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Vaginal practices and associations with barrier methods and gel use among Sub-Saharan African women enrolled in an HIV prevention trial.

van der Straten A, Cheng H, Chidanyika A, De Bruyn G, Padian N, MIRA Te - AIDS Behav (2010)

Bottom Line: Vaginal practices may interfere with the use and/or the effectiveness of female-initiated prevention methods.Additionally, washing, wiping, and insertion, were all independently and inversely associated with consistent diaphragm and gel use and with condom use as well, regardless of study arm.A better understanding of the socio-cultural context in which these practices are embedded could improve educational strategies to address these potentially modifiable behaviors, and may benefit future HIV prevention interventions of vaginal methods.

View Article: PubMed Central - PubMed

Affiliation: Women's Global Health Imperative, RTI International, 114 Sansome Street, Suite 500, San Francisco, CA 94104, USA. ariane@rti.org

ABSTRACT
Vaginal practices may interfere with the use and/or the effectiveness of female-initiated prevention methods. We investigated whether vaginal practices differed by randomization group in a phase III trial of the diaphragm with lubricant gel (MIRA) in Sub-Saharan Africa (n = 4925), and if they were associated with consistent use of study methods. At baseline, vaginal practices were commonly reported: vaginal washing (82.77%), wiping (56.47%) and insertion of dry or absorbent materials (20.58%). All three practices decreased during the trial. However, women in the intervention group were significantly more likely to report washing or wiping during follow-up compared to those in the control group. Additionally, washing, wiping, and insertion, were all independently and inversely associated with consistent diaphragm and gel use and with condom use as well, regardless of study arm. A better understanding of the socio-cultural context in which these practices are embedded could improve educational strategies to address these potentially modifiable behaviors, and may benefit future HIV prevention interventions of vaginal methods.

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a Percent women reporting specific vaginal practices over time and by study group proportion of women within each study group, reporting “ever” engaging in a specified vaginal practice at every quarterly visit. Visit number: Baseline = 1, 3-month follow-up visit = 3, 6-month visit = 4, 9-month visit = 5, etc. b Linear trend test for specific vaginal practices, by study group study arm-specific: within-group linear trend tests for the three vaginal practices, controlling for repeated measures (with GEE) and study site. Odds ratio indicates odds of “ever” engaging in specified vaginal practice at one visit compared to previous visit. Vaginal practices (washing, wiping and insertion) were measured at baseline and every quarterly visit. Study Arm by visit interaction: for each specified vaginal practice, odds ratio of study arm by visit interaction term (with intervention group as reference category). 95% CI 95% confidence interval
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Fig1: a Percent women reporting specific vaginal practices over time and by study group proportion of women within each study group, reporting “ever” engaging in a specified vaginal practice at every quarterly visit. Visit number: Baseline = 1, 3-month follow-up visit = 3, 6-month visit = 4, 9-month visit = 5, etc. b Linear trend test for specific vaginal practices, by study group study arm-specific: within-group linear trend tests for the three vaginal practices, controlling for repeated measures (with GEE) and study site. Odds ratio indicates odds of “ever” engaging in specified vaginal practice at one visit compared to previous visit. Vaginal practices (washing, wiping and insertion) were measured at baseline and every quarterly visit. Study Arm by visit interaction: for each specified vaginal practice, odds ratio of study arm by visit interaction term (with intervention group as reference category). 95% CI 95% confidence interval

Mentions: We further explored the change in vaginal practices over time: all three decreased with time in the study and the time effect was significant (Chi-square P < 0.0001) for each vaginal practice overall, and within each study group (see Fig. 1a, b). Furthermore, as shown by the study group by visit interaction term (Fig. 1b), the rate of decrease over time in vaginal washing was significantly less in the intervention group compared with the control group (Chi-square P = 0.0004). The rate of decrease for wiping was marginally less in the intervention group compared with the control group (Chi-square P = 0.05). The study group effect was not observed for vaginal insertion.Fig. 1


