***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: Context Cost-effective , scalable programs are urgently needed in countries deeply affected by HIV . Methods This parallel-group RCT was conducted in four secondary schools in Mbarara , Ug and a. Participants were 12 years and older , reported past-year computer or Internet use , and provided informed caregiver permission and youth assent . The intervention , CyberSenga , was a five-hour online healthy sexuality program . Half of the intervention group was further r and omized to receive a booster at four-months post-intervention . The control arm received ‘ treatment as usual ’ ( i.e. , school-delivered sexuality programming ) . The main outcome measures were : 1 ) condom use and 2 ) abstinence in the past three months at six-months ' post-intervention . Secondary outcomes were : 1 ) condom use and 2 ) abstinence at three-month 's post-intervention ; and 6-month outcomes by booster exposure . Analyses were intention to treat . Results All 416 eligible youth were invited to participate , 88 % ( n = 366 ) of whom enrolled . Participants were r and omized to the  intervention ( n = 183 ) or  control ( n = 183 ) arm ; 91 intervention participants were further r and omized to the booster . No statistically significant results were noted among the main outcomes . Among the secondary outcomes : At three-month follow-up , trends suggested that intervention participants ( 81 % ) were more likely to be abstinent than control participants ( 74 % ; p = 0.08 ) , and this was particularly true among youth who were abstinent at baseline ( 88 % vs. 77 % ; p = 0.02 ) . At six-month follow-up , those in the booster group ( 80 % ) reported higher rates of abstinence than youth in the intervention , no booster ( 57 % ) and control ( 55 % ) groups ( p = 0.15 ) ; they also reported lower rates of unprotected sex ( 5 % ) compared to youth in the intervention , no booster ( 24 % ) and control ( 21 % ) groups ( p = 0.21 ) among youth sexually active at baseline . Conclusions The CyberSenga program may affect HIV preventive behavior among abstinent youth in the short term and , with the booster , may also promote HIV preventive behavior among sexually active youth in the longer term . Trial Registration NCT00906178 Background Worldwide , about 50 % of all new cases of HIV occur in youth between age 15 and 24 years . Studies in various sub-Saharan African countries show that both out of school and in school adolescents and youth are engaged in risky sexual behaviors . School-based health education has been a cornerstone of youth-focused HIV prevention efforts since the early 1990s . In addition , peer-based interventions have become a common method to effect important health-related behavior changes and address the HIV/AIDS p and emic . Thus , the aim of this study was to evaluate efficacy of peer education on changing HIV related risky sexual behaviors among school youth in Addis Ababa , Ethiopia . Methods A quasi experimental study with peer education intervention was conducted in purposively selected four secondary schools ( two secondary schools for the intervention and other two for the control group ) in Addis Ababa , Ethiopia . Five hundred sixty students from r and omly selected sections of grade 11 were assessed through anonymous question naires conducted in pre- and post-intervention periods . Pertinent data on socio-demographic and sexual behavior related factors were collected . The statistical packages used for data entry and analysis were epi-info version 3.5.4 and SPSS version 20.0 respectively . Chi-square test and multivariable logistic regressions were used for testing association between peer education intervention and sexual behaviors of students . In addition to testing association between dependent and independent variables , multi-variable analysis was employed to control for the effects of confounding variables . Results When the pre and post intervention data of each group were compared , comprehensive Knowledge of HIV ( P-Values = 0.004 ) and willingness to go for HIV counseling and testing ( P-value = 0.01 ) showed significant differences among intervention group students during post intervention period . Moreover , students in the intervention group were more likely to use condoms during post intervention period compared to students of the control group [ AOR = 4.73 ( 95 % CI ( 1.40–16.0 ) ] . Conclusion Despite short follow up period , students in the intervention group demonstrated positive changes in HIV related comprehensive knowledge and showed better interest to go for HIV testing in the near future . Furthermore , positive changes on risky sexual behaviors were reported from the intervention