***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To investigate HIV incidence during a trial of two voluntary counselling and testing ( VCT ) strategies . Counselling may promote beneficial behavioural change , although knowledge of negative status does not appear to contribute further benefit . Design : The parent cluster-r and omized trial demonstrated much greater uptake of VCT when counselling and rapid testing were available on-site ( intensive VCT ) than through pre-paid vouchers to an external provider ( st and ard VCT ) . Anonymous HIV tests had been requested from all employees at enrolment and after 2 years intervention . Methods : The study setting was 22 businesses in Harare , Zimbabwe . Participants were 3146 HIV-negative individuals remaining in employment at the end of intervention , of whom 2966 ( 94.3 % ) consented to repeat testing . VCT linked to basic HIV care was provided and the main outcome measures were HIV incidence under each study arm , as a retrospective secondary analysis . Results : Mean VCT uptake in this cohort was 70.7 and 5.2 % , respectively , in the intensive and st and ard arms . Crude HIV incidence was 1.21 per 100 person-years , with non-significantly higher rates in the intensive VCT arm [ mean site incidence 1.37 and 0.95 per 100 person-years , respectively ; adjusted rate ratio 1.49 ( 95 % confidence interval 0.79–2.80 ) . Conclusions : Highly acceptable VCT did not reduce HIV incidence in this predominantly male cohort .  HIV incidence was highest in the high uptake VCT arm , lending support to a US trial in which rapid testing appeared to have adverse behavioural consequences in some HIV-negative clients . Careful comparison of outcomes under different counselling and testing strategies is needed to maximize HIV prevention from global scale-up of VCT Objective : To assess effects of a combined microfinance and training intervention on HIV risk behavior  among young female participants in rural South Africa . Design : Secondary analysis of quantitative and qualitative data from a cluster r and omized trial , the Intervention with Microfinance for AIDS and Gender Equity study . Methods : Eight villages were pair-matched and r and omly allocated to receive the intervention . At baseline and after 2 years , HIV risk behavior was assessed among female participants aged 14–35 years . Their responses were compared with women of the same age and poverty group from control villages . Intervention effects were calculated using adjusted risk ratios employing village level summaries . Qualitative data collected during the study explored participants ' responses to the intervention including HIV risk behavior . Results : After 2 years of follow-up , when compared with controls , young participants had higher levels of HIV-related communication ( adjusted risk ratio 1.46 , 95 % confidence interval 1.01–2.12 ) , were more likely to have accessed voluntary counseling and testing ( adjusted risk ratio 1.64 , 95 % confidence interval 1.06–2.56 ) , and less likely to have had unprotected sex at last intercourse with a nonspousal partner ( adjusted risk ratio 0.76 , 95 % confidence interval 0.60–0.96 ) . Qualitative data suggest a greater acceptance of intrahousehold communication about HIV and sexuality . Although women noted challenges associated with acceptance of condoms by men , increased confidence and skills associated with participation in the intervention supported their introduction in sexual relationships . Conclusions : In addition to impacts on economic well being , women 's empowerment and intimate partner violence , interventions addressing the economic and social vulnerability of women may contribute to reductions in HIV risk behavior Abstract Objective To assess effects on condom use and other sexual behaviour of an HIV prevention programme at school that promotes the use of condoms with and without emergency contraception . Design Cluster r and omised controlled trial . Setting 40 public high schools in the state of Morelos , Mexico . Participants 10 954 first year high school students . Intervention Schools were r and omised to one of three arms : an HIV prevention course that promoted condom use , the same course with emergency contraception as back-up , or the existing sex education course . Self administered anonymous question naires were completed at baseline , four months , and 16 months . Students at intervention schools received a 30 hour course ( over 15 weeks ) on HIV prevention and life skills , design ed in accordance with guidelines of the joint United Nations programme on HIV/AIDS . Two extra hours of education on emergency contraception were given to students in the condom promotion with contraception arm . Main outcome measures Primary outcome measure was reported condom use . Other outcomes were reported sexual activity ; knowledge and attitudes about HIV and emergency contraception ; and attitudes and confidence about condom use . Results