itatio
n
[
2
4
]
,
ex
er
cise
p
r
o
g
r
am
[
2
5
]
,
a
n
d
ae
r
o
b
ic
ex
e
r
cise
[
2
6
]
,
[
2
7
]
.
Hea
lth
ed
u
ca
tio
n
ca
n
b
e
p
r
o
v
id
ed
th
r
o
u
g
h
f
ac
e
-
to
-
f
ac
e
co
m
m
u
n
icatio
n
,
au
g
m
en
ted
b
y
leaf
lets
an
d
f
o
llo
w
-
u
p
telep
h
o
n
e
ca
lls
f
o
r
t
wo
wee
k
s
[
1
8
]
.
T
h
e
em
p
o
we
r
m
en
t
in
ter
v
en
tio
n
f
o
cu
s
ed
o
n
au
to
n
o
m
y
an
d
co
m
m
u
n
ity
ac
tiv
is
m
,
s
elf
-
wo
r
th
an
d
s
elf
-
ef
f
icac
y
,
s
elf
-
ca
r
e,
o
p
tim
is
m
,
co
n
tr
o
l o
v
er
th
e
f
u
tu
r
e,
f
a
m
ily
an
d
s
o
cial
r
elatio
n
s
h
ip
s
,
p
o
wer
less
n
ess
,
s
tr
ess
m
an
ag
em
en
t,
r
ig
h
teo
u
s
an
g
er
,
s
tig
m
a
an
d
d
is
cr
im
in
atio
n
is
s
u
es,
leg
al
p
r
o
v
is
io
n
s
,
an
d
h
u
m
an
an
d
h
ea
lth
r
ig
h
ts
[
2
8
]
.
Par
tici
p
an
ts
in
th
e
y
o
g
a
in
ter
v
en
tio
n
ca
n
tak
e
6
0
-
m
in
u
te
y
o
g
a
less
o
n
s
th
r
ee
tim
es
ea
ch
wee
k
.
T
h
e
y
o
g
a
p
r
o
g
r
a
m
f
ea
tu
r
ed
co
m
m
o
n
h
ata
y
o
g
a
p
r
ac
tices
s
u
ch
as
as
an
as
(
p
h
y
s
ical
p
o
s
es
o
r
p
o
s
tu
r
es),
m
ed
itatio
n
(
d
h
y
an
a)
,
b
r
ea
th
in
g
ex
er
cises
,
th
e
s
tu
d
y
o
f
in
tr
o
s
p
ec
tio
n
o
f
s
elf
-
s
tu
d
y
,
an
d
s
p
ir
itu
al
d
is
co
u
r
s
e
[
2
3
]
.
T
r
a
n
s
ce
n
d
en
tal
m
ed
itat
io
n
is
a
b
eh
av
io
r
al
s
tr
ess
-
r
ed
u
ctio
n
tech
n
iq
u
e
t
h
a
t
in
teg
r
ates
th
e
m
in
d
an
d
b
o
d
y
an
d
h
as
b
ee
n
s
h
o
wn
to
im
p
r
o
v
e
o
u
tco
m
es
b
y
lo
wer
in
g
s
tr
ess
[
2
4
]
.
T
h
e
in
te
n
s
iv
e
p
h
ase
o
f
tr
an
s
ce
n
d
e
n
tal
m
ed
itatio
n
co
n
s
is
ted
o
f
f
iv
e
c
o
n
s
ec
u
tiv
e
s
ess
io
n
s
o
f
two
h
o
u
r
s
ea
c
h
d
a
y
.
T
h
e
ex
er
cise
p
r
o
g
r
am
im
p
r
o
v
es
th
e
s
tan
d
ar
d
o
f
liv
i
n
g
f
o
r
HI
V
-
p
o
s
itiv
e
p
eo
p
le.
Par
ticip
an
ts
in
th
e
ex
er
cise
p
r
o
g
r
am
u
n
d
er
wen
t
a
lo
wer
lim
b
p
r
o
g
r
ess
iv
e
-
r
esis
ted
ex
er
cise
(
PR
E
)
in
ter
v
en
tio
n
(
q
u
ad
r
ice
p
s
,
h
am
s
tr
in
g
,
tib
iali
s
an
ter
io
r
,
a
n
d
g
astro
cn
em
i
u
s
)
.
W
ar
m
-
u
p
ex
er
cises
,
s
tr
etch
i
n
g
,
a
n
d
PR
E
m
ad
e
u
p
th
e
wo
r
k
o
u
t
r
o
u
tin
e.
At
th
e
p
h
y
s
ical
th
er
ap
y
f
ac
ilit
y
,
th
e
ae
r
o
b
ic
ex
e
r
cise
co
n
s
is
ted
o
f
th
r
ee
4
0
-
m
in
u
te
s
ess
io
n
s
o
f
m
o
d
er
ately
in
ten
s
e
tr
ea
d
m
ill
wo
r
k
.
E
x
er
cise
is
b
en
ef
icial
to
th
e
g
en
er
al
h
ea
lt
h
an
d
well
-
b
ein
g
o
f
th
e
HI
V
p
o
p
u
latio
n
[
2
6
]
.
3
.
1
.
2
.
F
a
m
ily
a
nd
co
m
m
un
it
y
inte
rv
ent
io
n
C
o
m
m
u
n
ity
an
d
p
ee
r
in
ter
v
en
tio
n
s
f
o
cu
s
ed
o
n
t
h
e
m
o
tiv
atio
n
al
asp
ec
t
o
f
b
eh
av
i
o
r
ch
a
n
g
e.
B
ased
o
n
liter
atu
r
e
s
tu
d
ies,
in
ter
v
en
tio
n
s
th
at
ca
n
im
p
r
o
v
e
q
u
ality
o
f
life
ar
e
f
am
ily
-
ce
n
ter
ed
in
ter
v
en
tio
n
[
2
8
]
,
p
ee
r
co
u
n
s
elin
g
[
2
9
]
–
[
3
1
]
,
s
o
cial
a
n
d
f
a
m
ily
s
u
p
p
o
r
t
[
3
2
]
a
n
d
co
m
m
u
n
ity
ad
o
lescen
t
t
r
ea
tm
en
t
s
u
p
p
o
r
ter
s
(
C
AT
S)
s
er
v
ice
[
3
3
]
.
T
h
e
b
aselin
e
an
d
o
n
g
o
in
g
ass
ess
m
en
t
o
f
th
e
p
h
y
s
ical,
m
ed
ical,
s
o
cial,
an
d
p
s
y
ch
o
l
o
g
ical
r
eq
u
ir
em
e
n
ts
,
v
o
lu
n
teer
ass
is
tan
ce
,
ad
v
an
ce
ca
r
e
p
lan
n
in
g
,
ca
r
e
co
o
r
d
in
atio
n
,
an
d
s
u
p
p
o
r
t
f
o
r
tr
an
s
itio
n
s
b
etwe
en
clin
ical
lev
els
o
f
ca
r
e
ar
e
all
co
m
p
o
n
en
ts
o
f
co
m
m
u
n
ity
n
a
v
ig
atio
n
i
n
ter
v
en
tio
n
[
3
1
]
.
