***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: Visual inspection with Acetic Acid ( VIA ) and Visual Inspection with Lugol ’s Iodine ( VILI ) are increasingly recommended in various cervical cancer screening protocol s in low-re source setting s. Although VIA is more widely used , VILI has been advocated as an easier and more specific screening test . VILI has not been well-vali date d as a st and -alone screening test , compared to VIA or vali date d for use in HIV-infected women . We carried out a r and omized clinical trial to compare the diagnostic accuracy of VIA and VILI among HIV-infected women . Women attending the Family AIDS Care and Education Services ( FACES ) clinic in western Kenya were enrolled and r and omized to undergo either VIA or VILI with colposcopy .  Lesions suspicious for cervical intraepithelial neoplasia 2 or greater ( CIN2 + ) were biopsied . Between October 2011 and June 2012 , 654 were r and omized to undergo VIA or VILI . The test positivity rates were 26.2 % for VIA and 30.6 % for VILI ( p = 0.22 ) . The rate of detection of CIN2 + was 7.7 % in the VIA arm and 11.5 % in the VILI arm ( p = 0.10 ) . There was no significant difference in the diagnostic performance of VIA and VILI for the detection of CIN2 + . Sensitivity and specificity were 84.0 % and 78.6 % , respectively , for VIA and 84.2 % and 76.4 % for VILI . The positive and negative predictive values were 24.7 % and 98.3 % for VIA , and 31.7 % and 97.4 % for VILI . Among women with CD4 + count < 350 , VILI had a significantly decreased specificity ( 66.2 % ) compared to VIA in the same group ( 83.9 % , p = 0.02 ) and compared to VILI performed among women with CD4 + count ≥ 350 ( 79.7 % , p = 0.02 ) . VIA and VILI had similar diagnostic accuracy and rates of CIN2 + detection among HIV-infected women . Trial Registration Clinical Trials.gov Background Over 85 % of cervical cancer cases and deaths occur in developing countries . HIV-seropositive women are more likely to develop precancerous lesions that lead to cervical cancer than HIV-negative women . However , the literature on cervical cancer prevention in seropositive women in developing countries has not been review ed . The aim of this study is to systematic ally review cervical cancer prevention modalities available for HIV-seropositive women in developing countries . Methods / design This protocol was developed by following the Preferred Reporting Items for Systematic Review s and Meta-Analyses Protocol s ( PRISMA -P ) statement , and the systematic review will be reported in accordance with the PRISMA guidelines . Embase , MEDLINE , PubMed , CINAHL and Cochrane Library will be search ed from inception up to date of final search , and additional studies will be located through citation and reference list tracking . Eligible studies will be r and omised controlled trials , prospect i ve and retrospective cohort studies , case-control and cross-sectional studies carried out in developing countries . Studies will be included if they are published in English and examine cervical cancer prevention modalities in HIV-seropositive women . Results will be summarised in tables and , where appropriate , combined using meta- analysis . Discussion This review will address the gap in evidence by systematic ally review ing the published literature on the different prevention modalities being used to prevent  cervical cancer in HIV-seropositive women in developing countries . The findings may be used to inform evidence -based guidelines for prevention of cervical cancer in seropositive women as well as future research . Systematic review registration PROSPERO CRD42017054678 OBJECTIVE To determine the factors influencing cervical cancer diagnosis and treatment in countries of East , Central and Southern Africa ( ECSA ) . METHODS Data were collected from r and omly selected primary health care centres , district and provincial hospitals , and tertiary hospitals in each participating country . Health care workers were interviewed , using a question naire ; the facilities for screening , diagnosing , and treating