***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: Introduction Globally , HIV-related stigma is prevalent in healthcare setting s and is a major barrier to HIV prevention and treatment adherence . Some intervention studies have showed encouraging outcomes , but a gap continues to exist between what is known and what is actually delivered in medical setting s to reduce HIV-related stigma . Methods This article describes the process of implementing a  stigma reduction intervention trial that involved 1760 service providers in 40 hospitals in China . Guided by Diffusion of Innovation theory , the intervention identified and trained about 15–20 % providers as popular opinion leaders ( POLs ) to disseminate stigma reduction  messages in each intervention hospital . The intervention also engaged governmental support in the provision of universal pre caution supplies to all participating hospitals in the trial . The frequency of message diffusion and reception , perceived improvement in universal pre caution practice s and reduction in the level of stigma in hospitals were measured at 6- and 12-month follow-up assessment s. Results Within the intervention hospitals , POL providers reported more frequent discussion s with their co-workers regarding universal pre caution principles , equal treatment of patients , provider-patient relationships and reducing HIV-related stigma . Service providers in the intervention hospitals reported more desirable intervention outcomes than providers in the control hospitals . Our evaluation revealed that the POL model is compatible with the target population , and that the unique intervention entry point of enhancing universal pre caution and occupational safety was the key to improved acceptance by service providers . The involvement of health authorities in supporting occupational safety was an important element for sustainability . Conclusions This report focuses on explaining the elements of our intervention rather than its outcomes . Lessons learned from the intervention implementation will enrich the development of future programs that integrate this or other intervention models into routine medical practice , with the aim of reducing HIV-related stigma and improving HIV testing , treatment and care in medical setting People living with HIV ( PLWH ) experience greater psychological distress than the general population . Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms , quality of life , and HIV care engagement . However , little is known about the effectiveness of mental health interventions for PLWH in low- and middle-income countries ( LMICs ) , where the large majority of PLWH reside . This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these setting s. A systematic search strategy was undertaken to identify peer- review ed published papers of intervention trials addressing negative psychological states or disorders ( e.g. depression , anxiety ) among PLWH in LMIC setting s. Search results were assessed against pre-established inclusion and exclusion criteria . Data from papers meeting criteria were extracted for synthesis . Twenty-six papers , published between 2000 and 2014 , describing 22 unique interventions were identified . Trials were implemented in sub-Saharan Africa ( n = 13 ) , Asia ( n = 7 ) , and the Middle East ( n = 2 ) , and addressed mental health using a variety of approaches , including cognitive-behavioral ( n = 18 ) , family-level ( n = 2 ) , and pharmacological ( n = 2 ) treatments . Four r and omized controlled trials reported significant intervention effects in mental health outcomes , and 11 preliminary studies demonstrated promising findings . Among the limited mental health intervention trials with PLWH in LMICs , few demonstrated efficacy .  Mental health interventions for PLWH in LMICs must be further developed and adapted for re source -limited setting s to improve effectiveness This study assessed the effect of a brief intervention aim ed at reducing  HIV-related stigma among service providers in China . From December 2005 to June 2006 , 138 service providers from four county hospitals in the Yunnan province of China were r and omly assigned into either an intervention or a control condition .  HIV stigma reduction concepts were conveyed through participatory small group activities , including role-plays , games , group discussion s , and testimony by an HIV advocate . Participants were assessed at baseline before the intervention , and at 3- and 6-month follow-ups . Data were analyzed using a logistic regression mixed-effects model . Service providers in the brief intervention condition were significantly more likely to report better protection of patients ' confidentiality and right to HIV testing , lower levels of negative feelings toward people living with HIV/AIDS , and more accurate underst and ing and practice of universal pre caution s. This brief intervention pilot showed potential in reducing HIV stigma and discrimination among service providers in China . Further intervention trials are needed to test the efficacy and long-term outcomes of this intervention HIV infection is increasingly prevalent in adolescents , and primary prevention programmes have been most effective when based on existing theories , including social