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

Citation

Norris Turner, Abigail; Van Damme, Kathleen; Jamieson, Denise J.; Khan, Maria R.; Pettifor, Audrey E.; Swezey, Teresa A.; Bell, April J.; Newman, Daniel R.; Penman-Aguilar, Ana; & Raharinivo, Mbolatiana S. M., et al. (2009). 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, 36(4), 249-257. PMCID: PMC5824631

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: 1.98, 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.

URL

http://dx.doi.org/10.1097/OLQ.0b013e3181901aec

Reference Type

Journal Article

Year Published

2009

Journal Title

Sexually Transmitted Diseases

Author(s)

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

PMCID

PMC5824631

ORCiD

Pettifor - 0000-0002-3387-0817