Cervical cancer is a common and deadly disease, especially in developing countries. We developed and implemented an interactive, tablet-based educational intervention to improve cervical cancer knowledge among women in rural Malawi. Chichewa-speaking adult women in six rural villages participated. Each woman took a pre-test, participated in the lesson, and then took a post-test. The lesson included information on cervical cancer symptoms, causes, risk factors, prevention, and treatment. Over the 6-month study period, 243 women participated. Women ranged in age from 18 to 77 years. Only 15% had education beyond primary school. Nearly half of participants (48%) had heard of cervical cancer prior to viewing the lesson. For these women, the median number of correct responses on the pre-test was 11 out of 20; after the lesson, they had a median of 18 correct responses (p<0.001). After the intervention, 93% of women indicated a desire for cervical cancer screening. Despite lack of familiarity with computers (96%), most women (94%) found the tablet easy to use. A tablet-based educational program was an effective, feasible and acceptable strategy to disseminate cervical cancer information to women with low education in rural Malawi. This method may be appropriate to distribute health information about other health topics in low-resource settings.

No abstract

unknown-status partners in the prior 12 months. We defined three mutually-exclusive behavioural categories: serosorting (condomless anal intercourse [CAI] only with HIV-concordant partners); non-concordant CAI (any CAI with HIV-discordant/ unknown-status partners; [NCCAI]); and no CAI (consistent condom use or no AI). We estimated adjusted relative risks (aRR) between sexual behaviour and HIV/STI, and calculated the population attributable risk (PAR%) as the proportion of HIV/STI cases attributable to serosorting (assuming serosorters would have otherwise consistently used condoms) and the population prevented fraction (PF) as the proportion of hypothetical HIV/STI cases averted by serosorting (assuming serosorters would have otherwise had NCCAI). Results Behavioural data were complete for 49,912 visits; 91% (n = 45,220) were among self-reported HIV-negative MSM. Overall, serosorting was reported by 35% and 38% of HIV-negative and positive MSM, respectively. Compared to men reporting no CAI, HIV-negative serosorters had a significantly higher risk of HIV (aRR = 2.0), syphilis (aRR = 2.0), urethral gonorrhoea/chlamydia (GC/CT) (aRR = 1.5) and rectal GC/CT (aRR = 1.7). The proportion of HIV/STI cases attributable to serosorting (PAR%) were: HIV (15.3%); syphilis (16.9%); urethral GC/CT (11.9%); rectal GC/CT (19.3%). Serosorters had a significantly lower risk of HIV (aRR = 0.53) and syphilis (aRR = 0.76) compared to men reporting NCCAI; the proportion of HIV and syphilis cases averted by serosorting (PF) were 14.6% and 8.3%, respectively. Among HIV-positive MSM, syphilis risk was significantly higher for serosorters compared to consistent condom users (aRR = 1.4; PAR% = 12.1%). Conclusion These data suggest that serosorting is responsible for, but also prevents, 15% of HIV cases among MSM (PAR% = 15.3% and PF = 14.6%), depending on the behaviour it replaces. Disclosure of interest statement No pharmaceutical grants were received in the development of this study.

intervention was gradually implemented over time through increasing awareness and engagement with education and exposure to the project. Logistical issues, such as remembering to offer a test, were overcome with practical facilitators like computer alerts. However, integration was limited as not all GPs utilised the intervention components or other clinic staff to increase testing because of restrictions in clinic structure. Conclusion GPs reported that the ACCEPt intervention and its implementation within the NPT framework have been effective at facilitating chlamydia testing in general practice.