group . Implementing secondary school targeted peer education by allocating appropriate amounts of re sources ( money , man power , material s and time ) could play significant role to prevent and control HIV/AIDS among school youth BACKGROUND The ability of specific behaviour-change interventions to reduce HIV infection in young people remains question able . Since January 1999 , an adolescent sexual and reproductive health ( SRH ) intervention has been implemented in ten r and omly chosen intervention communities in rural Tanzania , within a community r and omised trial ( see below ; NCT00248469 ) . The intervention consisted of teacher-led , peer-assisted in-school education , youth-friendly health services , community activities , and youth condom promotion and distribution . Process evaluation in 1999 - 2002 showed high intervention quality and coverage . A 2001/2 intervention impact evaluation showed no impact on the primary outcomes of HIV seroincidence and herpes simplex virus type 2 ( HSV-2 ) seroprevalence but found substantial improvements in SRH knowledge , reported attitudes , and some reported sexual behaviours . It was postulated that the impact on " upstream " knowledge , attitude , and reported behaviour outcomes seen at the 3-year follow-up would , in the longer term , lead to a reduction in HIV and HSV-2 infection rates and other biological outcomes . A further impact evaluation survey in 2007/8 ( approximately 9 years post-intervention ) tested this hypothesis . METHODS AND FINDINGS This is a cross-sectional survey ( June 2007 through July 2008 ) of 13,814 young people aged 15 - 30 y who had attended trial schools during the first phase of the MEMA kwa Vijana intervention trial ( 1999 - 2002 ) . Prevalences of the primary outcomes HIV and HSV-2 were 1.8 % and 25.9 % in males and 4.0 % and 41.4 % in females , respectively . The intervention did not significantly reduce risk of HIV ( males adjusted prevalence ratio [ aPR ] 0.91 , 95%CI 0.50 - 1.65 ; females aPR 1.07 , 95%CI 0.68 - 1.67 ) or HSV-2 ( males aPR 0.94 , 95%CI 0.77 - 1.15 ; females aPR 0.96 , 95%CI 0.87 - 1.06 ) . The intervention was associated with a reduction in the proportion of males reporting more than four sexual partners in their lifetime ( aPR 0.87 , 95%CI 0.78 - 0.97 ) and an increase in reported condom use at last sex with a non-regular partner among females ( aPR 1.34 , 95%CI 1.07 - 1.69 ) . There was a clear and consistent beneficial impact on knowledge , but no significant impact on reported attitudes to sexual risk , reported pregnancies , or other reported sexual behaviours . The study population was likely to have been , on average , at lower risk of HIV and other sexually transmitted infections compared to other rural population s , as only youth who had reached year five of primary school were eligible . CONCLUSIONS SRH knowledge can be improved and retained long-term , but this intervention had only a limited effect on reported behaviour and no significant effect on HIV/STI prevalence .  Youth interventions integrated within intensive , community-wide risk reduction programmes may be more successful and should be evaluated . TRIAL REGISTRATION Clinical Trials.gov In this study , the effects on  young adolescent sexual risk behaviour of teacher-led school HIV prevention programmes were examined in two sites in South Africa ( Cape Town and Mankweng ) and one site in Tanzania ( Dar es Salaam ) . In Cape Town , Dar es Salaam and Mankweng , 26 , 24 and 30 schools , respectively , were r and omly allocated to intervention or comparison groups . Primary outcomes were delayed sexual debut and condom use among adolescents aged 12 - 14 years ( grade 8 in South Africa and grade s 5 and 6 in Tanzania ) . In total , 5352 , 4197 and 2590 students participated at baseline in 2004 in Cape Town , Dar es Salaam and Mankweng , respectively , and 73 % ( n = 3926 ) , 88 % ( n = 3693 ) and 83 % ( n = 2142 ) were retained 12 - 15 months later . At baseline , 13 % ( n = 224 ) , 5 % ( n = 100 ) and 17 % ( n = 164 ) had had their sexual debut , and 44 % ( n = 122 ) , 20 % ( n = 17 ) and 37 % ( n = 57 ) of these used a condom at last sex , respectively . In Dar es Salaam , students in the intervention were less likely to have their sexual debut during the study ( OR 0.65 , 95 % CI 0.48 - 0.87 ) . In Cape Town and Mankweng , the intervention had no impact . The current interventions were effective at delaying sexual debut in Dar es Salaam but not in South Africa , where they need to be supplemented with programmes to change the environment in which adolescents make decisions about sexual behaviour Background While the HIV epidemic is levelling off in sub-Saharan Africa , it remains at