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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Patterns and predictors of adherence to diaphragm use in a phase III trial in sub-Saharan Africa: A trajectory analysis
Journal of Acquired Immune Deficiency Syndromes, Volume 50, No. 4, Year 2009
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Description
Background: We examined diaphragm adherence among 2429 women randomized to the intervention arm (diaphragm - gel + condoms) in Methods for Improving Reproductive Health in Africa, a phase III trial of the diaphragm for HIV prevention in Zimbabwe and South Africa. Methods: Women were followed for a median of 7 quarterly visits (range: 1-8 quarterly visits) during which diaphragm adherence was assessed. We conducted trajectory analyses to identify behavioral groups associated with specific diaphragm adherence patterns. Multivariate multinomial logistic regression was used to identify baseline characteristics associated with higher probability of being in a particular trajectory group. Results: Diaphragm uptake was very high (3.1% never used diaphragms). However, diaphragm adherence was reported at only 49% of visits. Women were clustered, into 4 diaphragm adherence groups based on their highest estimated group membership probability: low adherers (3.1.0%), decreasing adherers (28.9%), increasing adherers (9.3%), and high adherers (30.8%). Women classified as high adherers (as compared with low adherers) were more likely to be older [adjusted odds ratio (AOR) = 1.09, 95% confidence interval (CI): 1.07 to 1.11] and to report baseline condom adherence (AOR = 2.00, 95% CI: 1.47 to 2.71). They were less likely to have high-risk behavior (AOR = 0.51; 95% CI: 0.37 to 0.71) and to have high-risk partners (AOR = 0.58; 95% CI: 0.43 to 0.78). They were most likely to be from the Zimbabwe site (AOR = 2.82; 95% CI: 1.89 to 4.20) and least likely to be from the Johannesburg site (AOR = 0.51; 95% CI: 0.37 to 0.77). Conclusion: This analytic approach could help to identify high compilers for enrollment in future HIV prevention trials or the types of participants who may need intensive adherence counseling during follow-up. Copyright © 2009 Lippincott Williams & Wilkins.
Authors & Co-Authors
van der Straten, Ariane
United States, Research Triangle Park
Rti International
United States, San Francisco
Ucsf School of Medicine
Shiboski, Stephen C.
United States, San Francisco
University of California, San Francisco
Montgomery, Elizabeth T.
United States, Research Triangle Park
Rti International
Moore, Jie G.
United States, San Francisco
University of California, San Francisco
De Bruyn, Guy
South Africa, Johannesburg
University of the Witwatersrand
Ramjee, Gita A.
South Africa, Tygerberg
South African Medical Research Council
Chidanyika, Agnes
Zimbabwe, Harare
University of Zimbabwe
Kacanek, Deborah
United States, Cambridge
Ibis Reproductive Health
Padian, Nancy S.
United States, Research Triangle Park
Rti International
Statistics
Citations: 27
Authors: 9
Affiliations: 7
Identifiers
Doi:
10.1097/QAI.0b013e3181958511
ISSN:
15254135
Research Areas
Infectious Diseases
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Cohort Study
Case-Control Study
Study Locations
South Africa
Zimbabwe
Participants Gender
Female