title: Promoting continuous use as a strategy for achieving adherence in a trial of the diaphragm with candidate microbicide.
abstract: Women need more choices for protection from HIV and other sexually transmitted infections (STIs). We conducted a randomized 4-week study in Madagascar in preparation for a Phase III randomized controlled trial (RCT) of the diaphragm with a candidate microbicide for STI prevention. All participants completed quantitative surveys; half participated in a qualitative interview. We advised women to wear the diaphragm at all times except for daily cleaning (rather than inserting it before intercourse). The objective of this analysis was to determine whether women who followed this "continuous use" approach more often used the diaphragm for 100% of sex acts as compared with other women. If so, this would support advising continuous diaphragm use in the upcoming RCT. To meet our objective, we analyzed qualitative data thematically, developed a measure of continuous diaphragm use based on qualitative data, and used multiple regression to evaluate the measure's association with adherence to diaphragm use during 100% of sex acts. Women who wore the diaphragm continuously had 4 times higher odds of reporting diaphragm use during 100% of sex acts (OR: 4.6, 95% CI: 1.2, 24.0). If the diaphragm proves effective against STI, continuous use may help women achieve high levels of protection.
authors.affiliation: Centers for Disease, Control and Prevention (CDC), Atlanta, GA, 30341, USA. bpv4@cdc.gov
authors.forename: Ana
authors.initials: A
authors.lastname: Penman-Aguilar
authors.forename: Teresa
authors.initials: T
authors.lastname: Swezey
authors.forename: Abigail Norris
authors.initials: AN
authors.lastname: Turner
authors.forename: April J
authors.initials: AJ
authors.lastname: Bell
authors.forename: Felasoa Noroseheno
authors.initials: FN
authors.lastname: Ramiandrisoa
authors.forename: Jennifer
authors.initials: J
authors.lastname: Legardy-Williams
authors.forename: Bodo
authors.initials: B
authors.lastname: Randrianasolo
authors.forename: Kathleen
authors.initials: K
authors.lastname: Van Damme
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dulyx
authors.forename: Frieda
authors.initials: F
authors.lastname: Behets
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
mesh_terms: D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D003268:Contraception Behavior; D003274:Contraceptive Devices, Female / Q000382:microbiology* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008270:Madagascar; D008875:Middle Aged; D010349:Patient Compliance; D012044:Regression Analysis; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014622:Vaginal Creams, Foams, and Jellies / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; D014622:Vaginal Creams, Foams, and Jellies