an unacceptably high level . Young people aged 15 - 24 years remain particularly vulnerable , result ing in a regional HIV prevalence of 1.4 % in young men and 3.3 % in young women . This study assesses the effectiveness of a peer-led HIV prevention intervention in secondary schools in Rw and a on young people ’s sexual behavior , HIV knowledge and attitudes . Methods In a non-r and omized longitudinal controlled trial , fourteen schools were selected in two neighboring districts in Rw and a Bugesera ( intervention ) and Rwamagana ( control ) . Students ( n = 1950 ) in eight intervention and six control schools participated in three surveys ( baseline , six and twelve months in the intervention ) . Analysis was done using linear and logistic regression using generalized estimation equations adjusted for propensity score . Results The overall retention rate was 72 % . Time trends in sexual risk behavior ( being sexually active , sex in last six months , condom use at last sex ) were not significantly different in students from intervention and control schools , nor was the intervention associated with increased knowledge , perceived severity or perceived susceptibility . It did significantly reduce reported stigma . Conclusions Analyzing this and other interventions , we identified several reasons for the observed limited effectiveness of peer education : 1 ) intervention activities ( spreading information ) are not tuned to objectives ( changing behavior ) ; 2 ) young people prefer receiving HIV information from other sources than peers ; 3 ) outcome indicators are not adequate and the context of the relationship in which sex occurs and the context in which sex occurs is ignored . Effectiveness of peer education may increase through integration in holistic interventions and redefining peer educators ’ role as focal points for sensitization and referral to experts and services . Finally , we argue that a narrow focus on sexual risks will never significantly turn the tide Much attention has been placed on the need to develop and evaluate complex interventions targeting public health issues , such as reproductive health . However , and as has been the case in the recent past , even well- design ed trials will be flawed unless meticulous attention is paid to ensuring the most appropriate intervention is design ed and developed . This requires a well-re source d and carefully planned feasibility study , incorporating both formative and process evaluation , with particular attention being paid to the context of the proposed intervention . In this paper , we describe the way in which a feasibility study helped re design and shape a complex intervention targeting adolescent sexual health in rural Zimbabwe . By using a mixture of in-depth interviews , focus groups and participant observation with pupils , parents , teachers and education officers , we were able to show that the intervention as originally conceived was unlikely to be deliverable . Process evaluation findings from the feasibility study led to substantial changes to both the content and delivery of the proposed intervention , which is now subject to testing for effectiveness in a large community r and omized trial Research ers aim ed to determine the effects of a teenage pregnancy ( TP ) prevention program for 816 high school students attending 16 KwaZulu-Natal , South African schools through a r and omized control trial . Data were collected at baseline and at the 8-month follow-up in 2009 . Results were calculated using multivariate analyses of program effects employing Mplus 6 , and indicated significantly healthier attitudes , including intentions to abstain from sex whilst at school , plans to communicate with partners about teenage pregnancy , and increased reports of condom use . Research ers thus provide some support for the effectiveness of a TP prevention program that should be further strengthened in a comprehensive approach that includes schools and families This paper focuses on the community component of a larger action research project on HIV Prevention for Rural Youth ( HP4RY ) , funded by the Global Health Research Initiative ( Canada ) . It began with ethnographic research in 10 communities selected using geographic representative sampling and r and om assignment to one of three research arms . Using the AIDS Competent Community ( ACC ) model developed by Catherine Campbell , the ethnographic research identified factors in six domains that contributed to youth vulnerability to HIV infection . This was followed by recruitment , training and 
    Output:
    
ConclusionS chool-based sexual health education has the potential to promote condom use among young people in sub-Saharan Africa .