***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 effects of a behavioural intervention for prevention of HIV and sexually transmitted diseases that identified , trained , and engaged leaders of Roma ( Gypsy ) men 's social networks to counsel their own network members . Design A two arm r and omised controlled trial . Setting A disadvantaged , impoverished Roma settlement in Bulgaria . Participants 286 Roma men from 52 social networks recruited in the community . Intervention At baseline all participants were assessed for HIV risk behaviour , tested and treated for sexually transmitted diseases , counselled in risk reduction , and r and omised to intervention or control groups . Network leaders learnt how to counsel their social network members on risk prevention . Networks were followed up three and 12 months after the intervention to determine evidence of risk reduction . Main outcome measure Occurrence of unprotected intercourse during the three months before each assessment . Results Reported prevalence of unprotected intercourse in the intervention group fell more than in control group ( from 81 % and 80 % , respectively , at baseline to 65 % and 75 % at three months and 71 % and 86 % at 12 months ) . Changes were more pronounced among men with casual partners . Effects remained strong at long term follow-up , consistent with changes in risk reduction norms in the social network . Other measures of risk reduction corroborated the intervention 's effects . Conclusions Endorsement and advice on HIV prevention from the leader of a social network produces well maintained change in the reported sexual practice s in members of that network . This model has particular relevance for health interventions in population s such as Roma who may be distrustful of outsiders . Trial registration Clinical Trials NCT00310973 Background : Sexually transmitted disease ( STD ) , including AIDS , disproportionately affects African-American and Hispanic women . Goal : To evaluate efficacy of st and ard and enhanced ( addition of optional support groups ) gender- and culture-specific , small-group behavioral interventions , compared to interactive STD counseling , in high risk minority women for two years . Methods : Women with a non-viral STD were treated and enrolled in a r and omized trial . Follow-up screens and interviews occurred at 6 months , 1 year , 18 months ( short interview , optional exam ) and 2 years . The primary outcome was subsequent infection with chlamydia and /or gonorrhea . Secondary outcomes included risky sexual behaviors . We employed logistic regression based on intention-to-treat . Results : Data from 775 women were included ; the retention rate was 91 % . Adjusted infection rates were higher in the controls in Year 1 ( 26.8 % ) , Year 2 ( 23.1 % ) , and cumulatively ( 39.8 % ) than in the enhanced ( 15.4 % , P = 0.004 ; 14.8 % , P < 0.03 ; 23.7 % , P < 0.001 , respectively ) and st and ard ( 15.7 % , P = 0.006 ; 14.7 % , P = 0.03 ; 26.2 % , P < 0.008 , respectively ) intervention arms at these time points . Enhanced-intervention women who opted to attend support groups ( attendees ) had the lowest adjusted infection rates in Year 1 ( 12.0 % ) and cumulatively ( 21.8 % ) . Intervention women in general , but particularly attendees , were significantly less likely than controls to have repeat infections . Multiple partners and unprotected sex with an untreated or incompletely treated partner helped explain group differences in infection . Conclusions : Risk-reduction interventions significantly decreased both single and multiple infective episodes with chlamydia and /or gonorrhea and risky sexual behaviors in the two-year study period . Support-group attendance appeared to contribute additional risk reduction in Year 1 BACKGROUND Oral contraceptive ( OC ) knowledge deficits may contribute to OC discontinuation . We examined the effect of an innovative educational intervention on young women 's OC knowledge . STUDY DESIGN As part of a r and omized trial evaluating the impact of text message reminders on OC continuation , we assessed  OC knowledge in 659 women ages 13 - 25 years . Women received routine care or routine care plus 6 months of daily educational text messages . We administered a comprehensive 41-item OC knowledge survey at baseline and 6 months . RESULTS Mean OC knowledge scores improved over time for all women ( baseline 22.8 , 56 % correct versus 24.7 , 60 % at 6 months ) , including knowledge of OC 's mechanisms of action ( p=.004 ) , effectiveness ( p<.001 ) , side effects ( p=.03 ) and benefits ( p<.001 ) . Mean 6-month scores were greater in the intervention ( 25.5 ) than the control group (23.7)(p<.001 ) . In multivariable linear regression models , the text message intervention most strongly predicted OC knowledge ( β=1.6 , 95 % confidence interval 0.9 - 2.2 ) . CONCLUSION Daily educational text messages can modestly improve knowledge of OCs , which may promote successful contraceptive outcomes OBJECTIVE To test the efficacy of a prevention intervention to reduce sexual risk behavior among Latino adolescents . DESIGN R and omized controlled