***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: BACKGROUND We sought to compare two methods of notifying sex partners of subjects infected with the human immunodeficiency virus ( HIV ) or persons who had shared needles with them ( needle-sharing partners )  : " patient referral , " in which the responsibility for notifying partners was left to the patient , and " provider referral , " in which providers attempted to notify partners . METHODS Names of sex partners and needle-sharing partners and information on how to locate them were obtained from consenting HIV-infected subjects identified in the HIV-testing programs at three public health departments in North Carolina . The subjects were r and omly assigned to a patient-referral group ( in which patients had the initial responsibility for notifying their partners ) or a provider-referral group ( in which the study counselor notified the partners ) . The success of attempts to notify partners was monitored by means of interviews with counselors conducted both in the field and at the health department . RESULTS Of 534 HIV-positive persons identified at the health departments , 247 ( 46 percent ) did not return for counseling after the test , 8 were counseled outside the study , and 117 ( 22 percent ) were ineligible . Of the 162 invited to participate , 88 ( 54 percent ) declined and 74 ( 46 percent ) agreed . The subjects were mostly male ( 69 percent ) , black ( 87 percent ) , homosexual or bisexual ( 76 percent of the men ) , and had a median age of 30 years . Thirty-nine were assigned to the provider-referral group and 35 to the patient-referral group . In the provider-referral group 78 of 157 partners ( 50 percent ) were successfully notified , whereas in the patient-referral group only 10 of 153 ( 7 percent ) were notified . Of the partners notified by the counselors , 94 percent were not aware that they had been exposed to HIV . Overall , 23 percent of the partners notified and tested were HIV-positive . CONCLUSIONS In this trial , leaving the notification of partners up to the subjects ( patient referral ) was quite ineffective , despite the North Carolina law requiring that partners be notified . Partner notification by public health counselors ( provider referral ) was significantly more effective . Although the effectiveness of notification procedures is constrained by the accuracy of the information provided by HIV-infected patients , counselors who notify the partners of an infected patient can refer them to educational , medical , and support services targeted to persons at high risk for HIV infection and may encourage the adoption of less risky behavior OBJECTIVE This analysis describes the Outreach-Assisted Model of Partner Notification , an innovative strategy for encouraging seropositive injecting drug users ( IDUs ) to inform their partners of shared human immunodeficiency virus ( HIV ) exposure . The analysis focuses on two core components of the notification process : the identification of at-risk partners and preferences for self-tell vs. outreach assistance in informing partners of possible exposure to the virus . METHODS Using community outreach techniques , 386 IDUs were recruited for HIV pretest counseling , testing , and partner notification over a 12-month period . Of these , 63 tested HIV seropositive , and all but three returned for their test results . The 60 who were informed of their serostatus were r and omly assigned to either a minimal or an enhanced intervention condition . Participants assigned to the minimal ( self-tell ) group were strongly encouraged to inform their partners of possible exposure . Those assigned to the enhanced ( outreach-assisted ) group had the option of either informing one or more of their partner(s ) themselves or choosing to have the project 's outreach team do so . RESULTS Together , the 60 index persons who received their results provided names or at least one piece of locating information for a total of 142 partners with whom they perceived having shared possible exposure to the virus within the past five years . By itself , drug use accounted for half of all partners named . Sexual behavior alone accounted for 25 % of named partners . Eighty-two percent of the enhanced group preferred to have the outreach team tell at least one partner ; the team was requested to notify 71 % of the total number of partners whom this group named . CONCLUSIONS Findings suggest that IDUs want to notify their partners of shared HIV exposure . Outreach assistance was the preferred mode in the majority of cases . Exp and ing traditional community-based HIV outreach activities to include delivering street-based counseling , test , a partner notification appears to be a positive and workable prevention strategy Unlike contact-tracing procedures for syphilis and gonorrhea , field follow-up to locate and treat patients with Chlamydia trachomatis infections has not been extensively applied in the United States . We implemented two studies to assess the efficiency and cost-effectiveness of using field follow-up for contact of two groups : patients with chlamydial infection detected as part of a screening program and women who were sexual partners of men with nongonococcal urethritis ( NGU ) . Of the 142 patients with chlamydial infection who had not been treated empirically , 112 ( 79 % ) returned for treatment when a reminder system was used , as compared with a return rate of 97 % ( 259/266 ) achieved by field follow-up ( P less than 0.0001 ) . Among the 678 men with NGU enrolled in a r and omized trial of  field follow-up vs. two self-referral methods  , field follow-up yielded over three times as many partners returning to the clinic for treatment as did either of the other two methods ( P less than 0.001 ) . Analyses using the estimated costs of the intervention strategies and the medical costs associated with an untreated chlamydial infection showed that field follow-up by trained investigators proved to be not only the most efficient method for locating patients with chlamydial infection and /or patients who were at risk for it , but also the most cost-effective in terms of total health-care dollars spent Urogenital infections with Chlamydia trachomatis are widespread and usually asymptomatic . Major complications from infection include ectopic pregnancies and female infertility.1 Although contact tracing reduces the prevalence of chlamydia infection,2 the test rate among partners is often low , partly because male contacts have to have a urethral swab taken by a doctor . As the polymerase chain reaction can successfully detect infection in urine sample s,3 we investigated whether the test rate could be increased by asking the male contacts of infected women to send a urine sample directly from home to a laboratory instead of having a doctor take a urethral swab .  