C
o
m
m
u
n
it
y
tr
ea
tm
en
t
s
u
p
p
o
r
ter
in
ter
v
en
ti
o
n
s
im
p
r
o
v
e
lin
k
a
g
e,
r
eten
tio
n
in
ca
r
e,
p
s
y
ch
o
s
o
cial
well
-
b
ein
g
,
an
d
ad
h
e
r
en
ce
to
AR
T
.
T
h
e
p
r
o
g
r
am
'
s
in
ter
v
en
tio
n
s
co
m
p
r
is
ed
a
wee
k
ly
h
o
m
e
v
is
it
d
u
r
in
g
wh
ich
t
h
e
d
esig
n
ated
C
AT
S
in
f
o
r
m
e
d
p
ar
ticip
a
n
ts
ab
o
u
t
HI
V
an
d
AR
T
,
o
f
f
er
e
d
co
u
n
s
elin
g
,
an
d
k
ep
t
tr
ac
k
o
f
p
a
r
ticip
an
t
ad
h
er
e
n
ce
.
C
AT
S
ad
d
itio
n
ally
s
u
p
p
o
r
ted
ca
r
eg
iv
er
s
with
in
f
o
r
m
atio
n
an
d
co
u
n
s
elin
g
.
T
h
e
au
th
o
r
i
ze
d
p
ee
r
co
u
n
s
elo
r
wo
u
ld
s
en
d
a
m
ess
ag
e
to
th
e
p
ar
ticip
an
ts
in
th
e
p
ee
r
co
u
n
s
elin
g
in
ter
v
en
tio
n
v
ia
s
o
cial
m
ed
ia
o
r
a
m
o
b
ile
d
ev
ice
[
3
2
]
.
A
6
0
-
m
in
u
te
d
is
cu
s
s
io
n
o
n
s
p
ec
if
ic
h
ig
h
-
r
is
k
b
eh
av
io
r
m
o
d
if
icatio
n
to
o
k
p
l
ac
e
d
u
r
in
g
th
e
p
ee
r
co
u
n
s
elin
g
s
ess
io
n
,
in
clu
d
in
g
h
o
w
to
cu
t
b
ac
k
o
n
m
ale
an
d
f
em
ale
s
ex
u
al
p
ar
tn
er
s
,
c
o
n
d
o
m
-
f
r
ee
an
al/o
r
al
s
ex
,
co
m
m
er
cial
s
ex
,
illeg
al
d
r
u
g
u
s
ag
e,
alco
h
o
l
d
r
u
n
k
e
n
n
ess
,
an
d
m
a
n
y
c
o
n
cu
r
r
en
t
r
elatio
n
s
h
ip
s
.
Fam
ily
an
d
s
o
cial
s
u
p
p
o
r
t w
er
e
p
r
o
v
i
d
ed
with
m
ater
ial,
s
o
cial,
em
o
tio
n
al,
in
f
o
r
m
ativ
e
,
an
d
ev
alu
atio
n
s
u
p
p
o
r
t
[
3
4
]
,
[
3
5
]
.
3
.
1
.
3
.
H
ea
lt
h sy
s
t
e
m
inte
rv
e
ntio
n
Hea
lth
s
y
s
tem
in
ter
v
en
tio
n
m
u
s
t
b
e
d
ev
elo
p
e
d
to
d
ea
l
with
h
ea
lth
p
r
o
b
lem
s
,
in
clu
d
in
g
h
ea
lth
o
f
f
ices,
p
u
b
lic
h
ea
lth
ce
n
ter
(
PHC
s
)
,
an
d
th
e
co
m
m
u
n
ity
[
2
0
]
.
Pro
v
id
i
n
g
ed
u
ca
tio
n
th
r
o
u
g
h
s
m
ar
tp
h
o
n
e
ap
p
s
[
3
3
]
,
wee
k
ly
tex
t
m
ess
ag
es
[
3
6
]
,
s
u
p
p
lem
en
ts
,
an
d
wh
ey
o
r
s
o
y
a
[
3
7
]
,
m
ess
ag
in
g
o
n
tak
in
g
AR
T
,
r
em
in
d
er
s
to
tak
e
AR
T
,
p
ee
r
e
d
u
ca
tio
n
,
an
d
p
ar
ticip
atio
n
in
o
n
lin
e
d
is
cu
s
s
io
n
[
3
1
]
,
[
3
8
]
.
T
h
e
in
f
o
r
m
atio
n
-
m
o
tiv
atio
n
-
b
eh
av
io
r
al
s
k
ills
p
ar
ad
i
g
m
o
f
AR
T
ad
h
er
en
ce
will
s
er
v
e
as
t
h
e
f
o
u
n
d
atio
n
f
o
r
a
f
o
u
r
-
p
a
r
t
h
ea
lth
in
ter
v
en
tio
n
.
ar
ticles
with
in
s
tr
u
ctio
n
al
c
o
n
ten
t,
p
r
iv
ate
o
n
lin
e
m
ess
ag
in
g
with
ca
s
e
m
an
a
g
er
s
,
d
et
ails
o
n
ass
is
tan
ce
s
er
v
ices,
an
d
r
em
in
d
e
r
s
f
o
r
m
ed
ical
v
is
its
[
3
9
]
,
PHC
i
n
ter
v
en
tio
n
[
4
0
]
,
h
o
m
e
-
b
ase
d
HI
V
test
in
g
a
n
d
im
m
ed
iate
AR
T
in
itiatio
n
[
4
1
]
,
a
b
u
n
d
le
o
f
in
ter
v
en
tio
n
s
in
ten
d
ed
to
s
tr
ea
m
lin
e
th
e
HI
V
ca
r
e
ca
s
ca
d
e
[
4
2
]
,
a
co
m
b
in
atio
n
o
f
p
h
o
n
e
ca
ll
in
ter
v
en
tio
n
,
tailo
r
ed
p
ee
r
s
u
p
p
o
r
t,
p
s
y
c
h
o
s
o
cial
co
u
n
s
elin
g
,
an
d
SMS
ap
p
o
in
tm
e
n
t r
em
in
d
e
r
s
[
1
8
]
,
[
3
0
]
.
3
.
1
.
4
.
M
ultilev
el
inte
rv
ent
io
n t
o
im
pro
v
e
qu
a
lity
o
f
life
R
esear
ch
o
n
s
tr
u
ctu
r
al
b
ar
r
i
er
s
,
p
o
licy
-
lev
el
ch
allen
g
es
an
d
en
ab
ler
s
o
f
HI
V
clin
ical
r
esear
ch
r
ec
r
u
itin
g
is
s
till
lack
in
g
.