Vaginal practices and associations with barrier methods and gel use among Sub-Saharan African women enrolled in an HIV prevention trial.

van der Straten A, Cheng H, Chidanyika A, De Bruyn G, Padian N, MIRA Te - AIDS Behav (2010)

a Percent women reporting specific vaginal practices over time and by study group proportion of women within each study group, reporting “ever” engaging in a specified vaginal practice at every quarterly visit. Visit number: Baseline = 1, 3-month follow-up visit = 3, 6-month visit = 4, 9-month visit = 5, etc. b Linear trend test for specific vaginal practices, by study group study arm-specific: within-group linear trend tests for the three vaginal practices, controlling for repeated measures (with GEE) and study site. Odds ratio indicates odds of “ever” engaging in specified vaginal practice at one visit compared to previous visit. Vaginal practices (washing, wiping and insertion) were measured at baseline and every quarterly visit. Study Arm by visit interaction: for each specified vaginal practice, odds ratio of study arm by visit interaction term (with intervention group as reference category). 95% CI 95% confidence interval
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Related In: Results  -  Collection

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Fig1: a Percent women reporting specific vaginal practices over time and by study group proportion of women within each study group, reporting “ever” engaging in a specified vaginal practice at every quarterly visit. Visit number: Baseline = 1, 3-month follow-up visit = 3, 6-month visit = 4, 9-month visit = 5, etc. b Linear trend test for specific vaginal practices, by study group study arm-specific: within-group linear trend tests for the three vaginal practices, controlling for repeated measures (with GEE) and study site. Odds ratio indicates odds of “ever” engaging in specified vaginal practice at one visit compared to previous visit. Vaginal practices (washing, wiping and insertion) were measured at baseline and every quarterly visit. Study Arm by visit interaction: for each specified vaginal practice, odds ratio of study arm by visit interaction term (with intervention group as reference category). 95% CI 95% confidence interval
Mentions: We further explored the change in vaginal practices over time: all three decreased with time in the study and the time effect was significant (Chi-square P < 0.0001) for each vaginal practice overall, and within each study group (see Fig. 1a, b). Furthermore, as shown by the study group by visit interaction term (Fig. 1b), the rate of decrease over time in vaginal washing was significantly less in the intervention group compared with the control group (Chi-square P = 0.0004). The rate of decrease for wiping was marginally less in the intervention group compared with the control group (Chi-square P = 0.05). The study group effect was not observed for vaginal insertion.Fig. 1

Bottom Line: Vaginal practices may interfere with the use and/or the effectiveness of female-initiated prevention methods.Additionally, washing, wiping, and insertion, were all independently and inversely associated with consistent diaphragm and gel use and with condom use as well, regardless of study arm.A better understanding of the socio-cultural context in which these practices are embedded could improve educational strategies to address these potentially modifiable behaviors, and may benefit future HIV prevention interventions of vaginal methods.

View Article: PubMed Central - PubMed

Affiliation: Women's Global Health Imperative, RTI International, 114 Sansome Street, Suite 500, San Francisco, CA 94104, USA. ariane@rti.org

ABSTRACT
Vaginal practices may interfere with the use and/or the effectiveness of female-initiated prevention methods. We investigated whether vaginal practices differed by randomization group in a phase III trial of the diaphragm with lubricant gel (MIRA) in Sub-Saharan Africa (n = 4925), and if they were associated with consistent use of study methods. At baseline, vaginal practices were commonly reported: vaginal washing (82.77%), wiping (56.47%) and insertion of dry or absorbent materials (20.58%). All three practices decreased during the trial. However, women in the intervention group were significantly more likely to report washing or wiping during follow-up compared to those in the control group. Additionally, washing, wiping, and insertion, were all independently and inversely associated with consistent diaphragm and gel use and with condom use as well, regardless of study arm. A better understanding of the socio-cultural context in which these practices are embedded could improve educational strategies to address these potentially modifiable behaviors, and may benefit future HIV prevention interventions of vaginal methods.

Show MeSH