Predictors of Adherent Use of Diaphragms and Microbicide Gel in a Four-Arm, Randomized Pilot Study Among Female Sex Workers in Madagascar

Abigail Norris Turner; Kathleen Van Damme; Denise J. Jamieson; Maria R. Khan; Audrey E. Pettifor; Theresa A. Swezey; April J. Bell; Daniel R. Newman; Ana Penman-Aguilar; Mbolatiana S. M. Raharinivo; Bodo Randrianasolo; Felasoa Noroseheno Ramiandrisoa; Frieda M. Behets; Mad STI Prevention Group

doi:10.1097/OLQ.0b013e3181901aec

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Predictors of Adherent Use of Diaphragms and Microbicide Gel in a Four-Arm, Randomized Pilot Study Among Female Sex Workers in Madagascar

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Predictors of Adherent Use of Diaphragms and Microbicide Gel in a Four-Arm, Randomized Pilot Study Among Female Sex Workers in Madagascar

Abigail Norris Turner, Kathleen Van Damme, Denise J. Jamieson, Maria R. Khan, Audrey E. Pettifor, Theresa A. Swezey, April J. Bell, Daniel R. Newman, Ana Penman-Aguilar, Mbolatiana S. M. Raharinivo, …

Sexually transmitted diseases, Vol.36(4), pp.249-257

04/01/2009

DOI: 10.1097/OLQ.0b013e3181901aec

PMCID: PMC5824631

PMID: 19265745

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Abstract

Background: Participants' protocol adherence may influence assessments of the effectiveness of new female-controlled methods for sexually transmitted infection prevention. Methods: In 2005 we conducted a randomized pilot study among female sex workers (FSWs) in Madagascar in preparation for sexually transmitted infection prevention trial of diaphragms and a vaginal microbicide. Participants (n = 192) were randomized into 4 arms: diaphragm plus microbicide (Acidform), diaphragm plus placebo gel hydroxyethyl cellulose (HEC), Acidform alone, or HEC alone. FSWs were seen weekly for 4 weeks. Using multivariable regression with generalized estimating equations, we assessed predictors of adherent product use during all sex acts in the last week. We collapsed the gel-diaphragm arms together and the gel-only arms together for this analysis. Results: Between 43% and 67% of gel-diaphragm users (varying by visit) reported using Study products during all sex acts in the last week, compared with 20% to 45% of gel-only users. Adherence increased with follow-up [visit 4 vs. visit 1 risk ratio (RR) for gel-diaphragm users: 1.55. P <0.01: for gel-only users, RR: 1.58, P = 0.01]. Gel-diaphragm users whose casual partners were never aware of products (RR: 2.02, P = 0.03) and who had experienced partner violence after requesting condom use (RR: 1.45, P <0.01) were more adherent. Gel-only users reporting lower sexual frequency (1-9 weekly acts vs. 19 acts, RR: 1.99, P <0.01) and no sex with primary partners in the past week (RR: 1.54, P = 0.02) were more adherent. Conclusions: Gel-diaphragm users had better adherence than gel-only users, and predictors of adherence differed between groups. Addressing modifiable factors during counseling sessions may improve adherence.

Infectious Diseases

Life Sciences & Biomedicine

Science & Technology

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Title: Subtitle: Predictors of Adherent Use of Diaphragms and Microbicide Gel in a Four-Arm, Randomized Pilot Study Among Female Sex Workers in Madagascar
Creators: Abigail Norris Turner - Univ N Carolina, Dept Epidemiol, Sch Publ Hlth, Chapel Hill, NC 27599 USA
Kathleen Van Damme - UNC MAD, Antananarivo, Madagascar
Denise J. Jamieson - US Ctr Dis Control & Prevent, Atlanta, GA USA
Maria R. Khan - Univ N Carolina, Dept Epidemiol, Sch Publ Hlth, Chapel Hill, NC 27599 USA
Audrey E. Pettifor - Univ N Carolina, Dept Epidemiol, Sch Publ Hlth, Chapel Hill, NC 27599 USA
Theresa A. Swezey - Univ N Carolina, Dept Epidemiol, Sch Publ Hlth, Chapel Hill, NC 27599 USA
April J. Bell - US Ctr Dis Control & Prevent, Atlanta, GA USA
Daniel R. Newman - US Ctr Dis Control & Prevent, Atlanta, GA USA
Ana Penman-Aguilar - US Ctr Dis Control & Prevent, Atlanta, GA USA
Mbolatiana S. M. Raharinivo - UNC MAD, Antananarivo, Madagascar
Bodo Randrianasolo - UNC MAD, Antananarivo, Madagascar
Felasoa Noroseheno Ramiandrisoa - UNC MAD, Antananarivo, Madagascar
Frieda M. Behets - Univ N Carolina, Dept Epidemiol, Sch Publ Hlth, Chapel Hill, NC 27599 USA
Mad STI Prevention Group
Resource Type: Journal article
Publication Details: Sexually transmitted diseases, Vol.36(4), pp.249-257
DOI: 10.1097/OLQ.0b013e3181901aec
PMID: 19265745
PMCID: PMC5824631
NLM abbreviation: Sex Transm Dis
ISSN: 0148-5717
eISSN: 1537-4521
Publisher: Lippincott Williams & Wilkins
Number of pages: 9
Grant note: T32DA007233 / NATIONAL INSTITUTE ON DRUG ABUSE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Drug Abuse (NIDA); European Commission United States Centers for Disease Control and Prevention through an Inter-Agency Agreement with the United States Agency for International Development; United States Department of Health & Human Services; Centers for Disease Control & Prevention - USA; United States Agency for International Development (USAID) CONRAD; United States Agency for International Development (USAID)
Language: English
Date published: 04/01/2009
Academic Unit: Obstetrics and Gynecology; VPMA - Administration
Record Identifier: 9984446273602771

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