A
f
ew
o
f
th
e
in
itiativ
es
s
o
u
g
h
t
to
r
aise.
T
h
e
m
ajo
r
ity
o
f
th
e
p
a
r
ticip
an
ts
'
d
iv
er
s
ity
was
co
n
ce
n
tr
ated
o
n
g
ettin
g
b
ey
o
n
d
p
er
s
o
n
al
o
b
s
tacle
s
th
at
p
r
ev
en
ted
th
em
f
r
o
m
tak
in
g
p
ar
t
in
th
e
s
tu
d
y
.
As
a
r
esu
lt,
cr
ea
tin
g
an
HI
V
/AI
DS
in
ter
v
en
tio
n
m
o
d
el
th
at
f
o
cu
s
es
th
e
r
elatio
n
s
h
ip
s
b
etwe
en
v
ar
i
o
u
s
s
o
cial
f
ac
to
r
s
th
r
o
u
g
h
a
lo
ca
l
s
o
cio
cu
ltu
r
al
ap
p
r
o
ac
h
is
ess
en
tial.
T
h
e
s
o
cio
-
ec
o
lo
g
ical
ap
p
r
o
ac
h
ca
n
s
er
v
e
as
a
r
o
ad
m
ap
f
o
r
cr
ea
tin
g
c
o
m
m
u
n
ity
-
b
ased
h
ea
lth
p
r
o
m
o
tio
n
in
i
tiativ
es
[
4
3
]
.
H
o
wev
er
,
ev
er
y
asp
ec
t
o
f
a
s
o
ciety
ca
n
b
e
o
p
tim
ized
in
th
e
tr
ea
tm
en
t
o
f
HI
V
/AI
DS.
A
m
u
lti
-
lev
el
in
ter
v
en
tio
n
s
tr
ateg
y
b
ased
o
n
th
e
s
o
cio
ec
o
lo
g
ical
ap
p
r
o
ac
h
m
ig
h
t
b
e
b
u
ilt
as
an
in
n
o
v
atio
n
to
ad
d
r
ess
th
e
is
s
u
es
p
r
esen
ted
b
y
HI
V
/AI
DS
in
th
e
co
m
m
u
n
ity
.
I
n
o
r
d
er
to
ac
h
ie
v
e
co
m
m
u
n
ity
-
b
ased
r
eh
a
b
ilit
atio
n
,
th
is
m
u
lti
-
lev
el
m
o
d
el
co
n
ce
n
tr
ates
o
n
th
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
A
s
ystema
tic
r
ev
ie
w
o
f m
u
lti
-
leve
l in
terven
tio
n
to
en
h
a
n
ce
t
h
e
q
u
a
lity
o
f …
(
Gu
s
ti A
yu
K
r
is
ma
Yu
n
ta
r
i)
1761
r
o
le
o
f
elem
en
ts
at
ea
c
h
lev
e
l
o
f
citizen
c
o
m
p
o
n
en
ts
in
th
e
co
m
m
u
n
ity
to
m
an
a
g
e
HI
V
/AI
DS
ch
allen
g
es.
T
h
ese
g
o
als
in
clu
d
e
im
p
r
o
v
i
n
g
p
atien
t
q
u
ality
o
f
life
,
l
o
wer
in
g
th
e
r
is
k
o
f
tr
an
s
m
is
s
io
n
,
a
n
d
d
o
i
n
g
awa
y
with
th
e
s
tig
m
a
ass
o
ciate
d
with
HI
V
/AI
DS p
atien
ts
in
th
e
s
o
cio
-
cu
ltu
r
al
co
n
tex
t
o
f
th
e
s
o
ciety
[
2
0
]
.
3
.
2
.
Dis
cus
s
io
n
T
h
e
2
7
s
tu
d
ies
in
t
o
tal
f
it
th
e
cr
iter
ia
in
th
is
r
esear
ch
.
T
h
e
r
e
is
an
o
p
p
o
r
tu
n
ity
a
n
d
n
ee
d
to
d
ev
elo
p
a
s
tr
ateg
y
m
o
d
el
f
o
r
tr
ea
tin
g
HI
V
/AI
DS
to
im
p
r
o
v
e
th
e
q
u
ality
o
f
life
PLWH.
Mu
ltil
ev
el
s
tr
ateg
ies
in
co
r
p
o
r
atin
g
i
n
d
iv
id
u
al,
co
m
m
u
n
ity
-
lev
el,
an
d
h
ea
lth
s
y
s
tem
lev
els,
f
o
r
in
s
tan
ce
.
h
ig
h
e
r
s
tan
d
ar
d
o
f
liv
i
n
g
em
p
h
asizin
g
en
c
o
u
r
ag
em
en
t
a
n
d
in
s
p
ir
atio
n
f
o
r
h
ab
it
ch
an
g
e.
T
h
e
r
esu
lts
o
f
in
d
iv
id
u
al
in
t
er
v
en
tio
n
m
eth
o
d
s
wer
e
m
o
r
e
m
ix
e
d
.
Hea
lth
ed
u
ca
tio
n
an
d
em
p
o
wer
m
e
n
t
in
te
r
v
en
tio
n
is
ef
f
ec
ti
v
e
in
im
p
r
o
v
in
g
t
h
eir
q
u
ality
o
f
life
[
2
2
]
,
[
4
4
]
.
T
h
e
m
o
s
t
ef
f
icien
t
an
d
ec
o
n
o
m
ical
in
ter
v
en
tio
n
s
f
o
r
PLWH
ar
e
h
ea
lth
ed
u
ca
tio
n
an
d
co
u
n
s
elin
g
.
Ad
d
itio
n
all
y
,
th
ey
in
cr
ea
s
e
p
atien
ts
'
k
n
o
wled
g
e
an
d
co
m
p
r
eh
e
n
s
io
n
o
f
th
e
illn
ess
[
4
5
]
.
Ad
d
itio
n
ally
,
g
o
o
d
h
ea
lth
ed
u
ca
tio
n
an
d
co
u
n
s
elin
g
ca
n
g
iv
e
PLWH
ac
ce
s
s
to
h
ea
lth
in
f
o
r
m
atio
n
.
E
x
er
cise
an
d
y
o
g
a
ar
e
th
e
o
t
h
er
in
ter
v
e
n
tio
n
s
we
ca
n
u
s
e
to
im
p
r
o
v
e
o
u
r
q
u
ality
o
f
life
[
4
6
]
.
A
s
ig
n
if
ican
t
in
cr
ea
s
e
in
C
D4
ce
ll
co
u
n
ts
o
f
ae
r
o
b
ic
an
d
r
esis
tan
ce
ex
er
cises
was
f
o
u
n
d
in
s
ev
er
al
s
tu
d
ies
[
2
6
]
,
[
3
5
]
.
