***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 determine the factors associated with participation in cervical cancer screening and follow-up treatment in the context of a r and omized controlled trial . The trial was initiated to evaluate the efficacy and cost effectiveness of visual inspection with acetic acid , cytological screening and testing for human papillomavirus in reducing the incidence of and mortality from cervical cancer in Maharashtra , India . METHODS Between October 1999 and November 2003 women aged 30 - 59 years were r and omized to receive one of the  three tests  or to a  control group . Participation was analysed for all three intervention arms . The differences between those who were screened versus those who were not was analysed according to the sociodemographic characteristics of the 100,800 eligible women invited for screening . Those who were treated versus those who were not were analysed according to the sociodemographic characteristics of the 932 women diagnosed with high- grade lesions .  Participation in screening and compliance with treatment were also analysed according to the type of test used . FINDINGS Compared with women who were not tested , screened women were younger ( aged 30 - 39 ) , better educated and had ever used contraception . A higher proportion of screened women were married and a lower proportion had never been pregnant . Of the 932 women diagnosed with high- grade lesions or invasive cancer , 85.3 % ( 795 ) received treatment . Women with higher levels of education , who had had fewer pregnancies and those who were married were more likely to comply with treatment . There were no differences in rates of screening or compliance with treatment when results were analysed by the test received . CONCLUSIONS Irrespective of the test being used , good participation levels for cervical cancer screening can be achieved in rural areas of developing countries by using appropriate strategies to deliver services . Communication methods and delivery strategies aim ed at encouraging older , less-educated women , who have less contact with reproductive services , are needed to further increase screening uptake BACKGROUND The proportion of women infected with human papillomavirus ( HPV )  varies greatly across population s , as might the distribution of HPV types . We aim ed to compare HPV-type distribution in representative sample s of women from different world regions . METHODS Women were r and omly selected from the general population of 13 areas from 11 countries ( Nigeria , India , Vietnam , Thail and , Korea , Colombia , Argentina , Chile , the Netherl and s , Italy , and Spain ) . A st and ardised protocol was used for cervical specimen collection . All HPV testing was by GP5+/6 + PCR-based EIA . The proportion of HPV-positive women infected with different HPV types was compared by study area and between pooled regions with age-adjusted odds ratios ( ORs ) with corresponding 95 % floating CIs . FINDINGS 15 613 women aged 15 - 74 years without cytological abnormalities were included in a pooled analysis . Age-st and ardised HPV prevalence varied nearly 20 times between population s , from 1.4 % ( 95 % CI 0.5 - 2.2 ) in Spain to 25.6 % ( 22.4 - 28.8 ) in Nigeria . Although both overall HPV prevalence and HPV16 prevalence were highest in sub-Saharan Africa , HPV-positive women in Europe were significantly more likely to be infected with HPV16 than were those in sub-Saharan Africa ( OR 2.64 , p=0.0002 ) , and were significantly less likely to be infected with high-risk HPV types other than HPV16 ( OR 0.57 , p=0.004 ) and /or low-risk HPV types ( OR 0.44 . p=0.0002 ) . Women from South America had HPV-type distribution in between those from sub-Saharan Africa and Europe . Heterogeneity between areas of Asia was significant . INTERPRETATION Heterogeneity in HPV type distribution among women from different population s should be taken into account when developing screening tests for the virus and predicting the effect of vaccines on the incidence of infection The objectives of this paper are to ( 1 ) underst and the nature of men ’s extramarital sexuality in three low income communities in Mumbai , India ; ( 2 ) explore the associations between marital relationships and extramarital sex ; and ( 3 ) assess the implication s of the research results for intervention . Results are based on survey data collected from 2,408 r and omly selected men from the three study communities and a matched subset of 260 r and omly selected men and their wives who responded to a female version of the men 's survey . These surveys produced a unique data set , which allows sociodemographic , attitudinal and behavioral variables from husb and and wife and variables that are the product of husb and and wife interaction to be utilized to predict men 's extramarital sex through multiple sequential logistic regression analysis . Results indicate that  men 's extramarital sex is significantly associated with husb and 's and wife 's age , wife 's perception of domestic violence , husb and 's education and place of birth , husb and 's alcohol use , wife 's willingness to engage in marital sex , and types of marital sexual acts . These results confirm the need to move from the individual to the couple as the unit of research and the need for intervention to reduce the risk of HIV/STI transmission within marriage both in India and internationally The authors evaluated direct visual inspection of the cervix after the application of 5 % acetic acid ( DVI ) as a cervical cancer screening test for use in low‐re source setting We evaluated the feasibility and performance of visual inspection with acetic acid ( VIA ) and Lugol 's iodine ( VILI ) for cervical cancer screening in a primary health-care setting in Kinshasa , Congo . Women ( 1,528 ) aged > or = 30 years were screened independently by nurses and physicians by VIA and VILI and Pap cytology . Biopsy sample s were obtained from women with abnormal colposcopies and from 290 r and omly chosen women with normal colposcopy . Cytological and histological examinations were performed in Lyon and Montreal , respectively . The prevalence of cervical intraepithelial neoplasia ( CIN ) of grade s 1 , 2 and 3 was 4.5 , 1.3 and 4 % , respectively . Using biopsy as the reference , the sensitivity , specificity and negative predictive