***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 
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    ***EXAMPLES*** 
    Input: Objective This study evaluates the feasibility and performance of careHPV , a novel human papillomavirus ( HPV ) DNA test , when used for screening women for cervical cancer in low-re source setting s. Methods and Material s Clinician-collected ( cervical ) and self-collected ( vaginal ) careHPV specimens , visual inspection with acetic acid ( VIA ) , and Papanicolaou test were evaluated among 16,951 eligible women in India , Nicaragua , and Ug and a. Women with positive screening results received colposcopy and histologic follow-up as indicated . The positivity of each screening method was calculated overall , by site , and age . In addition , the clinical performance of each screening test was determined for detection of cervical intraepithelial neoplasia ( CIN ) grade 2 ( CIN2 + ) and CIN grade 3 . Results Moderate or severe dysplasia or cancer ( taken together as CIN2 + ) was diagnosed in 286 women . The positivity rate ranged between 2.4 % to 19.6 % for vaginal careHPV , 2.9 % to 20.2 % for cervical careHPV , 5.5 % to 34.4 % for VIA , and 2.8 % to 51.8 % for Papanicolaou test . Cervical careHPV was the most sensitive for CIN2 + ( 81.5 % ; 95 % confidence interval [ CI ] , 76.5–85.8 ) and CIN grade 3 ( 85.3 % ; 95 % CI , 78.6–90.6 ) at all sites , followed by vaginal careHPV ( 69.6 % and 71.3 % , respectively ) . The sensitivity of VIA ranged from 21.9 % to 73.6 % and Papanicolaou test from 40.7 % to 73.7 % . The pooled specificities of cervical careHPV , vaginal careHPV , VIA , and Papanicolaou test were 91.6 % , 90.6 % , 84.2 % , and 87.7 % , respectively . Conclusions careHPV performed well in large multicountry demonstration studies conducted in re source -limited setting s that have not previously been conducted this type of testing ; its sensitivity using cervical sample s or vaginal self-collected sample s was better than VIA or Papanicolaou test . The feasibility of using careHPV in self-collected vaginal sample s opens the possibility of increasing coverage and early detection in re source -constrained areas Objective To investigate the value of acetic acid visualization of the cervix as an alternative to cytologic screening . Methods A prospect i ve study was conducted in a squatter area in Cape Town , South Africa , on 2426 women who underwent speculum examination , naked-eye inspection of the cervix after application of acetic acid , and cytologic smear .  The smears were stained and processed at the screening site . Patients with a positive reading after acetic acid or a smear indicating a high- grade squamous intraepithelial lesion ( SIL ) were referred for immediate colposcopy , biopsy , and when indicated , treatment by large loop excision of the transformation zone . Therefore , histology was obtained on all patients with a positive acetic acid test or a positive cytology . Results Seventy-six women with positive reactions to acetic acid . Among the 2350 women with negative reactions , 254 had positive  cervical smears ; only 11 of these had histologic high- grade SIL . In contrast , 20 of the 61 women with positive cytology and positive acetic acid test had high- grade SIL on histology . Therefore , the acetic acid reaction enabled the observer to detect 20 of the 31 women ( 64 % ) who exhibited a high- grade SIL both on cytology and histology . Conclusion In locations where access to cytopathology is limited , naked-eye visualization of the cervix after application of diluted acetic acid warrants consideration as an alternative in the detection of cervical premalignant lesions BACKGROUND In many low-re source setting s , there are barriers to cytologic screening for cervical cancer . This study evaluates human papillomavirus ( HPV ) DNA testing as an alternative screening method . METHODS Cervical sample s from 2944 previously unscreened South African women aged 35 - 65 years were tested for high-risk types of HPV with the use of the Hybrid Capture I ( HCI ) assay .  Women also had a Pap smear , direct visual inspection of the cervix , and Cervicography(TM ) . Women positive on any screening test were referred for colposcopy .  Sample s from women with biopsy-confirmed , low- grade squamous intraepithelial lesions ( SILs ) ( n = 95 ) , high- grade SILs ( n = 74 ) , or invasive cervical cancer ( n = 12 ) and a r and om sample of women with no cervical disease ( n = 243 ) were retested for HPV DNA with the use of the more sensitive Hybrid Capture II ( HCII ) assay . All P values are two-sided . RESULTS High-risk HPV DNA was detected in 73.3 % and 88.4 % of 86 women with high- grade SIL or invasive cancer and in 12.2 % of 2680 and 18.1 % of 243 women without evidence of cervical disease , with the use of the HCI and HCII assays , respectively . HPV DNA testing with the  HCII assay  was more sensitive than cytology for detecting high- grade SIL and invasive cancer ( McNemar 's test , P = .04 ) , and testing with the HCI assay was of equivalent sensitivity ( P = .61 ) . Cytology had a statistically significantly better specificity ( 96.8 % ) than either the HCI assay ( 87.8 % ) or the HCII assay ( 81.9 % ) ( P<.01 ) . Receiver operating characteristic curves identified test cutoff values that allow HPV DNA testing to identify 57 % of women with high- grade SIL or cancer , while classifying less than 5 % of women with no cervical disease as HPV DNA positive . CONCLUSIONS HPV DNA testing has a