***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 whether community engagement ( participation in grassroots organizations ) contributed to increases in HIV testing in Zimbabwe . Methods : Prospect i ve data on membership of local community organizations ( e.g. women 's groups and burial societies ) and uptake of HIV testing and counselling ( HTC ) and prevention-of-mother-to-child transmission ( PMTCT ) services were collected from 5260 adults interviewed in two consecutive rounds of a general- population cohort survey in eastern Zimbabwe between 2003 and 2008 . The effects of community engagement on uptake of services during the follow-up period were measured using logistic regression to adjust for observed confounding factors . Results : Sixteen percent of men and 47 % of women were consistent members of community organizations ; 58 and 35 % of these people discussed HIV in their meetings and were members of externally sponsored organizations , respectively . Fewer men ( 10.1 % ) than women ( 32.4 % ) took up HTC during follow-up [ adjusted odds ratio ( aOR ) = 4.08 , 95 % confidence interval ( CI ) 3.43–4.86 , P < 0.001 ] . HTC uptake was higher for members of community organizations than for nonmembers : men , 15.0 versus 9.2 % ( 1.67 , 1.15–2.43 , P = 0.007 ) ; women , 35.6 versus 29.6 % ( 1.26 , 1.06–1.49 , P = 0.008 ) . Membership of community organizations showed a nonsignificant association with PMTCT uptake amongst recently pregnant women ( 42.3 versus 34.2 % ; 1.30 , 0.94–1.78 , P = 0.1 ) . The most consistent positive associations between community participation and HTC and PMTCT uptake were found in organizations that discussed HIV and when external sponsorship was absent . Conclusion : Grassroots organizations contributed to increased uptake of HTC services in eastern Zimbabwe in the mid-2000s . Partnerships with these organizations could harness community support for the further increases in HIV testing needed in sub-Saharan Africa As community-level interventions become more common in HIV prevention , processes such as community mobilization ( CM ) are increasingly utilized in public health programs and research . Project Accept , a multi-site community r and omized controlled trial , is testing the hypothesis that CM coupled with community-based mobile voluntary counseling and testing and post-test support services will alter community norms and reduce the incidence of HIV . By using a multiple-case study approach , this qualitative study identifies seven major community mobilization strategies used in Project Accept , including stakeholder buy-in , formation of community coalitions , community engagement , community participation , raising community awareness , involvement of leaders , and partnership building , and describes three key elements of mobilization success . ResumenDebido a que las intervenciones a nivel de la comunidad llegan a ser más comunes en la prevención de VIH , los procesos como la Movilización Comunitaria ( MC ) están cada vez siendo más utilizados en programas en salud pública e investigaciones . Project Accept , un ensayo multi-sitio , aleatorio controlado , está prob and o la hipótesis de que MC junto con el asesoramiento y análisis voluntario ambulante de base comunitaria y los servicios de apoyo después del análisis , modificaran las normas comunitarias y reducirán la incidencia de VIH . Us and o el enfoque de múltiples casos , este estudio cualitativo identifica siete estrategias importantes para movilizar la comunidad utilizadas en Project Accept , incluyendo la aceptación de parte de los actores claves , la formación de coaliciones comunitarias , integración de la comunidad , participación comunitaria , incremento de la conciencia comunitaria , involucramiento de los lideres , fortalecimiento de las asociaciones , y describiendo los tres elementos claves del éxito de dicha movilización Recent debate about the evaluation of community based , HIV/AIDS behavioural interventions has focused on the appropriateness of the r and omised controlled trial ( RCT ) design , and the difficulty of obtaining reliable outcome measures . A  community based HIV AIDS behavioural change RCT , recently conducted in rural Ug and a , used HIV incidence as the principal outcome measure . This paper examines the acceptability of the trial from the community perspective . It asks whether , in a rural African setting , it is possible to implement a scientifically rigorous evaluation without compromising acceptability of the trial to the community . Opinions of the trial held by community members working as trial field workers were collected by semi-structured interview ( n = 37 ) , and focus group discussion s ( 4 ) Community opinions of the trial were ascertained through 10 focus groups . For both field workers and the community , the sero-survey was more salient than the intervention , and the source of many rumours and disputes . Despite intensive mobilisation and close monitoring of field workers , it was impossible to ensure the veracity of explanations about the survey at ground level , and to protect each individual from coercion . The community expected a reward in return on their blood . Although the introduction of incentives at the final survey round increased the acceptability of the trial , they not only created jealousies and tensions , but also led to expectations of greater rewards in future . We conclude that RCTs in poor , rural communities are feasible , but the challenges involved should not be underestimated . Obtaining community support for the trial , respecting established hierarchies , and close supervision of field workers are all essential , but even then , controversies should be anticipated . There is an urgent need for relevant guidelines to help research ers navigate the complex ethical issues involved Introduction Novartis recently launched Novartis Access , an initiative to provide a basket of reduced price medicines for non-communicable diseases ( NCDs ) to be sold through the public and private non-profit sectors in programme countries . This study will evaluate the impact of Novartis Access on the availability and price of NCD medicines at health facilities and households in Kenya , the first country to receive the programme . Methods and analysis This study will be a cluster-r and omised controlled trial . 