***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 
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    Input: Background Adolescents need access to effective sexual and reproductive health ( SRH ) interventions , but face barriers accessing them through traditional health systems . School-based approaches might provide accessible , complementary strategies . We investigated whether a 21-session after-school SRH education programme and school health service attracted adolescents most at risk for adverse SRH outcomes and explored motivators for and barriers to attendance . Methods Grade 8 adolescents ( average age 13 years ) from 20 schools in the intervention arm of an HIV prevention cluster r and omised controlled trial in the Western Cape Province of South Africa , were invited to participate in an after-school SRH program and to attend school health services . Using a longitudinal design , we surveyed participants at baseline , measured their attendance at weekly after-school sessions for 6 months and surveyed them post-intervention . We examined factors associated with attendance using bivariate and multiple logistic and Poisson regression analyses , and through thematic analysis of qualitative data . Results The intervention was fully implemented in 18 schools with 1576 trial participants . The mean attendance of the 21-session SRH programme was 8.8 sessions ( S.D. 7.5 ) among girls and 6.9 ( S.D. 7.2 ) among boys . School health services were visited by 17.3 % ( 14.9 % of boys and 18.7 % of girls ) . Adolescents who had their sexual debut before baseline had a lower rate of session attendance compared with those who had not ( 6.3 vs 8.5 , p < .001 ) . Those who had been victims of sexual violence or intimate partner violence ( IPV ) , and who had perpetrated IPV also had lower rates of attendance . Participants were motivated by a wish to receive new knowledge , life coaching and positive attitudes towards the intervention . The unavailability of safe transport and domestic responsibilities were the most common barriers to attendance . Only two participants cited negative attitudes about the intervention as the reason they did not attend . Conclusions Reducing structural barriers to attendance , after-school interventions are likely to reach adolescents with proven-effective SRH interventions . However , special attention is required to reach vulnerable adolescents , through offering different delivery modalities , improving the school climate , and providing support for adolescents with mental health problems and neurodevelopmental academic problems . Trial registration Current Controlled Trials IS RCT N56270821 ; Registered 13 February 2013 Recent evidence suggests that conditional cash transfer programs for schooling are effective in raising school enrollment and attendance . However , there is also reason to believe that such programs can affect other outcomes , such as the sexual behavior of their young beneficiaries .  Zomba Cash Transfer Program is a r and omized , ongoing conditional cash transfer intervention targeting young women in Malawi that provides incentives ( in the form of school fees and cash transfers ) to current schoolgirls and recent dropouts to stay in or return to school . An average offer of US$ 10/month conditional on satisfactory school attendance – plus direct payment of secondary school fees – led to significant declines in early marriage , teenage pregnancy , and self-reported sexual activity among program beneficiaries after just one year of program implementation . For program beneficiaries who were out of school at baseline , the probability of getting married and becoming pregnant declined by more than 40 percent and 30 percent , respectively . In addition , the incidence of the onset of sexual activity was 38 percent lower among all program beneficiaries than the control group . Overall , these results suggest that conditional cash transfer programs not only serve as useful tools for improving school attendance , but may also reduce sexual activity , teen pregnancy , and early marriage Background Only four out of 31 completed r and omized controlled trials ( RCTs ) of HIV prevention strategies against sexual transmission have shown significant efficacy . Poor adherence may have contributed to the lack of effect in some of these trials . In this paper we explore the impact of various levels of adherence on measured efficacy within an RCT . Analysis We used simple quantitative methods to illustrate the impact of various levels of adherence on measured efficacy by assuming a uniform population in terms of sexual behavior and the binomial model for the transmission probability per partnership . At 100 % adherence the measured efficacy within an RCT is a reasonable approximation of the true biological efficacy . However , as adherence levels fall , the efficacy measured within a trial substantially under-estimates