***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: Background Adherence is crucial for public health program effectiveness , though the benefits of increasing adherence must ultimately be weighed against the associated costs . We sought to determine the relationship between investment in community health worker ( CHW ) home visits and increased attendance at cervical cancer screening appointments in Cape Town , South Africa . Methodology /Principal Findings We conducted an observational study of 5,258 CHW home visits made in 2003–4 as part of a community-based screening program .  We estimated the functional relationship between spending on these visits and increased appointment attendance ( adherence ) . Increased adherence was noted after each subsequent CHW visit . The costs of making the CHW visits was based on re source use including both personnel time and vehicle-related expenses valued in 2004 R and . The CHW program cost R194,018 , with 1,576 additional appointments attended . Adherence increased from 74 % to 90 % ; 55 % to 87 % ; 48 % to 77 % ; and 56 % to 80 % for 6- , 12- , 24- , and 36-month appointments . Average per-woman costs increased by R14–R47 . The majority of this increase occurred with the first 2 CHW visits ( 90 % , 83 % , 74 % , and 77 % ; additional cost : R12–R26 ) . Conclusions / Significance We found that study data can be used for program planning , identifying spending levels that achieve adherence targets given budgetary constraints . The results , derived from a single disease program , are retrospective , and should be prospect ively replicated Background .We compared vaccine coverage achieved by 2 different delivery strategies for the quadrivalent human papillomavirus ( HPV ) vaccine in Tanzanian schoolgirls . Methods .In a cluster-r and omized trial of HPV vaccination conducted in Tanzania , 134 primary schools were r and omly assigned to  class-based ( girls enrolled in primary school grade [ class ] 6 ) or age-based ( girls born in 1998 ; 67 schools per arm )  vaccine delivery . The primary outcome was coverage by dose . Results .There were 3352 and 2180 eligible girls in schools r and omized to class-based and age-based delivery , respectively .  HPV vaccine coverage was 84.7 % for dose 1 , 81.4 % for dose 2 , and 76.1 % for dose 3 . For each dose , coverage was higher in class-based schools than in age-based schools ( dose 1 : 86.4 % vs 82.0 % [ P = .30 ] ; dose 2 : 83.8 % vs 77.8 % [ P = .05 ] ; and dose 3 : 78.7 % vs 72.1 % [ P = .04 ] ) . Vaccine-related adverse events were rare . Reasons for not vaccinating included absenteeism ( 6.3 % ) and parent refusal ( 6.7 % ) . School absenteeism rates prior to vaccination ranged from 8.1 % to 23.5 % . Conclusions .HPV vaccine can be delivered with high coverage in schools in sub-Saharan Africa . Compared with age-based vaccination , class-based vaccination located more eligible pupils and achieved higher coverage .  HPV vaccination did not increase absenteeism rates in selected schools . Innovative strategies will be needed to reach out-of-school girls . Clinical Trials Registration . NCT01173900 Objective Human papillomavirus ( HPV ) self-sampling ( Self-HPV ) may be used as a primary cervical cancer screening method in a low re source setting . Our aim was to evaluate whether an educational intervention would improve  women 's knowledge and confidence in the Self-HPV method . Method Women aged between 25 and 65 years old , eligible for cervical cancer screening , were r and omly chosen to receive st and ard information ( control group ) or st and ard information followed by educational intervention ( interventional group ) . St and ard information included explanations about what the test detects ( HPV ) , the link between HPV and cervical cancer and how to perform HPV self-sampling . The educational intervention consisted of a culturally tailored video about HPV , cervical cancer , Self-HPV and its relevancy as a screening test . All participants completed a question naire that assessed sociodemographic data , women 's knowledge about cervical cancer and acceptability of Self-HPV . Results A total of 302 women were enrolled in 4 health care centers in Yaoundé and the surrounding countryside . 301 women ( 149 in the “ control group ” and 152 in the “ intervention group ” ) completed the full process and were included into the analysis . Participants who received the educational intervention had a significantly higher knowledge about HPV and cervical cancer than the control group ( p<0.05 ) , but no significant difference on Self-HPV acceptability and confidence in the method was noticed between the two groups . Conclusion Educational intervention promotes an increase in knowledge about HPV and cervical cancer . Further investigation should be conducted to determine if this intervention can be sustained beyond the short term and influences screening behavior . Trials Registration International St and ard R and omised Controlled Trial Number ( IS RCT N ) Register IS RCT Background Cervical cancer is a disease of public health importance affecting many women and contributing to avoidably high levels of cancer deaths in Nigeria . In spite of the relative ease of prevention , the incidence is on the increase . This study aim ed to determine the effect of health education on the awareness , knowledge and perception of cervical cancer and screening among women in rural Nigerian communities . Methods The study design was quasi-experimental . The study was carried out among adult women in Odogbolu ( intervention ) and Ikenne ( control ) local government areas ( LGA ) of Ogun state . Three hundred and fifty ( 350 ) women were selected per group by multistage r and om sampling technique . Data was collected by semi structured interviews with the aid of question naire . The intervention consisted of structured health education based on a movie . Result The intervention raised the level of awareness of cervical cancer and screening to 100 % ( p < 0.0001 ) . The proportion of women