Sexually Transmitted Diseases

Skip Navigation LinksHome > April 2009 - Volume 36 - Issue 4 > Predictors of Adherent Use of Diaphragms and Microbicide Gel...
Sexually Transmitted Diseases:
doi: 10.1097/OLQ.0b013e3181901aec
Articles

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

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

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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: 1.98, 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

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