the true biological efficacy . For example , at 60 % adherence , the measured efficacy can be less than half of the true biological efficacy . Conclusion Poor adherence during a trial can substantially reduce the power to detect an effect , and improved methods of achieving and maintaining high adherence within trials are needed . There are currently 12 ongoing HIV prevention trials , all but one of which require ongoing user-adherence . Attention must be given to methods of maximizing adherence when piloting and design ing RCTs and HIV prevention programmes A seven-year r and omized evaluation suggests education subsidies reduce  adolescent girls ' dropout , pregnancy , and marriage but not sexually transmitted infection ( STI ) . The government 's HIV curriculum , which stresses abstinence until marriage , does not reduce pregnancy or STI . Both programs combined reduce STI more , but cut dropout and pregnancy less , than education subsidies alone . These results are inconsistent with a model of schooling and sexual behavior in which both pregnancy and STI are determined by one factor ( unprotected sex ) , but consistent with a two-factor model in which choices between committed and casual relationships also affect these outcomes Objective To assess the impact of a theoretically based sex education programme ( SHARE ) delivered by teachers compared with conventional education in terms of conceptions and terminations registered by the NHS . Design Follow-up of cluster r and omised trial 4.5 years after intervention . Setting NHS records of women who had attended 25 secondary schools in east Scotl and . Participants 4196 women ( 99.5 % of those eligible ) .  Intervention SHARE programme ( intervention group ) v existing sex education ( control group ) . Main outcome measure NHS recorded conceptions and terminations for the achieved sample linked at age 20 . Results In an “ intention to treat ” analysis there were no significant differences between the groups in registered conceptions per 1000 pupils ( 300 SHARE v 274 control ; difference 26 , 95 % confidence interval −33 to 86 ) and terminations per 1000 pupils ( 127 v 112 ; difference 15 , −13 to 42 ) between ages 16 and 20 . Conclusions This specially design ed sex education programme did not reduce conceptions or terminations by age 20 compared with conventional provision . The lack of effect was not due to quality of delivery . Enhancing teacher led school sex education beyond conventional provision in eastern Scotl and is unlikely to reduce terminations in teenagers . Trial registration IS RCT N48719575 An exigent need exists for HIV prevention intervention research targeting young men who have sex with men (MSM)-a group of young adults that , despite composing the highest and most racially disproportionate rates of HIV incidence , have been least often the focus of behavioral intervention research . This pilot study tested a group-based HIV primary prevention intervention for young MSM to evaluate its initial efficacy , feasibility , and acceptability . Participants were r and omized ( N = 101 ; aged 16–20 years ) to one of two group-level , HIV and STI education programs :  controls participated in a non-interactive , lecture-based program , while intervention participants took part in a highly interactive program tailored to young MSM aged 16–20 . Sexual risk and social cognitive outcomes were assessed at baseline , 6- , and 12-weeks post-intervention . Over the entire follow-up period , intervention participants were less likely than controls to engage in any sexual behavior while under the influence of substances ( p < .05 ) , and a decreasing trend in unprotected anal sex while under the influence of substances was also observed in this group ( p = .08 ) . Follow-up differences between groups on social cognitive outcomes favored the intervention group , though these differences were non-significant . Acceptability ratings were modest . A 6-session behavioral intervention tailored to young MSM , aged 16–20 , is feasible , acceptable , and demonstrates evidence of preliminary efficacy in reducing sexual risk , specifically sexual risk while under the influence of substances Abstract Objective : To determine whether a theoretically based sex education programme for adolescents ( SHARE ) delivered by teachers reduced unsafe sexual intercourse compared with current practice . Design : Cluster r and omised trial with follow up two years after baseline ( six months after intervention ) . A process evaluation investigated the delivery of sex education and broader features of each school . Setting : Twenty five secondary schools in east Scotl and . Participants : 8430 pupils aged 13 - 15 years ; 7616 completed the baseline question naire and 5854 completed the two year follow up question naire . Intervention : SHARE programme ( intervention group ) versus existing sex education ( control programme ) . Main