T
h
e
m
o
s
t
p
r
ev
alen
t
s
y
m
p
to
m
s
am
o
n
g
th
o
s
e
in
f
ec
ted
an
d
s
ig
n
s
o
f
a
p
o
o
r
q
u
ality
o
f
life
ar
e
an
x
iety
a
n
d
d
ep
r
ess
io
n
[
4
7
]
,
[
4
8
]
.
Patien
ts
b
en
ef
it
g
r
ea
tly
f
r
o
m
s
elf
-
m
an
ag
e
m
en
t
s
in
ce
it
allo
ws
th
em
to
co
n
tr
o
l
th
eir
b
eh
av
io
r
a
n
d
lear
n
d
is
ea
s
e
m
an
ag
em
en
t
tech
n
iq
u
es.
Settin
g
g
o
als
b
ased
o
n
PL
W
H
'
s
co
n
d
itio
n
an
d
ac
co
m
p
li
s
h
in
g
th
em
th
r
o
u
g
h
p
er
s
o
n
al
ef
f
o
r
t w
ill in
cr
ea
s
e
PLWH
'
s
co
n
f
id
en
ce
in
th
em
s
el
v
es
[
4
9
]
,
[
5
0
]
.
F
a
m
i
l
y
i
n
v
o
l
v
e
m
e
n
t
ca
n
a
l
t
er
a
n
H
I
V
-
i
n
f
e
c
t
e
d
p
e
r
s
o
n
'
s
p
s
y
c
h
o
l
o
g
i
c
a
l
s
t
a
t
e
a
n
d
i
n
c
r
e
a
s
e
t
h
ei
r
c
o
n
f
i
d
e
n
c
e
i
n
t
h
e
i
r
a
b
i
l
it
y
t
o
m
a
n
a
g
e
t
h
e
d
is
e
as
e
.
F
a
m
i
l
y
m
e
m
b
e
r
s
m
a
y
h
e
l
p
p
a
ti
e
n
ts
a
n
d
k
e
e
p
a
n
e
y
e
o
n
t
h
e
ir
c
o
n
d
i
t
i
o
n
a
t
t
h
e
s
a
m
e
t
i
m
e
.
Ho
w
e
v
e
r
,
f
a
m
i
l
y
s
u
p
p
o
r
t
i
s
c
r
u
c
i
a
l
f
o
r
r
e
d
u
c
i
n
g
m
e
n
t
al
s
t
r
ess
,
e
n
c
o
u
r
a
g
i
n
g
r
o
l
e
a
d
j
u
s
t
m
e
n
t
,
a
n
d
e
n
h
a
n
c
i
n
g
t
h
e
q
u
a
l
i
t
y
o
f
l
i
f
e
f
o
r
P
L
W
H
[
1
5
]
.
A
d
e
q
u
a
t
e
s
o
c
i
a
l
s
u
p
p
o
r
t
,
i
n
c
l
u
d
i
n
g
e
m
o
t
i
o
n
a
l
,
p
r
a
c
t
i
c
a
l
,
a
n
d
e
d
u
c
a
ti
o
n
a
l
h
e
lp
,
i
m
p
r
o
v
e
s
t
h
e
l
i
v
es
o
f
H
I
V
-
p
o
s
i
ti
v
e
i
n
d
i
v
i
d
u
a
ls
w
h
i
l
e
a
l
s
o
r
e
d
u
c
i
n
g
t
h
e
i
r
s
y
m
p
t
o
m
s
o
f
h
o
p
e
l
es
s
n
es
s
,
an
x
i
e
t
y
,
a
n
d
p
a
i
n
[
5
1
]
,
[
5
2
]
.
T
r
e
a
t
m
e
n
t
li
t
e
r
a
c
y
,
t
r
e
a
t
m
e
n
t
r
e
m
i
n
d
e
r
s
,
c
o
p
i
n
g
m
e
c
h
a
n
i
s
m
s
,
a
n
d
s
u
p
p
o
r
t
f
r
o
m
f
a
m
i
l
y
o
r
f
r
i
e
n
d
s
a
r
e
e
l
e
m
e
n
t
s
t
h
a
t
i
n
c
r
e
a
s
e
a
d
h
e
r
e
n
c
e
t
o
P
L
W
H
[
5
3
]
.
P
e
e
r
s
a
r
e
w
e
l
l
p
l
ac
e
d
t
o
p
r
o
v
i
d
e
t
h
i
s
d
u
e
t
o
t
h
i
s
s
h
a
r
e
d
e
x
p
e
r
i
e
n
c
e
a
n
d
u
n
d
e
r
s
t
a
n
d
i
n
g
.
A
P
L
W
H'
s
p
s
y
c
h
o
l
o
g
i
c
a
l
s
t
a
t
e
c
a
n
a
f
f
e
c
t
t
h
e
i
r
f
a
m
i
l
y
m
e
m
b
e
r
s
'
m
e
n
t
a
l
h
e
a
l
t
h
o
r
w
e
ll
-
b
e
i
n
g
;
f
a
m
i
l
y
m
e
m
b
e
r
s
'
c
o
p
i
n
g
m
e
ch
a
n
i
s
m
s
a
n
d
m
e
n
t
al
h
e
a
l
t
h
m
i
g
h
t
a
l
s
o
a
f
f
e
ct
a
P
L
H'
s
p
s
y
c
h
o
l
o
g
i
c
a
l
s
t
a
te
a
t
t
h
e
s
am
e
t
i
m
e
.
T
h
e
i
d
e
a
o
f
a
m
u
l
t
i
l
ay
e
r
i
n
t
e
r
v
e
n
t
i
o
n
w
as
b
u
i
l
t
o
n
t
h
e
p
r
e
m
is
e
t
h
a
t
b
ec
a
u
s
e
i
n
d
i
v
i
d
u
a
l
b
e
h
a
v
i
o
r
is
e
n
t
a
n
g
l
e
d
w
it
h
s
e
v
e
r
a
l
la
y
er
s
,
t
r
e
at
m
e
n
t
s
t
h
a
t
i
n
c
o
r
p
o
r
a
t
e
t
a
c
ti
c
s
f
o
r
d
e
a
li
n
g
w
i
t
h
t
h
es
e
l
a
y
e
r
s
c
a
n
c
o
n
c
u
r
r
en
t
l
y
h
a
v
e
a
b
i
g
g
e
r
o
v
e
r
a
l
l
i
n
f
l
u
e
n
c
e
.
Mo
s
t
s
tu
d
ies
s
h
o
w
th
at
tech
n
o
lo
g
y
u
tili
za
tio
n
p
r
o
d
u
c
es
s
ig
n
if
ican
t
q
u
ality
-
of
-
life
im
p
r
o
v
em
e
n
t
r
esu
lts
.
Mo
b
ile
h
ea
lth
tech
n
o
lo
g
y
(
m
Hea
lth
)
,
s
u
ch
as
u
s
in
g
a
p
h
o
n
e,
is
a
b
r
an
d
-
n
ew,
i
n
n
o
v
ativ
e
ch
o
ice
in
h
ea
lth
ca
r
e
[
5
4
]
–
[
5
6
]
.
