***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: OBJECTIVES The purpose of this study was to test the effects of an  education program in Tanzania  design ed to reduce children 's risk of human immunodeficiency virus ( HIV ) infection and to improve their tolerance of and care for people with acquired immunodeficiency syndrome ( AIDS ) . METHODS A r and omized controlled community trial including baseline and 12-month follow-up surveys was employed . Public primary schools in the Arusha and Kilimanjaro regions of Tanzania were stratified according to location and r and omly assigned to intervention ( n = 6 ) or comparison ( n = 12 ) conditions . Of the 1063 sixth- grade students ( average age : 13.6 years ) who participated at baseline , 814 participated in the follow-up survey . RESULTS At follow-up , statistically significant effects favoring the intervention group were observed for exposure to AIDS information and communication , AIDS knowledge , attitudes toward people with AIDS , and subjective norms and behavioral intentions toward having sexual intercourse . A consistent positive but nonsignificant trend was seen for attitudes toward having sexual intercourse and for initiation of sexual intercourse during the previous year ( 7 % vs 17 % ) . CONCLUSIONS It is feasible and effective to train local teachers and health workers to provide HIV/AIDS education to Tanzanian primary school children PURPOSE To evaluate an intervention ( based on one which had previously been successful in reducing adolescent human immunodeficiency virus ( HIV ) risk behaviors in the United States ) among adolescents residing in Namibia , a country located in sub-Saharan Africa . METHODS A r and omized trial of a 14-session face-to-face intervention emphasizing abstinence and safer sex was conducted among 515 youth ( median age 17 years ; median grade 11 ) attending 10 secondary schools located in two districts in Namibia .  Knowledge , attitudes , intentions , and HIV risk behaviors were assessed at baseline and in the immediate postintervention period . RESULTS Knowledge increased significantly among intervention compared to control youth ( 88 % vs. 82 % ; correct responses , p < .0001 ) . At postintervention follow-up , more intervention than control youth believed that they could be intimate without having sex , could have a girlfriend or boyfriend for a long time without having sex , could explain the process of impregnation , knew how to use a condom , and could ask for condoms in a clinic . Fewer intervention than control youth believed that if a girl refused to have sex with her boyfriend it was permissible for him to strike her , and that condoms took away a boy 's pleasure . More intervention than control youth anticipated using a condom when they did have sex , and fewer expected to drink alcohol . Finally , after intervention , there was a trend for increased condom use . There were significant gender-related differences at baseline , although intervention impact was generally equivalent . CONCLUSIONS These findings provide support for the judicious adaptation of successful Western HIV prevention programs in other cultural setting s. A single intervention approach appears to be effective in short-term follow-up with both genders This study investigated whether there were any changes in knowledge and normative beliefs regarding abstinence and condoms and personal risk perception of acquiring HIV among Zambian secondary -school students who were exposed to a peer sexual health intervention .  Schools were r and omly assigned to intervention and control groups . A baseline assessment that measured knowledge , normative beliefs about abstinence and condoms and personal risk perception was conducted in all schools . Students in the intervention group were exposed for a 1-hour- and -45-minute-long in-class peer sexual health intervention . Students in the control schools were exposed to a 1-hour-long in-class peer water purification intervention . A follow-up assessment of students was conducted after the intervention . Logistic regression analyses were conducted to determine whether significant differences between intervention and control groups emerged at follow-up . Relative to students in the control group , knowledge was higher and normative beliefs about abstinence and condoms were significantly more positive among students in the intervention schools . Students in the intervention schools also had a higher personal risk perception of acquiring HIV than students in control schools . These findings show that a school-based peer sexual health intervention implemented in Zambia was effective in increasing knowledge , positive normative beliefs about abstinence and condoms , and personal risk perception Objective : To evaluate an  HIV risk-reduction intervention among Namibian adolescents . Methods : A r and omized trial of a 14-session face-to-face intervention emphasizing abstinence and safer sexual practice s conducted among 515 youths ( median age 17 