outcome measures : Self reported exposure to sexually transmitted disease , use of condoms and contraceptives at first and most recent sexual intercourse , and unwanted pregnancies . Results : When the intervention group was compared with the conventional sex education group in an intention to treat analysis there were no differences in sexual activity or sexual risk taking by the age of 16 years . However , those in the intervention group reported less regret of first sexual intercourse with most recent partner ( young men 9.9 % difference , 95 % confidence interval −18.7 to −1.0 ; young women 7.7 % difference , −16.6 to 1.2 ) . Pupils evaluated the intervention programme more positively , and their knowledge of sexual health improved . Lack of behavioural effect could not be linked to differential quality of delivery of intervention . Conclusions : Compared with conventional sex education this specially design ed intervention did not reduce sexual risk taking in adolescents OBJECTIVE To evaluate the efficacy of an abstinence-only intervention in preventing sexual involvement in young adolescents . DESIGN R and omized controlled trial . SETTING Urban public schools . PARTICIPANTS A total of 662 African American students in grade s 6 and 7 . INTERVENTIONS An 8-hour abstinence-only intervention targeted reduced sexual intercourse ; an 8-hour safer sex-only intervention targeted increased condom use ; 8-hour and 12-hour comprehensive interventions targeted sexual intercourse and condom use ; and an 8-hour health-promotion control intervention targeted health issues unrelated to sexual behavior . Participants also were r and omized to receive or not receive an intervention maintenance program to extend intervention efficacy . OUTCOME MEASURES The primary outcome was self-report of ever having sexual intercourse by the 24-month follow-up . Secondary outcomes were other sexual behaviors . RESULTS The participants ' mean age was 12.2 years ; 53.5 % were girls ; and 84.4 % were still enrolled at 24 months .  Abstinence-only intervention  reduced sexual initiation ( risk ratio [ RR ] , 0.67 ; 95 % confidence interval [ CI ] , 0.48 - 0.96 ) . The model-estimated probability of ever having sexual intercourse by the 24-month follow-up was 33.5 % in the abstinence-only intervention and 48.5 % in the control group . Fewer abstinence-only intervention participants ( 20.6 % ) than control participants ( 29.0 % ) reported having coitus in the previous 3 months during the follow-up period ( RR , 0.94 ; 95 % CI , 0.90 - 0.99 ) . Abstinence-only intervention did not affect condom use . The 8-hour ( RR , 0.96 ; 95 % CI , 0.92 - 1.00 ) and 12-hour comprehensive ( RR , 0.95 ; 95 % CI , 0.91 - 0.99 ) interventions reduced reports of having multiple partners compared with the control group . No other differences between interventions and controls were significant . CONCLUSION Theory-based abstinence-only interventions may have an important role in preventing adolescent sexual involvement . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00640653 INTRODUCTION With the rising threat of HIV in India , youth are an important group to reach for prevention education . This pilot study tested the efficacy of STEP ( School-based Teenage Education Program focusing on HIV Prevention )  for school children . METHOD This pilot study r and omized 25 schools in Mumbai to receive STEP ( N = 1846 ) . We trained forty two undergraduates from local colleges to deliver the , ( six-session ) program over a six-week period to eighth grade rs ( age 13 - 15 years ) . Outcome measures collected at six weeks were HIV knowledge , attitudes toward abstinence/condom use , peer pressure , and confidence in dealing with risky social situations . A repeated measures analysis of variance was conducted with pretest and posttest scores with knowledge , beliefs , attitudes , and confidence as the within-group measures and gender as the between-group measure . RESULTS Both boys and girls significantly improved on knowledge , attitudes , and beliefs regarding HIV/AIDS and in their confidence level in dealing with risky behavior . However girls increased more on knowledge ( P < .05 ) , agreement with abstinence ( P < .05 ) , and agreement with condom use ( P < .001 ) . Girls had significantly less need to follow peers ( P < .05 ) , better underst and ing of pre caution s against HIV ( P < .001 ) , and a higher confidence level in dealing with risky social situations ( P < .05 ) . CONCLUSIONS Overall , girls benefited more from the STEP intervention than boys . The literature documents strong gender disparities in HIV/AIDS knowledge , information sources , and consequences of sex for youth in India . However , more work is needed to define and 
    Output:
    
There is little evidence that educational curriculum‐based programmes alone are effective in improving sexual and reproductive health outcomes for adolescents .