I
t
ca
n
g
et
b
ey
o
n
d
o
b
s
tacle
s
lik
e
s
tig
m
a,
in
v
asio
n
o
f
p
r
iv
ac
y
,
an
d
tr
an
s
p
o
r
tatio
n
is
s
u
es
b
r
o
u
g
h
t
o
n
b
y
co
n
v
en
tio
n
al
in
ter
v
en
tio
n
s
[
5
7
]
,
[
5
8
]
.
M
o
b
ile
p
h
o
n
e
tec
h
n
o
lo
g
y
allo
ws
f
o
r
v
o
ice
ca
lls
,
in
f
o
r
m
atio
n
s
h
ar
in
g
,
p
r
escr
ip
tio
n
r
em
in
d
e
r
s
v
ia
s
h
o
r
t
m
e
s
s
ag
in
g
s
er
v
ice,
an
d
in
ter
ac
t
io
n
with
m
ed
ical
p
er
s
o
n
n
el
[
5
9
]
.
A
k
ey
co
n
s
id
e
r
atio
n
in
th
e
d
eliv
er
y
o
f
m
ed
ic
al
ca
r
e
an
d
t
r
ea
tm
en
ts
is
q
u
ality
o
f
life
.
I
n
C
h
in
a
,
h
o
m
e
v
is
its
an
d
a
telep
h
o
n
e
in
ter
v
en
tio
n
wer
e
th
e
s
u
b
jects o
f
an
in
ter
v
en
tio
n
s
tu
d
y
th
at
r
e
v
ea
led
h
ig
h
er
lev
els
o
f
p
h
y
s
ical,
m
en
tal
h
ea
lth
,
s
o
c
ial
in
ter
ac
tio
n
,
an
d
en
v
ir
o
n
m
e
n
tal
q
u
ality
o
f
life
[
6
0
]
.
4.
CO
NCLU
SI
O
N
Sig
n
if
ican
t
in
ter
v
en
tio
n
in
n
o
v
atio
n
s
in
q
u
ality
-
of
-
life
r
es
ea
r
ch
co
m
b
in
i
n
g
s
ev
er
al
in
ter
v
en
tio
n
s
,
in
clu
d
in
g
in
d
iv
i
d
u
al,
f
am
ily
,
co
m
m
u
n
ity
,
an
d
h
ea
lth
s
y
s
tem
in
ter
v
e
n
tio
n
,
s
h
o
w
th
e
m
o
s
t
p
r
o
m
is
in
g
r
esu
lts
.
T
h
is
s
tu
d
y
'
s
q
u
an
titativ
e
co
m
p
ar
is
o
n
o
f
in
ter
v
en
tio
n
s
is
r
estricte
d
b
y
th
e
d
iv
er
s
ity
o
f
in
ter
v
en
tio
n
d
esig
n
s
an
d
th
e
f
ac
t
th
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[1
9
]
RCT
1
8
0
p
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30
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Evaluation Warning : The document was created with Spire.PDF for Python.
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T
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Stu
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O
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[2
4
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RCT
8
2
P
L
W
H
In
t
h
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s
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ri
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h
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.
[2
2
]
RCT
2
2
P
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fo
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M
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.
[2
0
]
RCT
1
2
0
W
o
me
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H
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V
A
f
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fe.
[2
1
]
RCT
2
2
me
d
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ca
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ab
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e
P
L
W
H
Fo
r
1
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.
[2
3
]
RCT
8
0
p
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p
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n
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s
Part
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p
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A
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S
.
[2
6
]
RCT
1
,
4
4
7
P
L
W
H
T
w
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t
r
ai
n
e
rs
w
i
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T
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en
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p
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emp
o
w
er
me
n
t
i
n
t
e
rv
en
t
i
o
n
p
ro
v
e
d
s
u
cce
s
s
fu
l
i
n
r
ai
s
i
n
g
t
h
e
q
u
a
l
i
t
y
o
f
l
i
f
e
f
o
r
H
IV
-
i
n
fe
ct
ed
i
n
d
i
v
i
d
u
al
s
.
Fam
i
l
y
an
d
co
mm
u
n
i
t
y
i
n
t
e
rv
en
t
i
o
n
[2
7
]
T
w
o
-
arm
co
n
t
ro
l
l
e
d
cl
i
n
i
ca
l
t
r
i
a
l
2
8
8
P
L
W
H
T
w
o
i
n
-
p
er
s
o
n
s
e
s
s
i
o
n
s
w
i
t
h
a
p
r
o
fe
s
s
i
o
n
al
faci
l
i
t
a
t
o
r
ma
k
e
u
p
t
h
e
fa
mi
l
y
-
ce
n
t
er
ed
i
n
t
er
v
e
n
t
i
o
n
arm:
D
i
s
ea
s
e
-
Sp
ec
i
fi
c
A
d
v
a
n
c
e
Car
e
Pl
a
n
n
i
n
g
Res
p
e
ct
i
n
g
Ch
o
i
ce
s
(S
es
s
i
o
n
1
)
I
n
t
er
v
i
ew
;
s
ec
o
n
d
s
e
s
s
i
o
n
:
f
i
n
i
s
h
i
n
g
t
h
e
a
d
v
a
n
ce
d
i
rec
t
i
o
n
.
T
h
e
c
o
n
t
ro
l
arm
f
o
r
h
eal
t
h
y
l
i
v
i
n
g
i
s
D
e
v
e
l
o
p
me
n
t
al
/
Re
l
a
t
i
o
n
s
h
i
p
H
i
s
t
o
ry
Se
s
s
i
o
n
1
;
a
n
d
N
u
t
r
i
t
i
o
n
Se
s
s
i
o
n
2
.
F
o
l
l
o
w
i
n
g
t
h
e
i
n
t
er
v
e
n
t
i
o
n
,
fo
l
l
o
w
-
u
p
d
a
t
a
w
i
l
l
b
e
g
at
h
e
re
d
3
,
6
,
1
2
,
a
n
d
1
8
mo
n
t
h
s
l
a
t
er
.
In
t
er
v
e
n
t
i
o
n
s
i
m
p
r
o
v
e
p
a
t
i
en
t
q
u
al
i
t
y
o
f
l
i
fe,
i
m
p
r
o
v
e
p
a
t
i
en
t
-
cen
t
er
ed
co
mm
u
n
i
ca
t
i
o
n
w
i
t
h
a
s
u
rr
o
g
at
e
d
e
ci
s
i
o
n
-
ma
k
er
reg
a
rd
i
n
g
e
n
d
-
of
-
l
i
f
e
t
rea
t
m
en
t
p
ref
ere
n
ce
s
o
v
er
t
i
me
,
a
n
d
s
a
v
e
h
ea
l
t
h
care
c
o
s
t
s
.