Intervention did not affect reported condom use . Knowledge of HIV improved in both intervention arms and knowledge of emergency contraception improved in the condom promotion with contraception arm . Reported sexual behaviour was similar in the intervention arms and the control group . Conclusion A rigorously design ed , implemented , and evaluated HIV education course based in public high schools did not reduce risk behaviour , so such courses need to be re design ed and evaluated . Addition of emergency contraception did not decrease reported condom use or increase risky sexual behaviour but did increase reported use of emergency contraception This study evaluates the efficacy of Keepin ' It Safe , a theory-based , gender-specific , CD-ROM-mediated HIV prevention program for urban , early adolescent girls . Intervention effects were examined in a r and omized , pretest-posttest wait-list control-group design . Changes in HIV/AIDS knowledge , protective attitudes , and skills for reducing HIV risk-related sexual behaviors were tested using linear regression models that were controlled for baseline values of each outcome . Recruited through youth services agencies located in the greater New York City area , study participants comprised 204 adolescent girls aged 11 - 14 years . Girls exposed to Keepin ' It Safe , relative to wait-list control girls , increased their HIV/AIDS knowledge , perceived efficacy and enjoyment of abstinence , perceived efficacy and enjoyment of condoms , and sexual assertiveness , suggesting that a theory-based , gender-specific , CD-ROM-mediated HIV prevention program can enhance knowledge , protective attitudes , and skills for reducing HIV risk-related sexual behaviors among urban early-adolescent girls Background Consistent with observational studies , a r and omized controlled intervention trial of  adult male circumcision ( MC ) conducted in the general population in Orange Farm ( OF ) ( Gauteng Province , South Africa ) demonstrated a protective effect against HIV acquisition of 60 % . The objective of this study is to present the first cost-effectiveness analysis of the use of MC as an intervention to reduce the spread of HIV in sub-Saharan Africa . Methods and Findings Cost-effectiveness was modeled for 1,000 MCs done within a general adult male population . Intervention costs included performing MC and treatment of adverse events .  HIV prevalence was estimated from published estimates and incidence among susceptible subjects calculated assuming a steady-state epidemic . Effectiveness was defined as the number of HIV infections averted ( HIA ) , which was estimated by dynamically projecting over 20 years the reduction in HIV incidence observed in the OF trial , including secondary transmission to women . Net savings were calculated with adjustment for the averted lifetime duration cost of HIV treatment . Sensitivity analyses examined the effects of input uncertainty and program coverage . All results were discounted to the present at 3 % per year . For Gauteng Province , assuming full coverage of the MC intervention , with a 2005 adult male prevalence of 25.6 % , 1,000 circumcisions would avert an estimated 308 ( 80 % CI 189–428 ) infections over 20 years . The cost is $ 181 ( 80 % CI $ 117–$306 ) per HIA , and net savings are $ 2.4 million ( 80 % CI $ 1.3 million to $ 3.6 million ) . Cost-effectiveness is sensitive to the costs of MC  and of averted HIV treatment , the protective effect of MC , and HIV prevalence . With an HIV prevalence of 8.4 % , the cost per HIA is $ 551 ( 80 % CI $ 344–$1,071 ) and net savings are $ 753,000 ( 80 % CI $ 0.3 million to $ 1.2 million ) . Cost-effectiveness improves by less than 10 % when MC intervention coverage is 50 % of full coverage . Conclusions In setting s in sub-Saharan Africa with high or moderate HIV prevalence among the general population  , adult MC is likely to be a cost-effective HIV prevention strategy , even when it has a low coverage . MC generates large net savings after adjustment for averted HIV medical costs BACKGROUND In Thail and , phase 1/2 trials of monovalent subtype B and bivalent subtype B/E ( CRF01_AE ) recombinant glycoprotein 120 human immunodeficiency virus type 1 ( HIV-1 ) vaccines were successfully conducted from 1995 to 1998 , prompting the first HIV-1 vaccine efficacy trial in Asia . METHODS This r and omized , double-blind , placebo-controlled efficacy trial of AIDSVAX B/E ( VaxGen ) , which included 36-months of follow-up , was conducted among injection drug users ( IDUs ) in Bangkok , Thail and . The primary end point was HIV-1 infection ; secondary end points included plasma HIV-1 load , CD4 cell count , onset of acquired immunodeficiency syndrome-defining conditions , and initiation of antiretroviral therapy . RESULTS A total of 2546 IDUs were enrolled between March 1999 and August 2000 ; the median age was 26 years , and 93.4 % were men . The overall HIV-1 incidence was 3.4 infections/100 