Ninety six women with C trachomati s infection seen in general practice s in Aarhus County , Denmark , were r and omly divided according to their date of birth into an intervention group ( 45 patients ) and a Objective : To determine the cost and effectiveness of three approaches to partner notification for infectious syphilis . Study Design : People with syphilis were r and omly assigned to : ( 1 ) notification of partners by patients themselves within 2 days or disease intervention specialists would notify them ; ( 2 ) immediate notification by intervention specialist ; or ( 3 ) immediate notification by intervention specialists , who had the option of drawing blood in the field .  Costs of intervention specialists ' time , travel , and overhead were measured . Intention‐to‐treat analysis measured outcomes per r and omized index patient . Results : From December , 1990 through March , 1993 , 1,966 index patients with syphilis ( primary 9 % ; secondary 18 % ; and early latent 73 % ) were r and omized in Broward County ( Ft . Lauderdale ) , Florida ( 1,191 ) ; Tampa , Florida ( 569 ) ; and Paterson , New Jersey ( 206 ) . Index patients reported 11,272 potentially exposed partners and sufficient information to initiate investigations for 2,761 . Of these , 2,236 were located , 367 had newly identified infections , and 870 others received preventive treatment . The three partner notification approaches had similar success locating partners ( 1.1–1.2 per index patient ) and treating partners ( 0.61–0.67 per index ) . The cost was $ 317 to $ 362 per partner treated ; the optimal strategy differed by study site . Conclusions : Partner notification identified many infected and potentially infected people . The cost and effectiveness of the three types of provider notification were similar . Alternative approaches are needed to reach infected partners who could not be notified Background Patient-based partner referral ( PBPR ) , which is the main method for treating sexual partners of patients with sexually transmitted diseases ( STDs ) , has limited effectiveness . Goal The authors compared the efficacy of PBPR with patient-delivered partner medication ( PDPM ) among patients attending the Mulago STD clinic in Kampala , Ug and a. Study Design A total of 383 patients ( 187 women , 196 men ) with STDs were r and omized to the PBPR or PDPM group . The proportion of sexual partners treated in either group was compared using the chi-square statistic by intention to treat for partners whose follow-up status was unknown . Results The two groups had similar background characteristics . Of the 237 partners elicited , 176 ( 74 % ) were reported treated in the PDPM group . In the PBPR group , in which 234 partners were elicited , 79 ( 34 % ) were referred to the treatment clinic . This difference was statistically significant ( risk ratio [ RR ] , 2.44 ; 95 % CI , 1.95–3.07;P < 0.001 ) . Furthermore , PDPM was more effective than PBPR for women and for casual partners for whom PBPR is considered difficult . For women , 86 of 103 partners in the PDPM group were reported treated , compared with 23 of 104 partners in the PBPR group ( RR , 4.55 ; 95 % CI , 2.92–7.08;P < 0.001 ) . For casual partners , 18 of 51 ( 34 % ) were reported treated in the PDPM group , compared with only three of 45 partners ( 7 % ) who were referred in the PBPR group ( RR , 1.43 ; 95 % CI , 1.40–2.65;P < 0.01 ) . Conclusion Patient-delivered partner medication is more effective than patient-based partner referral in the treatment of sexual partners Background : Sexually transmitted diseases ( STD ) are a major health problem in Zambia . Partner notification , which is a recommended strategy to decrease STD , must be improved . Goal : To assess whether individual counseling of patients with STD , combined with contact slip(s ) , had any impact on the proportion of sex partners traced in an urban setting in Zambia . Study Design : A r and omized trial comprised of 94 women and 302 men with STD . Results : Women and men in the intervention group informed more partners than did those in the control group . In the intervention group , 1.8 partners per man was treated compared to 1.2 in the control group ( P < 0.001 ) . There was no difference between the two groups of women . There was a gradual decline from numbers of partners informed to numbers of partners treated according to the patient to number of contact slips filed . Conclusions : Individual counseling of men with STD improved partner notification Introduction Gonorrhea has emerged recently as an epidemic disease of major proportions in the United States , with more than one million cases reported to state and local health departments in 1975.1 True incidence is unknown , but significant under-reporting is likely . A control program facing over a million cases per year must choose the general focus and specific techniques that best utilize its limited re sources . Except in some special geographic areas , interviewing and contact investigation of a significant proportion of the infected population appears to be an insurmountable task . Our purpose was to examine the efficacy of an alternative to the  st and ard case interview and investigation . Although we recognized from the outset that a short-term evaluation could not provide data on disease control , we were able to evaluate the ability of the alternative to detect new cases , and on that basis we developed a sense of its comparative effectiveness and cost The impact of a ten-minute , soap opera-style videotape on knowledge and treatment behavior of black men with gonorrhea was tested in r and omized clinical trials . The videotape , shown to individual patients after diagnosis , produced a sizeable increase in the percentage of  patients who returned for their test-of-cure examination : while only 43.3 % of control group patients returned , 53.5 % of those in the videotape group did so ; chi 2(1 ) = 9.0 ; P less than 0.003 . In a follow-up study , similar results were found : videotape group ( 59.0 % ) , control group ( 39.1 % ) ; chi 2(1 ) = 6.2 ; P less than 0.015 . The videotape also produced large , significant increases in patient knowledge , as measured by a test administered during patients ' clinic visit ( P less than 0.0001 ) . No measureable effect of the videotape was detected on patients ' willingness to refer sexual contacts for treatment . The findings suggest that clinic-based educational material s , particularly soap opera-style videotapes that engender audience identification , create emotional significance for the viewer , and model requisite communication skills , may have a significant role to play in control of sexually transmitted diseases 
    Output:
    
The review found moderately strong evidence that : 1 .
provider referral alone , or the choice between patient and provider referral , when compared with patient referral among patients with HIV or any STD , increases the rate of partners presenting for medical evaluation ; 2 .
contract referral , when compared with patient referral among patients with gonorrhoea , results in more partners presenting for medical evaluation ; 3 .
verbal , nurse-given health education together with patient-centred counselling by lay workers , when compared with st and ard care among patients with any STD , results in small increases in the rate of partners treated .