years and median grade 11 ) attending 10 secondary schools located in two districts in Namibia . Youths were r and omly assigned to the intervention or control condition at the level of the individual . HIV risk behaviours , intentions and perceptions were assessed at baseline , immediately post-intervention and at 6 and 12 months post-intervention . Results : Among all 515 youths who enrolled in the programme , rates of either abstinence or sex with a condom were not different between control and intervention youths at baseline or in the follow-up period . However , analyses conducted among the subset of youths who were sexually inexperienced at baseline ( n = 255 ) revealed that a higher percentage of intervention youths ( 17 % ) than control youths ( 9 % , P < 0.05 ) remained sexually inexperienced one year later . Moreover , in the immediate post-intervention period , among baseline virgins who subsequently initiated sex , intervention youths were more likely than control youths to use a condom ( 18 versus 10 % , P < 0.05 ) . Additional HIV-related risk behaviours ( failure to discuss previous HIV risk exposure with one 's sexual partner and alcohol use ) , intentions to use condoms , and perceptions of the ability to use condoms were positively affected by the intervention . Conclusions : There is evidence that the ‘ My Future is My Choice ’ ( MFMC ) intervention is reducing HIV risk behaviours among sexually inexperienced participants aged 15–18 . Related risk behaviours and perceptions are also positively impacted by the intervention PURPOSE To assess the impact of exposure to life skills education by youth in KwaZulu-Natal Province ( KZN , South Africa ) on knowledge and behaviors associated with the spread of HIV/AIDS . METHODS Data come from a panel study of 2222 youth from several population subgroups in KZN . The youth were aged 14 - 24 years when interviewed in 1999 and 2001 . The intervention was a full coverage life skills education program for all students in middle and secondary schools . Impact was measured as net dose-response relationships between life skills exposure and outcomes . Econometric methods were used to control for nonr and om exposure to life skills education . Outcomes included sexual behavior and condom use indicators . RESULTS Significant effects , albeit modest in magnitude , were observed on selected areas of sexual-reproductive health knowledge and perceived condom self-efficacy , along with larger effects on condom use at first and last sex . No consistent effects on age at sexual initiation , secondary abstinence , or partnering behaviors were observed among these youth . CONCLUSIONS School-based life skills education appears capable of communicating key information and helping youth develop skills relevant to reducing HIV risk . However , the South African national program has yet to be fully implemented , and whether this initiative will result in sustained behavior modification among youth on a sufficient scale to affect the HIV/AIDS epidemic is uncertain BACKGROUND Interventions to treat STDs have been reported to reduce HIV incidence . Interventions to improve treatment-seeking for STDs may impact on the duration and prevalence of STDs . Nigeria has high rates of STDs and an increasing incidence of HIV . OBJECTIVE To evaluate the impact of an intervention on STD treatment-seeking behavior and STD prevalence among Nigerian youth . METHODS A r and omized controlled trial in 12 schools in Edo State was conducted to evaluate an intervention to improve STD treatment-seeking and STD treatment provision . The intervention , based on formative research , consisted of community participation , peer education , public lectures , health clubs in the schools , and training of STD treatment providers , including those with no formal training . A question naire measured outcomes before and 10 months into the intervention . The effect of the intervention among four r and omly selected intervention schools compared to eight r and omly selected control schools was assessed using logistic regression with Huber 's formula to account for school clusters . RESULTS One thous and eight hundred and ninety-six and 1858 youths 14 - 20 years of age were enrolled in the pre- and post-intervention surveys . Youths in the intervention schools , compared to control schools , reported statistically significant improvements in knowledge of STDs , condom use , partner awareness that the youth had an STD , and STD treatment-seeking behavior . Treatment by private physicians increased ( OR=2.1 , 95 % CI=1.1 - 4.0 ) , and treatment by patent medicine dealers or pharmacists decreased ( OR=0.44 , 95 % CI=0.22 - 0.88 ) . The reported prevalence of STD symptoms in the past 6 months was significantly reduced in the intervention compared to control schools ( OR=0.68 , 95 % CI=0.48 - 0.95 ) . CONCLUSION Significant improvements in treatment-seeking for STD symptoms can be effected among Nigerian youths . The prevalence of reported STD symptoms can