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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Predictors of adherent use of diaphragms and microbicide gel in a four-arm, randomized pilot study among female sex workers in madagascar
Sexually Transmitted Diseases, Volume 36, No. 4, Year 2009
Notification
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Description
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: 1.98, 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. Copyright © 2009 American Sexually Transmitted Diseases Association.
Authors & Co-Authors
Turner, Abigail Norris
United States, Chapel Hill
The University of North Carolina at Chapel Hill
van Damme, Kathleen
Madagascar, Antananarivo
Unc-mad
Jamieson, Denise J.
United States, Atlanta
Centers for Disease Control and Prevention
Khan, Maria Rabia
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Pettifor, Audrey E.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Swezey, Teresa A.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Bell, April J.
United States, Atlanta
Centers for Disease Control and Prevention
Newman, Daniel R.
United States, Atlanta
Centers for Disease Control and Prevention
Penman-Aguilar, Ana
United States, Atlanta
Centers for Disease Control and Prevention
Raharinivo, Mbolatiana S.M.
Madagascar, Antananarivo
Unc-mad
Randrianasolo, Bodo Sahondra
Madagascar, Antananarivo
Unc-mad
Ramiandrisoa, Felasoa Noroseheno
Madagascar, Antananarivo
Unc-mad
Behets, Frieda M.T.F.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Statistics
Citations: 19
Authors: 13
Affiliations: 3
Identifiers
Doi:
10.1097/OLQ.0b013e3181901aec
ISSN:
01485717
Research Areas
Sexual And Reproductive Health
Study Design
Cohort Study
Study Locations
Madagascar
Participants Gender
Female