[2
8
]
Ran
d
o
m
i
ze
d
In
t
er
v
e
n
t
i
o
n
St
u
d
y
3
6
7
H
I
V
-
Po
s
i
t
i
v
e
Cl
i
n
i
c
p
r
o
f
es
s
i
o
n
a
l
s
p
ro
v
i
d
e
d
h
i
g
h
-
r
i
s
k
b
e
h
a
v
i
o
r
red
u
c
t
i
o
n
t
h
era
p
y
t
o
s
t
a
n
d
ar
d
s
o
f
c
are
(S
O
C
)
mem
b
er
s
.
Par
t
i
ci
p
a
n
t
s
i
n
t
h
e
i
n
t
er
v
e
n
t
i
o
n
g
o
t
p
ee
r
co
u
n
s
e
l
i
n
g
a
s
w
e
l
l
a
s
S
O
C
.
O
v
er
t
i
me,
co
n
d
o
m
l
e
s
s
v
a
g
i
n
al
s
e
x
w
i
t
h
w
o
me
n
,
c
o
n
d
o
ml
e
s
s
a
n
a
l
s
e
x
w
i
t
h
m
al
es
,
a
n
d
i
l
l
i
c
i
t
d
r
u
g
u
s
a
g
e
al
l
d
ec
rea
s
e
d
m
o
re
s
i
g
n
i
f
i
ca
n
t
l
y
w
i
t
h
p
e
er
c
o
u
n
s
el
i
n
g
.
[5
0
]
RCT
7
0
W
o
m
en
W
i
t
h
H
I
V
T
h
e
c
o
n
t
r
o
l
g
ro
u
p
o
n
l
y
rece
i
v
e
d
mi
n
i
ma
l
c
are,
w
h
i
l
e
t
h
e
e
x
p
er
i
me
n
t
a
l
g
r
o
u
p
rec
ei
v
e
d
fu
l
l
s
o
c
i
al
an
d
fam
i
l
i
a
l
s
u
p
p
o
rt
.
T
h
e
c
h
a
n
g
e
s
i
n
f
ert
i
l
i
t
y
r
at
e
,
fert
i
l
i
t
y
n
u
mb
er,
a
n
d
f
ert
i
l
i
t
y
i
n
t
erv
a
l
w
e
re
co
m
p
a
re
d
t
o
t
h
e
i
m
p
r
o
v
eme
n
t
s
i
n
Q
o
L
)
,
s
el
f
-
ra
t
i
n
g
an
x
i
et
y
s
c
al
e
(S
A
S
),
an
d
s
e
l
f
-
rat
i
n
g
d
e
p
r
es
s
i
o
n
s
ca
l
e
(S
D
S)
s
c
o
r
es
b
et
w
e
en
t
h
e
t
w
o
g
r
o
u
p
s
.
Su
p
p
o
r
t
f
ro
m
fr
i
e
n
d
s
an
d
f
am
i
l
y
fo
r
H
I
V
-
p
o
s
i
t
i
v
e
w
o
me
n
ca
n
h
el
p
t
h
em
b
ec
o
me
m
o
r
e
fer
t
i
l
e,
h
a
v
e
mo
r
e
ch
i
l
d
r
en
,
a
n
d
h
a
v
e
b
a
b
i
e
s
s
o
o
n
er
.
I
t
ca
n
a
l
s
o
h
e
l
p
t
h
e
m
d
ea
l
w
i
t
h
an
x
i
e
t
y
,
d
ep
r
es
s
i
o
n
,
a
n
d
o
t
h
er
emo
t
i
o
n
a
l
i
s
s
u
es
.
T
h
e
s
e
b
e
n
ef
i
t
s
meri
t
w
i
d
es
p
r
ea
d
a
p
p
l
i
ca
t
i
o
n
an
d
s
o
ci
al
p
ro
mo
t
i
o
n
.
F
o
l
l
o
w
i
n
g
t
h
e
i
n
t
er
v
e
n
t
i
o
n
,
t
h
e
ex
p
e
ri
me
n
t
a
l
g
r
o
u
p
'
s
Q
O
L
s
c
o
re
s
w
ere
n
o
t
i
ce
ab
l
y
h
i
g
h
er
t
h
a
n
t
h
o
s
e
o
f
t
h
e
co
n
t
ro
l
g
r
o
u
p
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
A
s
ystema
tic
r
ev
ie
w
o
f m
u
lti
-
leve
l in
terven
tio
n
to
en
h
a
n
ce
t
h
e
q
u
a
lity
o
f …
(
Gu
s
ti A
yu
K
r
is
ma
Yu
n
ta
r
i)
1763
T
ab
le
1
.
Stu
d
y
ch
ar
ac
ter
is
tic
(
C
o
n
tin
u
e
)
A
u
t
h
o
r
Res
earc
h
d
e
s
i
g
n
Po
p
u
l
a
t
i
o
n
/
s
am
p
l
e
In
t
er
v
e
n
t
i
o
n
O
u
t
co
me
mea
s
u
re
s
[3
7
]
RCT
2
8
2
P
L
W
H
In
J
i
mm
a,
E
t
h
i
o
p
i
a
,
t
h
ree
A
R
T
c
l
i
n
i
c
s
h
o
u
s
e
d
i
n
p
u
b
l
i
c
h
ea
l
t
h
i
n
s
t
i
t
u
t
i
o
n
s
u
n
d
er
w
e
n
t
a
ran
d
o
m
i
ze
d
co
n
t
ro
l
l
e
d
s
t
u
d
y
.
T
h
r
o
u
g
h
o
u
t
t
h
e
f
i
r
s
t
t
h
ree
m
o
n
t
h
s
o
f
A
RT
o
r
t
h
e
f
o
l
l
o
w
i
n
g
m
o
n
t
h
s
i
f
t
h
e
y
w
e
re
PL
H
I
V
e
l
i
g
i
b
l
e
t
o
s
t
a
rt
A
R
T
w
i
t
h
a
b
o
d
y
ma
s
s
i
n
d
e
x
g
r
eat
er
t
h
a
n
1
7
k
g
/
m,
p
art
i
c
i
p
a
n
t
s
r
ece
i
v
e
d
d
a
i
l
y
s
u
p
p
l
eme
n
t
s
o
f
2
0
0
g
o
f
L
N
S
c
o
n
t
ai
n
i
n
g
w
h
e
y
o
r
s
o
y
a
(
2
)
.
T
h
e
fi
r
s
t
t
h
ree
m
o
n
t
h
s
o
f
A
R
T
s
h
o
u
l
d
i
n
c
l
u
d
e
t
h
e
u
s
e
o
f
l
i
p
i
d
-
b
a
s
e
d
n
u
t
ri
t
i
o
n
a
l
s
u
p
p
l
e
me
n
t
s
(L
N
S)
,
w
h
i
ch
e
n
h
a
n
ce
P
L
H
I
V
'
s
q
u
al
i
t
y
o
f
l
i
fe.