cognitive theory ( SCT ) . Nurses play an important role in assessing adolescents ' risk for HIV infection and in recommending preventive behaviour change , if their comfort with these activities is increased . Practising nurses ( n = 88 , mean age = 40.8 ) from a university medical centre and surrounding hospitals participated in either a didactic or SCT-based workshop and a vignette-based assessment . Utilizing a r and omized controlled design , this study compared the effectiveness of the two types of workshops by measuring HIV-related knowledge and attitudes , as well as comfort with and intent to perform HIV-related risk assessment s. Differences in comfort and intent based on target patients ' cultural descriptors were also evaluated . The SCT-based workshops yielded more positive results for all four outcome variables at the 8-week follow-up ( F2,71 = 4.27 , P < 0.02 ) . Cultural stereotyping also appeared to play a role in nurses ' intent to perform assessment s ( F2,74 = 11.81 , P < 0.001 ) . Suggestions for improving the workshops and incorporating other theory-based approaches are discussed BACKGROUND The st and ardized patient approach has proved to be an effective training tool for medical educators . This article explains the process of employing  st and ardized patients  in an  HIV stigma reduction intervention in healthcare setting s in China . METHODS The study was conducted in 40 hospitals in two provinces of China . One year after the stigma reduction intervention , st and ardized patients made unannounced visits to participating hospitals , r and omly approached service providers on duty and presented symptoms related to HIV and disclosed HIV-positive test results . After each visit , the st and ardized patients evaluated their providers ' attitudes and behaviours using a structured checklist . St and ardized patients also took open-ended observation notes about their experience and the evaluation process . RESULTS Seven st and ardized patients conducted a total of 217 assessment s ( 108 from 20 hospitals in the intervention condition ; 109 from 20 hospitals in the control condition ) . Based on a comparative analysis , the intervention hospitals received a better rating than the control hospitals in terms of general impression and universal pre caution compliance as well as a lower score on stigmatizing attitudes and behaviours toward the st and ardized patients . CONCLUSION St and ardized patients are a useful supplement to traditional self-report assessment s , particularly for measuring intervention outcomes that are sensitive or prone to social desirability The aim of the study was to improve health workers ' skills and confidence in dealing with patients with HIV disease and increase attention to patients ' human rights . A longitudinal controlled trial was carried out in which one Nigerian state served as the intervention site and the adjacent state served as the control site for an intervention and dissemination of training in clinical management , health education , and attitudinal change toward patients with HIV disease . The intervention group n=1072 , control group n=480 . Following initial question naire-defining focus groups , nurses , laboratory technologists and physicians in all base hospitals in the intervention state were trained by influential role models who attended the initial training . Data were collected in all sites pre-training and 1 y later . Hierarchical multiple regression analysis controlling for baseline data , and orthogonal factor analysis to define scales were used . Data showed significant positive changes after 1 y in the intervention group on perception of population risk assessment , attitudes and beliefs about people with HIV disease , less fear and more sympathy for and responsibility toward HIV patients , and an increase in self-perceived clinical skills . There was increased willingness to treat and teach colleagues about people with HIV . Clinician fear and discrimination were significantly reduced , and the climate of fear that was associated with HIV was replaced with a professional concern . There was increased underst and ing of appropriate psychosocial , clinical and human rights issues associated with HIV treatment and prevention . This intervention , targeting health workers in an entire state and using HIV/AIDS information , role modeling , diffusion of training and discussion s of discrimination and human rights , significantly affected the perception of risk groups and behaviors , perceived skills in treatment and counseling , reduced fears and increased concern for people with HIV disease , and improved the climate of treatment and prevention of HIV disease compared with a control state & NA ; We tested the impacts of a professionally assisted peer‐group intervention on Chilean health workers ' HIV‐related knowledge , attitudes , and behaviors using a quasi‐experimental design with a pretest and 3‐month posttest . Two Santiago suburbs were r and omly assigned to the intervention or delayed intervention control condition . Five community clinics per suburb participated . Interested workers at the intervention ( n = 262 ) and control ( n = 293 ) clinics participated and completed both evaluations . At posttest , intervention clinic workers had