***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: The objective of this study was to determine acceptability and feasibility of patient-based partner referral ( PBPR ) and patient-delivered partner medication ( PDPM ) among female sexually transmitted infection ( STI ) patients in a community-based STI screening study . Women were r and omized to STI screening at home or at a clinic . STI patients could choose between PBPR and PDPM . Six-week follow-up interviews , and in-depth interviews , were conducted . STI prevalence was high . Most of the 106 women with an STI chose PDPM , mainly because partners would not have time or would not want to attend a clinic , and to ensure that partners received treatment . Nearly all partners reportedly took medication ( 94 ; 89 % took it in front of the woman ) or went to a clinic for treatment ( 92 % ) . No adverse events were reported . Good communication emerged as the key to successful partner notification . In conclusion , PDPM could be used as a strategy to improve STI treatment coverage Objective : To measure quality of sexually transmitted disease (  STD  )  syndromic case management and aspects of health-seeking behaviour at baseline in an intervention trial . Setting : Ten rural primary care clinics , Hlabisa district , South Africa . Design :  Simulated patients ( fieldworkers trained to present with STD syndromes ) made a total of 44 clinic visits ; 49 STD patients were interviewed when exiting clinics ; facilities were assessed for availability of necessary equipment and drugs ; 10 focus group discussion s were held with staff ; and STD syndrome surveillance was performed in all 10 clinics . Results : A total of 9 % of simulated patients were correctly managed ( given correct drugs , plus condoms and partner notification cards ) , recommended drug treatment was given in only 41 % of visits , and appropriate counselling was given in 48 % of visits . Among patients leaving the clinic , although 39 % waited over an hour to be seen and only 37 % were consulted in private , all reported staff attitudes as satisfactory or good . Only six clinics had syndromic management protocol s available , three reported intermittent drug shortages , and seven lacked partner notification cards . Focus group discussion s revealed good staff knowledge about STD , but showed lack of training in syndromic management and low morale . Surveillance data showed that while 75 % of those presenting for care did so within 1 week of symptom onset , 27 % had been treated for an STD in the preceding 3 months , and only 6 % of those treated were contacts . Conclusions : Quality of STD case management was poor despite good staff knowledge and availability of most essential re sources . An intervention comprising staff training and STD syndrome packets has been design ed to improve quality of case management Objectives : To describe important details of the design and operational features of the Mwanza sexually transmitted diseases ( STD ) control programme . To assess the feasibility of the intervention , the distribution of STD syndromes observed , the clinical effectiveness of syndromic STD case management , the utilisation of STD services by the population , and the quality of syndromic STD services delivered at rural health units . Methods : The intervention was integrated into rural primary healthcare ( PHC ) units . It comprised improved STD case management using the syndromic approach , facilitated by a regional programme office which ensured the training of health workers , a reliable supply of effective drugs , and regular support supervision . Five studies were performed to evaluate operational performance : ( i ) a survey of register books to collect data on patients presenting with STDs and reproductive tract infections ( RTIs ) to rural health units with improved STD services , ( ii ) a survey of register books from health units in communities without improved services , ( iii ) a survey of register books from referral clinics , ( iv ) a home based cross sectional study of STD patients who did not return to the intervention health units for follow up  , ( v ) a cross sectional survey of reported STD treatment seeking behaviour in a r and om cohort of 8845 adults served by rural health units . Results : During the 2 years of the Mwanza trial , 12 895 STD syndromes were treated at the 25 intervention health units . The most common syndromes were urethral discharge ( 67 % ) and genital ulcers ( 26 % ) in men and  vaginal discharge ( 50 % ) , lower abdominal tenderness ( 33 % ) , and genital ulcers ( 13 % ) in women . Clinical treatment effectiveness was high in patients from whom complete follow up data were available , reaching between 81 % and 98 % after first line treatment and 97%–99 % after first , second , and third