cervical cancer in each institution were recorded , using a previously design ed checklist . FINDINGS Although 95 % of institutions at all health care levels in ECSA countries had the basic infrastructure to carry out cervical cytology screening , only a small percentage of women were actually screened . Lack of policy guidelines , infrequent supply of basic material s , and a lack of suitable qualified staff were the most common reasons reported . CONCLUSIONS This study demonstrates that there is an urgent need for more investment in the diagnosis and treatment of cervical cancer in ECSA countries . In these , and other countries with low re sources , suitable screening programmes should be established BACKGROUND The objective of this study was to determine whether the 3-dose quadrivalent human papillomavirus ( HPV ) vaccine series ( HPV-6 , -11 , -16 , -18 ) is immunogenic and safe in young women infected with human immunodeficiency virus ( HIV ) . METHODS We enrolled 99 women aged 16 - 23 years in a phase 2 , open-label , multicenter trial , conducted from 2008 to 2011 by the Adolescent Medicine Trials Network for HIV/AIDS Interventions . Outcome measures were immunogenicity 4 weeks after dose 3 , measured by ( 1 ) geometric mean titers ( GMTs ) and ( 2 ) seroconversion rates for HPV-6 , -11 , -16 , and -18 , among those seronegative and HPV DNA negative for each type . Immune responses were compared to those of a historical comparison group of HIV-negative women ( n = 267 ) using univariate methods . Clinical and laboratory adverse events were assessed after each dose . RESULTS The mean age of subjects was 21.4 years ; 80 % were non-Hispanic black , 69 were not taking antiretroviral therapy ( ART ) , and 30 were taking ART . No differences in GMTs were noted among participants taking ART vs the comparison group , but GMTs were lower in participants not taking ART vs the comparison group for HPV-16 ( 2393 vs 3892 milli-Merck units per milliliter [ mMU/mL ] , P = .012 ) and HPV-18 ( 463 vs 801 mMU/mL , P = .003 ) . Seroconversion rates were 100 % for HPV-6 , -11 , -16 , and -18 among participants taking ART . Rates ranged from 92.3 % ( for HPV-18 ) to 100.0 % ( for HPV-6 ) among participants not taking ART . One severe adverse event ( fatigue ) was noted . CONCLUSIONS In a sample of HIV-infected women who were HPV DNA and HPV seronegative , immune responses to HPV vaccination were generally robust and the vaccine was well tolerated BACKGROUND Women infected with human immunodeficiency virus ( HIV ) are disproportionately affected by human papillomavirus (HPV)-related anogenital disease , particularly with increased immunosuppression . AIDS Clinical Trials Group protocol A5240 was a trial of 319 HIV-infected women in the United States , Brazil , and South Africa to determine immunogenicity and safety of the quadrivalent HPV vaccine  in 3 strata based on screening CD4 count : > 350 ( stratum A ) , 201 - 350 ( stratum B ) , and ≤200 cells/µL ( stratum C ) . METHODS Safety and serostatus of HPV types 6 , 11 , 16 , and 18 were examined . HPV serological testing  was performed using competitive Luminex immunoassay ( HPV-4 cLIA ) . HPV type-specific seroconversion analysis was done for participants who were seronegative for the given type at baseline . RESULTS Median age of patients was 36 years ; 11 % were white , 56 % black , and 31 % Hispanic . Median CD4 count was 310 cells/µL , and 40 % had undetectable HIV-1 load . No safety issues were identified . Seroconversion proportions among women at week 28 for HPV types 6 , 11,16 , and 18 were 96 % , 98 % , 99 % , and 91 % , respectively , for stratum A ; 100 % , 98 % , 98 % , and 85 % , respectively , for stratum B , and 84 % , 92 % , 93 % , and 75 % , respectively , for stratum C. CONCLUSIONS The quadrivalent HPV vaccine targeted at types 6 , 11 , 16 , and 18 was safe and immunogenic in HIV-infected women aged 13 - 45 years . Women with HIV RNA load > 10 000 copies/mL and /or CD4 count < 200 cells/µL had lower rates of seroconversion rates . Clinical Trials Registration . NCT00604175 Human papillomavirus ( HPV ) infection is highly prevalent and can lead to cancer ; the development of safe and efficacious vaccines for HPV is a major public health concern . The two licensed HPV vaccines contain recombinant virus-like particles of HPV 16 and 18 ; one of such vaccines also protects against HPV types 6 and 11 which cause genital warts . We determined safety and immunogenicity of quadrivalent HPV vaccine in HIV-infected and HIV-negative adolescents and young adults , aged 13 - 27 years . The seroconversion rate , assessed by antibody titers , 1 month after the administration of the third vaccine dose was 0.85 ( 95 % CI 0.75 - 0.95 ) in the HIV-infected group and 0.91 ( 0.83 - 0.99 ) in the HIV-negative subjects ( p=0.52 ) . The vaccine was generally safe and well tolerated ; the most common side effect was local pain and the most frequent systemic side effect was headache . This is the first report on response to HPV vaccination in both female and male HIV-infected adolescents and young adults and highlights that this population may benefit from HPV immunoprophylaxis . Further studies are needed to examine the long term efficacy of this vaccine in HIV-infected individuals Individuals infected with human immunodeficiency virus ( HIV ) have excess risk of developing human papillomavirus (HPV)-related disease . A substantial fraction of HPV-associated cancers is caused by HPV serotypes not included in the currently available vaccines . Among healthy women , both Cervarix ® ( HPV-16/18 , GlaxoSmithKline Biologicals , GSK ) and Gardasil ® ( HPV-6/11/16/18 , Merck ) have demonstrated partial cross-protection against certain oncogenic non-vaccine HPV-types . Currently , there are no available data on vaccine-induced cross-protection in men and little is known about cross-reactive immunity after HPV-vaccination of HIV-infected individuals . In an investigator-initiated trial , we r and omized 91 HIV-positive men and women to receive vaccination  with Cervarix ® or Gardasil ® . The HPV-DNA status of the participants was determined with pcr before and after immunization . Cross-reactive antibody responses against HPV-31 , HPV-33 , and HPV-45 were evaluated for up to 12 months using a pseudovirion-based neutralization assay ( PBNA ) . Geometric mean antibody titers ( GMTs ) were compared among vaccine groups and genders at 7 and 12 months . Both vaccines induced anti-HPV-31 , -33 , and -45 neutralizing antibodies in participants who were seronegative and HPV-DNA negative for those types at study entry . Geometric mean antibody titers were comparable between vaccine groups . Interestingly , anti-HPV-31 and -33 antibody titers were higher among women compared with men at 7 and 12 months . In conclusion , both licensed HPV-vaccines induced cross-neutralizing antibodies against frequent oncogenic non-vaccine serotypes HPV-31 , HPV-33 , and HPV-45 in HIV-infected adults , and women had greater serological responses against HPV-31 and -33 compared with men BACKGROUND It is estimated that 1%-2 % of women develop cervical intraepithelial neoplasia grade 2 - 3 ( CIN 2 - 3 ) annually worldwide . The prevalence among women living with HIV is higher , at 10 % . If left untreated , CIN 2 - 3 can progress to cervical cancer . WHO has previously published guidelines for strategies to screen and treat precancerous cervical lesions and for treatment of histologically confirmed CIN 2 - 3 . METHODS Guidelines were developed using the WHO H and book for Guideline Development and the GRADE ( Grading of Recommendations , Assessment , Development and Evaluation ) approach . A multidisciplinary guideline panel was created . Systematic review 
    Output:
    
The screening methods used for HIV-seropositive women are the same for HIV-negative women , with varying clinical performance and accuracy .
HPV testing has a better accuracy/efficiency than other methods with a sensitivity of 80.0–97.0 % and specificity of 51.0–78.0 % .
Sequential screening using VIA or visual inspection with Lugol ’s iodine ( VILI ) and HPV testing has shown better clinical performance in screening HIV-seropositive women .