sensitivity equivalent to , or better than , that of cytology . Since HPV DNA testing programs may be easier to implement than cytologic screening , HPV testing should be considered for primary cervical cancer screening in low-re source setting Objective To describe how demographic characteristics and knowledge of cervical cancer influence screening acceptance among women living in Dar es Salaam , Tanzania . Methods Multistage cluster sampling was carried out in 45 r and omly selected streets in Dar es Salaam . Women between the ages of 25–59 who lived in the sample d streets were invited to a cervical cancer screening ; 804 women accepted and 313 rejected the invitation . Information on demographic characteristics and knowledge of cervical cancer were obtained through structured question naire interviews . Results Women aged 35–44 and women aged 45–59 had increased ORs of 3.52 and 7.09 , respectively , for accepting screening . Increased accepting rates were also found among single women ( OR 2.43 ) and among women who had attended primary or secondary school ( ORs of 1.81 and 1.94 ) . Women who had 0–2 children were also more prone to accept screening in comparison with women who had five or more children ( OR 3.21 ) . Finally , knowledge of cervical cancer and awareness of the existing screening program were also associated with increased acceptance rates ( ORs of 5.90 and 4.20 ) . Conclusion There are identifiable subgroups where cervical cancer screening can be increased in Dar es Salaam . Special attention should be paid to women of low education and women of high parity . In addition , knowledge and awareness raising campaigns that goes h and in h and with culturally acceptable screening services will likely lead to an increased uptake of cervical cancer screening As acetic acid-aided visual inspection ( VIA ) and colposcopic-directed biopsy miss small > /=cervical intraepithelial neoplasia ( CIN ) 2 , inflation of sensitivity of VIA may occur when colposcopic-directed biopsy is the gold st and ard for > /=CIN 2 . To determine whether such inflation occurs , we review ed 375 women with > /=CIN 2 from the Shanxi Province Cervical Cancer Screening Study II . These women had positive self or physician-collected tests for high-risk human papillomavirus or abnormal cervical cytology and had VIA followed by colposcopy with directed biopsy and endocervical curettage ( ECC ) .  If a cervical quadrant had no lesion , a r and om biopsy at the squamocolumnar junction within that quadrant was obtained . Sensitivity of colposcopic-directed biopsy  was higher for > /=CIN 2 involving 3 - 4 cervical quadrants ( 81.3 % ) than for > /=CIN 2 involving 0 - 2 quadrants ( 49.0 % , p < 0.001 ) . Sensitivities of VIA , cytology of > /=ASC-US , > /=LSIL , and > /=HSIL were higher for > /=CIN 2 involving 3 - 4 quadrants than for > /=CIN 2 involving 0 - 2 quadrants . When a colposcopic-directed biopsy gold st and ard was compared with that of a 5-biopsy st and ard ( which included > /=CIN 2 from colposcopic-directed biopsy , r and om biopsy , or ECC ) , the sensitivity for > /=CIN 2 of VIA was inflated by 20.0 % ( 65.9 % vs. 45.9 % , p < 0.001 ) . Sensitivities of other screening tests were not affected . Similar inflation of sensitivity of VIA was found with an endpoint of > /=CIN 3 ( 70.4 % vs. 52.0 % , p = 0.0013 ) . Inflation of sensitivity of VIA depended upon agreement between colposcopic-directed biopsy and the screening tests as measured by kappa . Studies of VIA that used colposcopic-directed biopsy as the gold st and ard require reevaluation Cervix cancer remains a public health problem in developing countries . These results are an assessment for multicentric study based on visual inspection of the cervix after application of acetiq acid ( VIA ) and lugol 's iodine ( VILI ) . The aim of this study is to determine the feasibility and the impact of this screening in the community health centres " CSCOM " in the district of Bamako . It was a prospect i ve and multicentric study through 8 CSCOM , 3 Reference Centres " CSRéf " , Hôpital Gabriel Touré ( HGT ) and National Institute of Public Health ( INRSP ) in Bamako . During 28 months , 5016 women aged through 25 - 49 years were screened . After their consent and question naire filling , the patient is comfortably settled for visual test . The repartition of screened patients by health level is : CSCOM ( 19.24 % : 965/5016 ) , CSRéf ( 48.64 % : 2440/5016 ) , HGT ( 32.12 % : 1611/5016 ) . In general , the positivity of tests was : 5.2 % ( VIA ) and 6.8 % ( VILI ) . The positive women at the CSCOM level were oriented to the CSRéf or the HGT for the colposcopy , possible biopsy or care . At all 177 biopsies were done , and histological diagnosis were : 67 dysplasias , 3 early invasive carcinomas , 69 invasive carcinomas and 38 inflammatory metaplasic lesions or nonconclusives aspects . Patients with dysplasias or cancers were treated by cryotherapy , loop electrosurgical excision procedure ( LEEP ) , cold-knife conization or surgery . This study showed that screening of cervical cancer by visual inspection is workable at CSCOM level . We wish a large diffusion of the method to the whole of the country 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 
    Output:
    
Accuracy of VIA and VILI increased with sample size and time period .
Conclusions For primary screening of cervical cancer in sub-Saharan Africa , VILI is a simple and affordable alternative to cytology that demonstrates higher sensitivity than VIA .