line treatment . Only 26 % of patients referred to higher levels of health care had presented to their referral institutions . During the trial period , data from the cohort showed that 12.8 % of men and 8.6 % of women in the intervention communities experienced at least one STD syndrome . Based on various approaches , utilisation of the improved health units by symptomatic STD patients in these communities was estimated at between 50 % and 75 % . During the first 6 months of intervention attendance at intervention units increased by 53 % . Thereafter , the average attendance rate was about 25 % higher than in comparison communities . Home visits to 367 non-returners revealed that 89 % had been free of symptoms after treatment , but 28 % became symptomatic again within 3 months of treatment . 100 % of these patients reported that they had received treatment , but only 74 % had been examined , only 57 % had been given health education , and only 30 % were offered condoms . Patients did not fully recall which treatment they had been given , but possibly only 63 % had been treated exactly according to guidelines . Conclusions : This study demonstrated that it is feasible to integrate effective STD services into the existing PHC structure of a developing country . Improved services attract more patients , but additional educational efforts are needed to further improve treatment seeking behaviour . Furthermore , clear treatment guidelines , a reliable drug supply system , and regular supervision are critical . All efforts should be made to treat patients on the spot , without delay , as referral to higher levels of care led to a high number of dropouts . The syndromic approach to STD control should be supported by at least one reference clinic and laboratory per country to ensure monitoring of prevalent aetiologies , of the development of bacterial resistance , and of the effectiveness of the syndromic algorithms in use STUDY OBJECTIVE To assess quality of care of sexually transmitted diseases ( STDs ) and evaluate interactive training methods aim ed at improving providers ' performance . DESIGN AND SETTING This comparative study , with a baseline , intervention , and evaluation phases was conducted at two urban health centers in Zambia . The personnel at one health center were trained in STD management using interactive training methods . The other health center acted as a control . SUBJECTS AND METHODS Two-hundred patients with STD were interviewed and their interaction with health care providers observed before and after the training . Another 200 interviews and observations were conducted at the control health center . RESULTS The proportion of patients being examined , given health education and informed about partner notification increased significantly after the intervention . The proportion of patients who had complaints about the health care did not decrease . Long waiting time and lack of time to discuss the disease were the main complaints . CONCLUSION The training solved some , but not all , problems of poor case management . This indicates the need for a more process-oriented approach for improving quality of care Objective : To explore the role of primary health centers in provision of  voluntary counseling and testing ( VCT ) in Kenya . Design and Setting : Prospect i ve service evaluation at 3 ( 1 urban and 2 rural ) government health centers . Subjects : Consecutive adult clients . Main Outcome Measures : Uptake of services , user characteristics , quality of service . Results : Counseling services received 2315 new clients over 26 months . The last quarter averaged 101 clients per clinic . More than 80 % of clients lived locally . Overall 93 % opted to test , 91 % receiving results , 82 % on the same day . Most clients tested HIV negative ( 81 % ) . Youth and men were well represented . Few couples ( 10 % ) attended . Seventeen percent of women were pregnant . Self-referral was common and illness was an uncommon reason for testing ( < 20 % ) . Thirty-one percent of clients were referred from VCT to other health center services . Counseling was perceived as high quality by users and providers . Validation of the test algorithm showed a sensitivity of 98.0 % and specificity of 98.7 % . Conclusion : Government health centers in Kenya can be appropriate providers of VCT . This pilot helped initiate a new strategy of health center-based VCT in Kenya and this has facilitated rapid expansion and more equitable provision for Kenyans Unlike contact-tracing procedures for syphilis and gonorrhea , field follow-up to locate and treat patients with Chlamydia trachomatis infections has not been extensively applied in the United States . We implemented two studies to assess the efficiency and cost-effectiveness of using field follow-up for contact of two