higher knowledge and more positive attitudes regarding HIV , condoms , stigmatization , and self‐efficacy for prevention . They reported more partner discussion about safer sex , less unprotected sex , and more involvement in HIV prevention activities in the clinic and the community , but they did not report fewer sexual partners or more st and ard pre caution s behaviors . Because of these positive impacts , the program will become a regular continuing education unit that can be used to meet health‐worker licensing requirements Objective To evaluate an AIDS education intervention for health workers in Metro Manila hospitals . Methods A r and omized controlled education program consisting of lectures , role-plays , posters and pamphlets was delivered to physicians , nurses , laboratory technologists and orderlies in Manila hospitals .  Knowledge , attitudes and infection control practice s were measured before , immediately after , and 2 months after the intervention . Results Baseline survey among 641 hospital workers revealed poor knowledge , negative attitudes towards AIDS patients , and inappropriate infection control practice s. Immediately after the intervention , there was significant improvement in ( 1 ) knowledge scores ( 8.7–11.2 in the intervention group versus 8.5–9.5 in the control group ; range , 0–14 ) , ( 2 ) attitude scores ( 54.4–60.6 versus 54.6–56.8 ; range , 22–88 ) , and ( 3 ) needle-recapping practice s ( 14–43 % versus 39–43 % ) ( all P values < 0.001 ) . After 2 months , attitude scores in the experimental group fell to the same level as those of the control group , while improvements in knowledge and needle recapping were largely maintained . Role-playing was considered by the participants to be the most effective component of the intervention . Conclusions These results suggest that AIDS training for hospital workers in the Philippines and in similar countries is necessary and can be effective . Ideally , such training should include role-playing and should be ongoing in order to sustain the effect OBJECTIVES The objective of the intervention was to reduce service providers ' stigmatizing attitudes and behaviors toward people living with HIV .  METHODS The r and omized controlled trial was conducted in 40 county-level hospitals in 2 provinces of China between October 2008 and February 2010 . Forty-four service providers were r and omly selected from each hospital , yielding a total of 1760 study participants . We r and omized the hospitals to either an intervention condition or a control condition . In the intervention hospitals , about 15 % of the popular opinion leaders were identified and trained to disseminate stigma reduction messages . RESULTS We observed significant improvements for the intervention group in reducing prejudicial attitudes ( P < .001 ) , reducing avoidance intent towards people living with HIV ( P < .001 ) , and increasing institutional support in the hospitals ( P = .003 ) at 6 months after controlling for service providers ' background factors and clinic-level characteristics . The intervention effects were sustained and strengthened at 12 months . CONCLUSIONS The intervention reduced stigmatizing attitudes and behaviors among service providers . It has the potential to be integrated into the health care systems in China and other countries In response to a Department of Health , Engl and , circular encouraging policies of named voluntary antenatal HIV antibody testing , one West Midl and s health authority in Engl and introduced a policy of raising the issue proactively at the first antenatal attendance . In order to facilitate this policy a short staff education programme was provided for midwives . This paper reports on part of a study which aim ed to evaluate the impact of the HIV awareness training programme .  A sample of midwives ( n = 65 ) was r and omly selected for inclusion in the study . Thirty-three had attended training and 32 had not . Data were collected using a self-administered question naire exploring knowledge of aetiology of HIV/AIDS , knowledge of transmission , knowledge of obstetric and paediatric HIV , attitudes to HIV , issues related to antenatal HIV antibody testing and opinions about the HIV awareness training programme .  Results indicated no significant difference in levels of knowledge or in attitude between those who had attended the training programme and those who had not . Similarly , no significant difference was found in terms of how midwives would react to women requesting HIV antibody testing . Many of the results contradict the current literature and as a conclusion it is suggested that there is a need to review HIV-related training for midwives This study compared the effectiveness of an AIDS knowledge-only program 
    Output:
    
Conclusions Evidence of moderate quality indicates that training popular opinion leaders is effective in reducing avoidance intent and prejudicial attitude and improving compliance to universal pre caution .
Very low quality evidence indicates that professionally-assisted peer group interventions , modular interactive training , participatory self-guided assessment and intervention , contact strategy combined with information giving and empowerment are effective in reducing HIV-related stigma .