person-years ( 95 % confidence interval [ CI ] , 3.0 - 3.9 infections/100 person-years ) , and the cumulative incidence was 8.4 % . There were no differences between the vaccine and placebo arms . HIV-1 subtype E ( 83 vaccine and 81 placebo recipients ) accounted for 77 % of infections . Vaccine efficacy was estimated at 0.1 % ( 95 % CI , -30.8 % to 23.8 % ; P=.99 , log-rank test ) . No statistically significant effects of the vaccine on secondary end points were observed . CONCLUSION Despite the successful completion of this efficacy trial , the vaccine did not prevent HIV-1 infection or delay HIV-1 disease progression Objectives : This study was the first community-based intervention to test feasibility and effectiveness of an intervention targeting sex workers in China . Design : Prospect i ve , community-based , pre/post-intervention trial . Method : Thirty establishments in Chengjiang , 34 in Ruili and 23 in Longchuan were selected for the study . The study participants were female sex workers . Out-reach workers visited the establishments to conduct intervention activities over 6 weeks . The activities included lectures , discussion , video and audio cassettes , and distribution of educational folders and condoms . Pre- and post-intervention cross-sectional surveys assessed changes in sexually transmitted disease (STD)/AIDS knowledge and condom use . Results : After the intervention , knowledge of the three HIV transmission routes increased from 25 to 88 % ( P < 0.01 ) , knowledge that condoms can reduce the risk of STD/HIV infection increased from 56 to 94 % ( P < 0.01 ) . Condom use at last sex and in the last three sexual encounters increased from 61 to 85 % ( P < 0.01 ) and from 41 to 70 % , respectively . Multivariate analyses indicated that the intervention was an independent factor ( P < 0.01 ) for these changes . Conclusion : The intervention programme was effective at increasing HIV/AIDS knowledge and condom use rates among sex workers in the community and should be exp and ed PURPOSE To evaluate the effectiveness of peer education when compared to teacher-led curricula in AIDS prevention programs conducted in schools in Rome , Italy . METHODS Eighteen high schools were r and omly assigned to one of two prevention programs : one led by teachers and the other by peer leaders . A sample of students attending the last 2 years ( n = 1295 ) completed pre and post-intervention question naires . Changes in sexual behaviors , knowledge , prevention skills , risk perception and attitudes were first evaluated within each intervention group . Afterwards , changes in knowledge , prevention skills , risk perception , and attitudes total scale scores ( post-test scores minus pre-test scores ) were compared between the two groups , through linear regression models , in order to control for confounders , taking into account the within-school correlation in score changes . As for sexual behaviors , number of sexual partners and frequency of condom use in the 3 months before post-test were compared by intervention group through ordinal regression models , also taking into account behaviors reported before pre-test . RESULTS For both groups , we observed significant improvements in skills , knowledge , attitudes and risk perception . The peer-led group showed a 6.7 % ( 95 % C.I. 1.9 - 11.5 ) scores greater improvement in knowledge , compared to the teacher-led group . In neither group were improvements observed in condom use or number of sexual partners . CONCLUSIONS The only apparent benefit of the peer-led intervention , compared to that led by teachers , was a greater improvement in knowledge of HIV . Neither of the interventions induced changes in sexual behavior . However , the role of possible biases and method ological problems must be considered when interpreting these results BACKGROUND HIV infection and intimate-partner violence share a common risk environment in much of southern Africa . The aim of the Intervention with Microfinance for AIDS and Gender Equity ( IMAGE ) study was to assess a structural intervention that combined a microfinance programme 
    Output:
    
Results The findings demonstrated that school based-sex education plus life-skill programs , voluntary and routine HIV counselling and testing , male condoms , street outreach programs , needle and syringe programs , programs for the prevention of mother-to-child HIV transmission , male circumcision , screening blood products and donated organs for HIV , and increased alcohol tax were all effective in reducing HIV infection among target population s in a cost-effective manner .
Conclusion We found very limited local evidence regarding the effectiveness of HIV interventions amongst specific high risk population s. This underlines the urgent need to prioritise health research re sources to assess the effectiveness and cost-effectiveness of HIV interventions aim ed at reducing HIV infection among high risk groups in Thail and