[3
1
]
RCT
94
H
IV
-
P
o
s
i
t
i
v
e
ad
o
l
es
ce
n
t
s
4
7
i
n
d
i
v
i
d
u
al
s
r
ece
i
v
e
d
c
o
n
v
en
t
i
o
n
a
l
c
a
re,
w
h
i
l
e
4
7
fu
r
t
h
er
rece
i
v
e
d
C
A
T
S
s
er
v
i
c
es
.
T
h
e
i
n
t
er
v
e
n
t
i
o
n
g
r
o
u
p
re
p
o
rt
e
d
a
n
i
n
crea
s
e
i
n
c
o
n
fi
d
e
n
c
e,
s
el
f
-
w
o
r
t
h
,
s
e
l
f
-
e
s
t
eem
,
a
n
d
q
u
a
l
i
t
y
o
f
l
i
fe
t
h
a
t
w
a
s
s
t
at
i
s
t
i
ca
l
l
y
s
i
g
n
i
f
i
c
an
t
.
[3
0
]
Sel
f
-
an
d
f
am
i
l
y
m
an
ag
eme
n
t
i
n
t
er
v
e
n
t
i
o
n
(SA
FMI)
:
b
i
o
fee
d
b
ac
k
f
o
r
rel
ax
at
i
o
n
:
fa
mi
l
y
s
u
p
p
o
rt
;
a
n
x
i
et
y
,
s
t
re
s
s
,
a
n
d
d
e
p
re
s
s
i
o
n
man
ag
eme
n
t
;
c
o
g
n
i
t
i
v
e
-
b
e
h
a
v
i
o
ra
l
man
ag
eme
n
t
s
k
i
l
l
s
;
a
n
d
p
s
y
ch
o
-
ed
u
c
at
i
o
n
SA
F
MI
:
s
k
i
l
l
s
i
n
c
o
g
n
i
t
i
v
e
-
b
e
h
a
v
i
o
r
al
ma
n
a
g
em
en
t
,
f
am
i
l
y
s
u
p
p
o
rt
,
ma
n
a
g
i
n
g
s
t
re
s
s
,
a
n
x
i
e
t
y
,
an
d
d
e
p
r
es
s
i
o
n
.
B
i
o
fe
ed
b
a
ck
f
o
r
rel
a
x
a
t
i
o
n
.
H
ea
l
t
h
s
er
v
i
ce
i
n
t
e
rv
en
t
i
o
n
[5
8
]
RCT
4
2
5
H
I
V
p
a
t
i
e
n
t
Bo
t
h
t
h
e
i
n
t
er
v
e
n
t
i
o
n
g
ro
u
p
(
2
3
8
p
a
t
i
e
n
t
s
)
an
d
t
h
e
co
n
t
ro
l
g
ro
u
p
(
1
8
7
p
at
i
e
n
t
s
)
p
ar
t
i
c
i
p
at
e
d
i
n
1
-
an
d
3
-
m
o
n
t
h
fo
l
l
o
w
-
u
p
v
i
s
i
t
s
aft
er
re
ce
i
v
i
n
g
ro
u
t
i
n
e
med
i
c
al
c
o
n
s
u
l
t
at
i
o
n
s
.
Pa
t
i
en
t
s
i
n
t
h
e
i
n
t
er
v
e
n
t
i
o
n
g
r
o
u
p
rec
ei
v
e
d
a
t
h
e
o
r
y
-
d
r
i
v
en
s
mar
t
p
h
o
n
e
a
p
p
t
o
h
e
l
p
H
I
V
p
at
i
e
n
t
s
b
e
m
o
re
s
e
l
f
-
s
u
ff
i
c
i
e
n
t
a
n
d
s
t
i
c
k
t
o
t
h
e
i
r
me
d
i
ca
t
i
o
n
s
.
W
h
e
n
c
o
m
p
ar
ed
t
o
t
h
e
c
o
n
t
ro
l
g
r
o
u
p
,
t
h
e
a
d
h
ere
n
c
e
s
c
o
re
i
n
t
h
e
i
n
t
er
v
e
n
t
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o
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f
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ca
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crea
s
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m
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h
,
w
h
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t
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f
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eff
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H
I
V
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n
ce
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n
crea
s
e
d
aft
er
t
h
ree
m
o
n
t
h
s
.
[2
0
]
Ran
d
o
m
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ze
d
p
ara
l
l
e
l
-
g
ro
u
p
s
t
u
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y
7
0
0
P
L
W
H
Ran
d
o
m
l
y
ch
o
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n
p
art
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c
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g
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(
W
e
l
T
e
l
)
i
n
ad
d
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t
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o
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t
o
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t
an
d
a
rd
m
ed
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c
al
ca
re
o
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ar
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m
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d
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r
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.
T
o
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w
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v
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(
S
M
S
)
g
a
t
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w
a
y
.
P
a
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c
i
p
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w
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o
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m
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n
w
i
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h
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n
4
8
h
o
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r
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a
f
t
e
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r
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v
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n
g
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t
.
A
l
l
p
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t
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c
i
p
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n
t
s
w
h
o
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e
p
o
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d
a
p
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l
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m
o
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w
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h
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d
b
y
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h
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n
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,
w
h
o
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o
t
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d
t
h
e
c
o
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n
s
a
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d
t
h
e
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a
s
o
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f
o
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'
s
a
b
s
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e
.
T
h
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re
t
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t
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o
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s
rec
ei
v
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n
g
earl
y
H
IV
ca
re
d
i
d
n
o
t
i
n
cr
eas
e
a
s
a
re
s
u
l
t
o
f
t
h
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w
ee
k
l
y
t
ex
t
mes
s
a
g
e
p
r
o
g
ra
m.
T
h
e
i
n
t
e
rv
en
t
i
o
n
may
p
l
ay
a
l
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t
t
l
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f
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ce
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en
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a
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q
u
al
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y
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f
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fe
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t
p
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o
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w
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H
I
V
g
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v
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ro
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m
en
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s
s
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mi
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t
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h
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s
e
i
n
w
h
i
ch
t
h
e
y
rece
i
v
e
care
.
[2
9
]
RCT
5
7
6
p
ar
t
i
c
i
p
a
n
t
s
H
I
V
p
o
s
i
t
i
v
e
Bl
o
c
k
r
an
d
o
m
i
za
t
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o
n
w
as
u
s
ed
t
o
a
s
s
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g
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t
h
em
i
n
a
1
:
1
ra
t
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ar
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ar
m,
a
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d
w
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eac
h
ar
m,
t
h
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w
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t
h
ree
g
r
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p
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b
as
e
d
o
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t
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t
y
p
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o
f
me
s
s
a
g
e.