with very good knowledge of cervical cancer and screening rose from 2 % to 70.5 % ( χ2 = 503.7 , p < 0.0001 ) while the proportion of those with good perception rose from 5.1 % to 95.1 % ( p < 0.0001 ) . The mean knowledge and mean perception scores were also increased ( p < 0.0001 ) . There was increase in the proportion of women who had undertaken cervical screening from 4.3 % to 8.3 % ( p = 0.038 ) . The major reason stated by the women for not having had cervical screening done was lack of awareness about cervical cancer and screening . There was statistically significant difference between the intervention and control groups concerning their knowledge attitude and practice towards cervical and screening ( p < 0.05 ) after the intervention . Conclusion Multiple media health education based on a movie is effective in creating awareness for and improving the knowledge and perception of adult women about cervical cancer and screening . It also improves the uptake of cervical cancer screening . The creation of awareness is very crucial to the success of a cervical cancer prevention programme BACKGROUND Information about women 's acceptance of new screening methods in Sub-Saharan Africa is limited . The aim of this study was to report on women 's acceptance of human papillomavirus ( HPV ) self-sampling following an educational intervention on cervical cancer and HPV . METHODS Women were recruited from the city of Tiko and a low-income neighborhood of Yaoundé , both in Cameroon . Written and oral instructions about how to perform an unsupervised HPV self- sample were given to participants , who performed the test in a private room . Acceptability of HPV self-sampling  was evaluated by question naire . Participants previously screened for cervical cancer by a physician were asked additional questions to assess their personal preferences about HPV self-sampling  .  RESULTS A sample of 540 women were prospect ively enrolled in the study ; median age was 43 years old ( range 30 - 65 years ) . Participants expressed a high level of acceptance of HPV self-sampling  as a screening method following information sessions about cervical cancer and HPV . Most expressed no embarrassment , pain , anxiety , or discomfort ( 95.6 % , 87.8 % , 91.3 % , and 85.0 % , respectively ) during the information sessions . Acceptance of the method had no correlation with education , knowledge , age , or socio-professional class . Eighty-six women ( 16 % ) had a history of previous screening ; they also reported high acceptance of HPV self-sampling . CONCLUSION Educational interventions on cancer and HPV were associated with high acceptability of HPV self-testing by Cameroonian women . Further evaluation of the intervention in a larger sample and using a control group is recommended 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 impact of trained community health educators on the uptake of cervical and breast cancer screening , and HPV vaccination in rural communities in southeast Nigeria . METHODS A prospect i ve population -based intervention study , with a before- and -after design , involved four r and omly selected communities in southeast Nigeria from February 2014 to February 2016 . Before the intervention , baseline data were collected on the uptake of cervical and breast cancer prevention services . The intervention was house-to-house education on cervical cancer and breast cancer prevention . Postintervention outcome measures included the uptake of cervical and breast cancer screening , and HPV vaccination within 6 months of intervention . RESULTS In total , 1327 women were enrolled . Before the intervention , 42 ( 3.2 % ) women had undergone cervical cancer screening ; afterwards , 897 ( 67.6 % ) women had received screening ( P<0.001 ) . Clinical breast examination was performed for 59 ( 4.4 % ) women before and 897 ( 67.6 % ) after the intervention ( P<0.001 ) . Only 2 ( 0.9 % ) of 214 children eligible for HPV vaccination had received the vaccine before versus 71 ( 33.2 % ) after the intervention ( P<0.001 ) . CONCLUSION The use of community health educators for house-to-house cervical and breast cancer prevention education was associated with significant increases in the uptake of cervical cancer screening , clinical breast examination , and HPV vaccination BACKGROUND Cervical cancer is one of the most common forms of carcinoma among women worldwide , accounting for about 12 % of all cancers . Tragically , studies have shown generally low awareness levels on its symptoms , risk factors and prevention . This study evaluated the effect of a health education program on knowledge of cervical cancer amongst women at risk in Africa . METHOD This study was conducted in the city of Lagos , Nigeria , using a multistage sampling technique . Two model markets were chosen by simple r and om sampling method from a total of 10 local governments with model markets . One was design ated the intervention/experimental group while the other was the control . Systematic sampling method was used in selecting 350 women comprising of 175 participants from each model market . A baseline survey on cervical cancer awareness and screening practice s was carried out in both sample groups with the aid of interviewer-administered , structured and pre-tested question naires . Thereafter , respondents in the intervention group received sessions of community-based educational messages on cervical cancer and its prevention . Subsequently , participants in both groups were reassessed to evaluate the effect of the educational program . Data analysis was conducted with Epi-info statistical software . RESULTS Knowledge level was low on cervical cancer at baseline ; only about 15 % and 6.9 % of participants in the intervention and control groups respectively had heard of cervical cancer . The most common sources of information were friends and media prior to the inter 
    Output:
    
While education is important , implementation science literature reveals that education is not as effective in generating change .