value ( NPV ) for > or = CIN 2 for VIA-nurse were 55.5 % ( 95 % CI : 34.7 - 76.2 ) , 64.6 % ( 95 % CI : 62.0 - 67.1 ) and 96.8 % ( 95 % CI : 93.5 - 98.7 ) , respectively . The corresponding values for VILI-nurse were 44.0 % ( 95 % CI : 24.2 - 63.8 ) , 74.6 % ( 95 % CI : 72.3 - 76.9 ) and 96.7 % ( 95 % CI : 93.7 - 98.6 ) . The equivalent parameters for physicians were 71.1 % ( 95 % CI : 46.7 - 95.5 ) , 71.3 % ( 95 % CI : 68.9 - 73.6 ) and 98.6 % ( 95 % CI : 96.0 - 99.7 ) for VIA and 68.3 % ( 95 % CI : 42.5 - 94.0 ) , 76.2 % ( 95 % CI : 74.0 - 78.4 ) and 97.2 % ( 95 % CI : 95.3 - 98.5 ) for VILI . The sensitivity of cytology ranged between 31 and 72 % , depending on the abnormality threshold used to define positivity , with a corresponding specificity range of 94 - 99 % and a NPV range of 97 - 99 % . Our results show that VIA and VILI performed by nurses and physicians are slightly more sensitive but less specific than Pap cytology across multiple combinations of test and lesion thresholds . Given their lower cost and easy deployment , visual inspection methods merit further assessment as cervical cancer screening methods for low-re source countries The efficacy of a single round of screening of visual inspection with acetic acid ( VIA ) on cervical cancer incidence and mortality is investigated in a cluster r and omized controlled trial in south India . Women aged 30 - 59 years in 113 clusters in Dindigul District were r and omized to VIA screening by nurses ( 57 clusters , 48,225 eligible women ) and to a  control group ( 56 clusters , 30,167 women ) . 30,577 ( 63.4 % ) eligible women participated in screening . Younger , educated , married , multiparous , low-income women and those who have had tubal sterilization had a higher compliance with screening . Of the 2069 women diagnosed with CIN and invasive cancer , 1498 ( 72.4 % ) received treatment . Young women , those who practice d contraception and women with high- grade precursor lesions and invasive cancers were more likely to comply with treatment . In summary , our study indicates that women accept  screening with VIA by nurses and a moderate level of compliance with screening and treatment can be reached through appropriate service delivery systems including health education activities , personal invitations , clinics in proximity to the target women , and testing and treatment in the same session . Our results imply that integration of screening activities with primary health services seems to have the potential to replicate most of these service delivery conditions in routine programs A prospect i ve study was undertaken to determine the sensitivity and specificity of acetic application to the cervix followed by naked eye visualization as a screening test for detection of cervical intraepithelial neoplasia . Three hundred and seventy two sexually active woman in the reproductive age group were studied . All the women underwent Papanicolaou test , acetic acid test and colposcopy .  One hundred and seventy five woman were acetic acid test negative , 197 women were acetic acid test positive . The sensitivity of acetic acid test was 72.4 % , specificity 54 % and false negative rate 15.2 % , as compared to papanicolaou test which had a sensitivity of 13.2 % , specificity of 96.3 % and false negative rate of 24.4 % . The advantage of the acetic acid test lies in its easy technique , low cost and high sensitivity which are important factors for determining the efficacy of any screening programme in developing countries The impact of screening by visual inspection with acetic acid ( VIA ) , cytology or HPV testing on cervical cancer incidence and mortality is investigated in a cluster r and omized controlled trial in India . We report findings after the screening phase , when 52 clusters , with a total of 142,701 women aged 30 - 59 years in Osmanabad District , India , were r and omized into 4 arms for a single round of screening by trained midwives with either VIA , cytology or HPV testing as well as a control group . All laboratory tests were done locally . Test-positive women underwent investigations ( colposcopy/biopsy ) and treatment in the base hospital . Data on participation , test positivity , positive predictive value and detection rates of cervical neoplasia were analyzed using cluster design methodology . Of the eligible women , 72 - 74 % were screened .  Test positivity rates were 14.0 % for VIA , 7.0 % for cytology and 10.3 % for HPV . The detection rate of high- grade lesions was similar in all intervention arms ( 0.7 % for VIA , 1.0 % for cytology and 0.9 % for HPV testing ) ( p = 0.06 , Mann-Whitney test ) . While the detection rate for VIA dropped to 0.5 % with declining test positivity during the course of the study , it remained constant for cytology and HPV testing . Over 85 % of women with high- grade lesions received treatment . Our results show that a high level of participation and good- quality cytology can be achieved in low-re source setting s. VIA is a useful alternative but requires careful monitoring . Detection rates obtained by HPV testing were similar to cytology , despite higher investments The impact of a single round of screening of visual inspection with acetic acid ( VIA ) on cervical cancer incidence and mortality was investigated in a cluster r and omized trial in south India . Women 30 - 59 years of age in 113 clusters in Dindigul District were r and omized to VIA screening ( 57 clusters , 48,225 women ) by nurses  and to a control group ( 56 clusters , 30,167 women ) . 30,577 eligible women were screened between May 2000 and April 2003 ; 2,939 ( 9.6 % ) screen-positive women were investigated with colposcopy by nurses and 2,777 ( 9.1 % ) women had biopsy . CIN 1 was diagnosed in 1,778 women , CIN 2 - 3 lesions were found in 222 , and there were 69 screen detected invasive cervical cancers . The detection rates of lesions per 1,000 screened women were 58.2 for CIN 1 , 7.3 for CIN 2 - 3 , and 2.3 for invasive cancer . The detection rate of high- grade lesions in our study was 2 - 3-fold higher than those observed in repeatedly screened population s in developed countries . 71 % of women with CIN 1 and 80 % of those with CIN 2 - 3 lesions accepted  cryotherapy 
    Output:
    
New HPV vaccines will also help prevent HPV infection and the precancerous changes that lead to cervical cancer .