trial from April 2000 through March 2003 , with data collection before and after intervention and at 3 , 6 , and 12 months . SETTING Northeast Philadelphia schools . PARTICIPANTS Latinos aged 13 through 18 years ( 249 males and 304 females ) ; 81.6 % retained at 12-month follow-up . INTERVENTIONS The HIV and health-promotion control interventions consisted of six 50-minute modules delivered by adult facilitators to small , mixed-gender groups  in English or Spanish . Main Outcome Measure Self-reported sexual behavior . RESULTS Analyses using generalized estimation equations over the follow-up period revealed that adolescents in the HIV intervention were less likely to report sexual intercourse ( odds ratio , 0.66 ; 95 % confidence interval [ CI ] , 0.46 - 0.96 ) , multiple partners ( odds ratio , 0.53 ; 95 % CI , 0.31 - 0.90 ) , and days of unprotected intercourse ( relative risk , 0.47 ; 95 % CI , 0.26 - 0.84 ) and more likely to report using condoms consistently ( odds ratio , 1.91 ; 95 % CI , 1.24 - 2.93 ) . Baseline sexual experience and language use moderated intervention efficacy . Adolescents assigned to the HIV intervention who were sexually inexperienced at baseline reported fewer days of unprotected sex ( relative risk , 0.22 ; 95 % CI , 0.08 - 0.63 ) ; Spanish speakers were more likely to have used a condom at last intercourse ( odds ratio , 4.73 ; 95 % CI , 1.72 - 12.97 ) and had a greater proportion of protected sex ( mean difference , 0.35 ; P<.01 ) compared with similar adolescents in the health-promotion intervention . CONCLUSION Results provide evidence for the efficacy of HIV intervention in decreasing sexual activity and increasing condom use among Latino adolescents Objective To assess the impact of a theoretically based sex education programme ( SHARE ) delivered by teachers compared with conventional education in terms of conceptions and terminations registered by the NHS . Design Follow-up of cluster r and omised trial 4.5 years after intervention . Setting NHS records of women who had attended 25 secondary schools in east Scotl and . Participants 4196 women ( 99.5 % of those eligible ) .  Intervention SHARE programme ( intervention group ) v existing sex education ( control group ) . Main outcome measure NHS recorded conceptions and terminations for the achieved sample linked at age 20 . Results In an “ intention to treat ” analysis there were no significant differences between the groups in registered conceptions per 1000 pupils ( 300 SHARE v 274 control ; difference 26 , 95 % confidence interval −33 to 86 ) and terminations per 1000 pupils ( 127 v 112 ; difference 15 , −13 to 42 ) between ages 16 and 20 . Conclusions This specially design ed sex education programme did not reduce conceptions or terminations by age 20 compared with conventional provision . The lack of effect was not due to quality of delivery . Enhancing teacher led school sex education beyond conventional provision in eastern Scotl and is unlikely to reduce terminations in teenagers . Trial registration IS RCT N48719575 OBJECTIVES Women in impoverished inner-city neighborhoods are at high risk for contracting HIV . A r and omized , multisite community-level HIV prevention trial was undertaken with women living in 18 low-income housing developments in 5 US cities . METHODS Baseline and 12-month follow-up population risk characteristics were assessed by surveying 690 women at both time points . In the 9 intervention condition housing developments , a community-level intervention was undertaken that included HIV risk reduction workshops and community HIV prevention events implemented by women who were popular opinion leaders among their peers . RESULTS The proportion of women in the intervention developments who had any unprotected intercourse in the past 2 months declined from 50 % to 37.6 % , and the percentage of women 's acts of intercourse protected by condoms increased from 30.2 % to 47.2 % . Among women exposed to intervention activities , the mean frequency of unprotected acts of intercourse in the past 2 months tended to be lower at follow-up ( mean = 4.0 ) than at baseline ( mean = 6.0 ) . These changes were corroborated by changes in other risk indicators . CONCLUSIONS Community-level interventions that involve and engage women in neighborhood-based HIV prevention activities can bring about reductions in high-risk sexual behaviors 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 : The Information-Motivation-Behavioral Skills ( IMB ) model of HIV preventive behavior ( 1–4 ) specifies that treatment effects on behavior occur largely as the result of treatment effects on behavioral skills , which follow from effects on information and motivation . Purpose : The objective was to determine whether the variables specified by the IMB model of HIV preventive behavior ( 1–4 ) accounted for the relation between an IMB-based treatment and result ing HIV preventive behavior ( condom use ) . Method : Women ( n = 557 ) living in 18 
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Reports could be clearer about how the theory was used to design and implement the intervention