T
h
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p
art
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c
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n
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'
f
av
o
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d
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g
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t
al
t
act
i
c
s
w
ere
t
a
k
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n
i
n
t
o
c
o
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s
i
d
er
at
i
o
n
w
h
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l
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d
i
v
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d
i
n
g
t
h
e
g
r
o
u
p
s
.
T
h
e
i
n
t
er
v
e
n
t
i
o
n
g
r
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u
p
p
ar
t
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ci
p
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d
i
n
o
n
l
i
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c
h
at
s
a
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d
rec
ei
v
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d
A
RT
med
i
c
at
i
o
n
n
o
t
i
f
i
c
at
i
o
n
s
,
rem
i
n
d
er
s
,
an
d
p
ee
r
ed
u
ca
t
i
o
n
.
H
ea
l
t
h
b
eh
av
i
o
r
an
d
n
u
t
ri
t
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o
n
mes
s
a
g
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s
w
er
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d
e
l
i
v
er
ed
t
o
t
h
e
c
o
n
t
r
o
l
ar
m.
Fo
l
l
o
w
i
n
g
t
h
e
i
n
t
er
v
e
n
t
i
o
n
,
a
g
rea
t
e
r
p
erc
en
t
a
g
e
o
f
p
ar
t
i
c
i
p
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t
s
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h
e
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er
v
e
n
t
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o
n
arm
t
h
a
n
i
n
t
h
e
co
n
t
ro
l
ar
m
h
ad
ac
h
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d
o
p
t
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ma
l
A
R
T
a
d
h
er
en
ce.
A
R
T
ad
h
e
re
n
ce
w
a
s
d
r
ama
t
i
ca
l
l
y
i
n
c
rea
s
e
d
b
y
t
h
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t
a
i
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d
d
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g
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al
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n
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v
e
n
t
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.
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n
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to
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n
s
t
a
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t
m
es
s
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f
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n
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crea
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d
A
R
T
a
d
h
ere
n
c
e,
acc
o
rd
i
n
g
t
o
s
u
b
g
r
o
u
p
an
al
y
s
i
s
.
[3
9
]
RCT
3
0
0
me
n
w
h
o
h
a
v
e
s
e
x
w
i
t
h
men
(M
SM)
p
a
t
i
en
t
s
E
l
i
g
i
b
l
e
M
S
M
w
h
o
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r
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j
u
s
t
b
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n
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g
A
R
T
w
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t
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t
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a
n
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v
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p
(
s
t
a
n
d
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d
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of
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c
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a
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t
w
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h
m
H
e
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v
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t
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)
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p
(
s
t
a
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d
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of
-
c
a
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c
a
s
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m
a
n
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g
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m
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n
t
)
.
T
h
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n
f
o
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m
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m
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A
R
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d
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c
e
w
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l
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b
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f
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d
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t
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f
o
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t
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d
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m
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t
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f
t
h
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m
H
e
a
l
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h
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t
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r
v
e
n
t
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o
n
,
w
h
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c
h
w
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l
l
h
a
v
e
f
o
u
r
c
o
m
p
o
n
e
n
t
s
:
a
r
t
i
c
l
e
s
w
i
t
h
i
n
s
t
r
u
c
t
i
o
n
a
l
c
o
n
t
e
n
t
,
p
r
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v
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t
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o
n
l
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m
e
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s
a
g
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w
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c
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m
a
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a
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s
,
k
n
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l
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d
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f
a
v
a
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b
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p
p
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v
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s
,
a
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p
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m
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Mo
b
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ea
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v
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s
w
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k
w
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l
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cas
e
ma
n
a
g
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me
n
t
.
T
h
e
p
a
t
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en
t
man
ag
eme
n
t
s
er
v
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s
f
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ch
r
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ca
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t
o
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s
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t
h
es
e
m
H
ea
l
t
h
t
rea
t
m
en
t
s
.
[4
0
]
RCT
5
0
0
P
L
W
H
T
h
r
e
e
d
i
s
t
i
n
c
t
g
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l
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d
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t
h
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p
u
b
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c
h
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l
t
h
c
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t
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r
(
P
H
C
)
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v
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t
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n
.
I
d
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t
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f
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w
h
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P
H
C
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v
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d
(
V
L
)
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w
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t
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A
i
m
2
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s
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o
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P
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p
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P
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m
p
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t
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A
i
m
3
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n
v
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r
c
h
.
PH
C
w
as
crea
t
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d
w
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i
d
ea
o
f
b
e
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w
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s
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.
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s
fl
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s
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.
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y
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ret
e
n
t
i
o
n
i
n
H
I
V
care
o
v
e
r
a
y
ear.
[6
3
]
Cl
u
s
t
er
Ran
d
o
m
i
ze
d
Co
n
t
ro
l
l
e
d
T
r
i
a
l
3
0
2
P
L
W
H
T
h
e
i
n
t
e
rv
en
t
i
o
n
w
a
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crea
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IV
c
are
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n
s
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b
-
Sah
ara
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A
fr
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(SS
A
)
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fre
q
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amp
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V
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(H
B
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'
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l
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n
k
a
g
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t
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car
e,
a
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may
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o
n
i
n
s
u
b
-
Sa
h
ar
an
A
fr
i
ca
.
[1
7
]
RCT
1
9
6
P
L
W
H
A
l
l
p
at
i
e
n
t
s
g
o
t
s
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a
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d
ar
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me
d
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c
al
ca
r
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cl
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c
at
i
o
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r
H
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V
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A
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D
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.
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co
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o
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cer
n
s
an
d
me
d
i
ca
l
i
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.
Pa
t
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T
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.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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SS
N:
2252
-
8
8
0
6
A
s
ystema
tic
r
ev
ie
w
o
f m
u
lti
-
leve
l in
terven
tio
n
to
en
h
a
n
ce
t
h
e
q
u
a
lity
o
f …
(
Gu
s
ti A
yu
K
r
is
ma
Yu
n
ta
r
i)
1765
T
ab
le
1
.
Stu
d
y
ch
ar
ac
ter
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(
C
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)
A
u
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Res
earc
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Po
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In
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v
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i
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O
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mea
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s
[6
4
]
RCT
4
0
P
L
W
H
S
e
l
f
-
m
a
n
a
g
e
m
e
n
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cr
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b
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1
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5
p
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p
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m
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0
.
8
p
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s
.
[6
5
]
RCT
2
2
2
P
L
W
H
Part
i
c
i
p
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n
t
s
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h
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Ma
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Ma
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ma
y
o
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l
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b
e
t
r
an
s
i
e
n
t
.
[6
6
]
RCT
3
0
0
P
L
W
H
T
h
e
i
n
t
e
r
v
e
n
t
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N
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[
1
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L.
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,
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2
6
8
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2
6
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2
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[
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1
]
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Li
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[
3
2
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-
T.
C
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3
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[
3
4
]
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.
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[
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5
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[
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6
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.
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[
3
8
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