groups : patients with chlamydial infection detected as part of a screening program and women who were sexual partners of men with nongonococcal urethritis ( NGU ) . Of the 142 patients with chlamydial infection who had not been treated empirically , 112 ( 79 % ) returned for treatment when a reminder system was used , as compared with a return rate of 97 % ( 259/266 ) achieved by field follow-up ( P less than 0.0001 ) . Among the 678 men with NGU enrolled in a r and omized trial of  field follow-up vs. two self-referral methods  , field follow-up yielded over three times as many partners returning to the clinic for treatment as did either of the other two methods ( P less than 0.001 ) . Analyses using the estimated costs of the intervention strategies and the medical costs associated with an untreated chlamydial infection showed that field follow-up by trained investigators proved to be not only the most efficient method for locating patients with chlamydial infection and /or patients who were at risk for it , but also the most cost-effective in terms of total health-care dollars spent BACKGROUND Treatment of sexually-transmitted infections ( STIs ) and behavioural interventions are the main methods to prevent HIV in developing countries . We aim ed to assess the effect of these interventions on incidence of HIV-1 and other sexually-transmitted infections . METHODS We r and omly allocated all adults living in 18 communities in rural Ug and a to receive behavioural interventions alone ( group A ) , behavioural and STI interventions ( group B ) , or routine government health services and community development activities ( group C ) . The primary outcome was HIV-1 incidence . Secondary outcomes were incidence of herpes simplex virus type 2 ( HSV2 ) and active syphilis and prevalence of gonorrhoea , chlamydia , reported genital ulcers , reported genital discharge , and markers of behavioural change . Analysis was per protocol . FINDINGS Compared with group C , the incidence rate ratio of HIV-1 was 0.94 ( 0.60 - 1.45 , p=0.72 ) in group A and 1.00 ( 0.63 - 1.58 , p=0.98 ) in group B , and the prevalence ratio of use of condoms with last casual partner was 1.12 ( 95 % CI 0.99 - 1.25 ) in group A and 1.27 ( 1.02 - 1.56 ) in group B. Incidence of HSV2 was lower in group A than in group C ( incidence rate ratio 0.65 , 0.53 - 0.80 ) and incidence of active syphilis for high rapid plasma reagent test titre and prevalence of gonorrhoea were both lower in group B than in group C ( active syphilis incidence rate ratio , 0.52 , 0.27 - 0.98 ; gonorrhoea prevalence ratio , 0.25 , 0.10 - 0.64 ) . INTERPRETATION The interventions we used were insufficient to reduce HIV-1 incidence in rural Ug and a , where secular changes are occurring . More effective STI and behavioural interventions need to be developed for HIV control in mature epidemics Background Patient-based partner referral ( PBPR ) , which is the main method for treating sexual partners of patients with sexually transmitted diseases ( STDs ) , has limited effectiveness . Goal The authors compared the efficacy of PBPR with patient-delivered partner medication ( PDPM ) among patients attending the Mulago STD clinic in Kampala , Ug and a. Study Design A total of 383 patients ( 187 women , 196 men ) with STDs were r and omized to the PBPR or PDPM group . The proportion of sexual partners treated in either group was compared using the chi-square statistic by intention to treat for partners whose follow-up status was unknown . Results The two groups had similar background characteristics . Of the 237 partners elicited , 176 ( 74 % ) were reported treated in the PDPM group . In the PBPR group , in which 234 partners were elicited , 79 ( 34 % ) were referred to the treatment clinic . This difference was statistically significant ( risk ratio [ RR ] , 2.44 ; 95 % CI , 1.95–3.07;P < 0.001 ) . Furthermore , PDPM was more effective than PBPR for women and for casual partners for whom PBPR is considered difficult . For women , 86 of 103 partners in the PDPM group were reported treated , compared with 23 of 104 partners in the PBPR group ( RR , 4.55 ; 95 % CI , 2.92–7.08;P < 0.001 ) . For casual partners , 18 of 51 ( 34 % ) were reported treated in the PDPM group , compared with only three of 45 partners ( 7 % ) who were 
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Reported barriers included sociocultural factors such as stigma , fear of abuse for having an STI , and infrastructural factors related to the limited number of STD clinics , and trained providers and reliable diagnostic methods .
Client-oriented counselling was found to be effective in improving partner referral outcomes .
Conclusions STD clinics can improve PN with client-oriented counselling , which should help clients to overcome perceived barriers .