be decreased by improving treatment-seeking for and awareness of STDs PURPOSE To describe the implementation and evaluation of an  adolescent reproductive health peer education program  in West Africa . The program , known as the West African Youth Initiative ( WAYI ) , was developed to improve knowledge of sexuality and reproductive health , and promote safer sex behaviors and contraceptive use among sexually active adolescents in Nigeria and Ghana . METHODS Between November 1994 and April 1997 , two organizations , the Association for Reproductive and Family Health ( ARFH ) , based in Nigeria , and Advocates for Youth , based in Washington D.C. , supported community-based youth-serving organizations in the two countries to implement peer education projects . Consultants from the African Regional Health Education Centre ( ARHEC ) in Nigeria provided technical assistance in design ing and conducting a quasi-experimental process and outcome evaluation of the projects . RESULTS There were significant differences over time and between intervention and control groups concerning reproductive health knowledge , use of contraceptives in the previous 3 months , willingness to buy contraceptives , and self-efficacy in contraceptive use . CONCLUSIONS Overall , the project provides evidence that  peer education is most effective at improving knowledge and promoting attitudinal and behavior change among young people in school setting Unwanted teenage pregnancy and the attendant morbidity and mortality necessitate an underst and ing of the factors influencing adolescent sexuality and the implementation of programmes design ed to improve their knowledge and reproductive behaviour . A r and omized controlled study on reproductive health knowledge and behaviour was undertaken among adolescent pupils drawn from a multi-stage r and om cluster sample . A self-administered question naire was used to assess aspects of reproductive health knowledge and behaviour at baseline followed by a health education intervention , except for control schools . Results are based on 1689 responses made up of 1159 intervention and 530 control respondents . There was a significant increase in correct knowledge about aspects of menstruation in intervention as compared with control schools [ odds ratio ( OR ) = 4.5 , 95 % confidence interval ( CI ) = 3.4 - 6.1 ) . Significantly , ( OR = 2.0 , 95%CI = 1.1 - 3.9 ) more pupils from intervention than control schools scored correctly on practice relating to menstruation .  Pupils from intervention schools were more likely ( P < 0.001 ) to know that a boy experiencing wet dreams could make a girl pregnant and that a girl could get pregnant at her first sexual intercourse ( OR = 1.4 , 95%CI = 1.1 - 1.9 ) . Knowledge of family planning was low in both groups at baseline but was high at five months follow-up in the intervention schools . The findings point to the need for early school-based reproductive health education programmes , incorporating correct information on reproductive biology and the subsequent prevention of reproductive ill health BACKGROUND In the hierarchy of research design s , the results of r and omized , controlled trials are considered to be evidence of the highest grade , whereas observational studies are viewed as having less validity because they reportedly overestimate treatment effects . We used published meta-analyses to identify  r and omized clinical trials and observational studies that examined the same clinical topics . We then compared the results of the original reports according to the type of research design . METHODS A search of the Medline data base for articles published in five major medical journals from 1991 to 1995 identified meta-analyses of r and omized , controlled trials and meta-analyses  of either cohort or case-control studies that assessed the same intervention . For each of five topics , summary estimates and 95 percent confidence intervals were calculated on the basis of data from the individual r and omized , controlled trials and the individual observational studies . RESULTS For the five clinical topics and 99 reports evaluated , the average results of the observational studies were remarkably similar to those of the r and omized , controlled trials . For example , analysis of 13 r and omized , controlled trials of the effectiveness of bacille  Calmette-Guérin vaccine in preventing active tuberculosis yielded a relative risk of 0.49 ( 95 percent confidence interval , 0.34 to 0.70 ) among vaccinated patients , as compared with an odds ratio of 0.50 ( 95 percent confidence interval , 0.39 to 0.65 ) from 10 case-control studies . In addition , 
    Output:
    
Knowledge and attitude-related outcomes were the most associated with statistically significant change .
Behavioural intentions were more difficult to change and actual behaviour change was least likely to occur .
Behaviour change in favour of abstinence and condom use appeared to be greatly influenced by pre-intervention sexual history .