8 counties in Kenya will be r and omly assigned to the intervention or control group using a covariate constrained r and omisation method to maximise balance on demographic and health characteristics . In intervention counties , public and private non-profit health facilities will be able to order Novartis Access NCD medicines from the Mission for Essential Drugs and Supplies ( MEDS ) . Data will be collected from a r and om sample of 384 health facilities and 800 households at baseline , midline after 1-year of intervention , and end-line after 2 years . Quarterly surveillance data will also be collected from health facilities and a sub sample of households through phone-based interviews . Households will be eligible if at least one resident has been previously diagnosed and prescribed a medicine for an NCD addressed by Novartis Access , including hypertension and diabetes . The primary outcomes will be availability and price of NCD medicines at health facilities , and availability , price , and expenditures on NCD medicines at households . Impacts will be estimated using intention-to-treat analysis . Ethics and dissemination This protocol was approved by the Institutional Review Boards at Strathmore University and at Boston University . Informed consent will be obtained from all participants at the start of the trial . The findings of the trial will be disseminated through peer- review ed journals , international conferences , and meetings and events organised with local stakeholders . Trial registration number NCT02773095 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 Background : Sexually transmitted infection (STI)/HIV prevention programs , which do not modify social structural context s that contribute to risk of STI/HIV may fail to bring about improvements in health , particularly among groups who experience discrimination and exclusion from public life . We conducted a multilevel intervention with sex workers , including improved clinical care and community-mobilizing strategies to modify social structural factors that shape sexual behavior , to improve condom use and reduce incident STI . Methods : We followed 420 sex workers participating in the Encontros intervention in Corumbá , Brazil , between 2003 and 2005 . We estimated the effect of the intervention on incident chlamydia and gonorrhea infections and condom use using generalized estimating equations and inverse probability weighting by comparing those who actively engaged in the intervention activities ( exposed ) with those who were less engaged ( unexposed ) . We also determined the association of participation on reported social cohesion and participation in networks . Results : Exposed participants had significantly higher odds of reporting consistent condom use with regular clients ( odds ratio [ OR ] : 1.9 , 95 % confidence interval:1.1–3.3 ) and nonsignificantly increased odds with both new clients ( OR : 1.6 , 0.9–2.8 ) and nonpaying partners ( OR : 1.5 , 0.9–1.5 ) . The odds of an incident STI were nonsignificantly reduced for exposed participants compared with unexposed ( OR : 0.46 , 0.2–1.3 ) . Participation was significantly associated with increased perceived cohesion and participation in networks . Conclusion : This prospect i ve study provides evidence that multilevel interventions with mobilizing strategies to modify aspects of the social environment can improve condom use , reduce STIs , and increase social cohesion and participation in networks among sex workers Background Gender based violence , including violence by an intimate partner , is a major global human rights and public health problem , with important connections with HIV risk . Indeed , the elimination of sexual and gender based violence is a core pillar of HIV prevention for UNAIDS . Integrated strategies to address the gender norms , relations and inequities that underlie both violence against women and HIV/AIDS are needed . However there is limited evidence about the potential impact of different intervention models . This protocol describes the SASA ! Study : an evaluation of a community mobilisation intervention to prevent violence against women and reduce  HIV/AIDS risk in Kampala , Ug and a. Methods / Design The SASA ! Study is a pair-matched cluster r and omised controlled trial being conducted in eight communities in Kampala . It is design ed to assess the community-level impact of the SASA ! intervention on the following six primary outcomes : attitudes towards the acceptability of violence against women and the acceptability of a woman refusing sex ( among male and female community members ) ; past year experience of physical intimate partner violence and sexual intimate partner violence ( among females ) ; community responses to women experiencing violence ( among women reporting past year physical/sexual partner violence ) ; and past year concurrency of sexual partners ( among males ) . 1583 women and men ( aged 18–49 years ) were surveyed in intervention and control communities prior to intervention implementation in 2007/8 . A follow-up cross-sectional survey of community 
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Among most at risk groups ( particularly sex workers ) , the evidence is somewhat consistent , indicating a tendency for positive impact , with stronger results for behavioural and social outcomes than for biomedical ones .
Among youth and general communities , the evidence remains inconclusive .
Success appears to be enhanced by engaging groups with a strong collective identity and by simultaneously addressing the socio-political context .
En grupos de riesgo ( particularmente trabajadoras sexuales ) la evidencia es más bien consistente , indic and o una tendencia general de impacto positivo , siendo los result ados conductuales y sociales más robustos que los biomédicos .
En los jóvenes y comunidades en general la evidencia no es concluyente .
Result ados favorables parecen ser mejorados al involucrar grupos con una fuerte identidad colectiva y , simultáneamente , atender al context o socio-político .
Proponemos que la naturaleza poco concluyente de los hallazgos refleja problemas con la evidencia , en lugar de sugerir que la MC es inefectiva .