title: Objective Measurement of Inaccurate Condom Use Reporting Among Women Using Depot Medroxyprogesterone Acetate for Contraception.
abstract: Observational analyses have suggested that women using the injectable contraceptive depot medroxyprogesterone acetate (DMPA) may have heightened risk of acquiring HIV. However, those analyses were potentially confounded by sexual behavior, with possible differential condom use and reporting by women using DMPA versus no contraception. In a cross-sectional study, we measured the presence of a biomarker of recent condomless sex (Y chromosomal [Yc] DNA) in vaginal swabs from HIV-uninfected African women who had an HIV-infected partner and reported 100 % condom use. Half of the samples tested were from women reporting DMPA and half were from women using no contraception. Among 428 specimens tested (213 from DMPA users and 215 from women using no contraception), 32.0 % had Yc DNA detected, with a mean of 193 copies/10,000 human cells (range 0.1-8201). The frequency of detection did not differ by contraceptive use: 34.2 % of DMPA users versus 29.8 % of women using no contraception, adjusted odds ratio 1.3 (95 % confidence interval 0.9-2.0). These results suggest that inaccurate reporting of condom use by DMPA users may not account for the heightened risk of HIV acquisition among DMPA users in some observational studies.
authors.affiliation: Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA. rheffron@uw.edu.|Department of Epidemiology, University of Washington, Seattle, WA, USA. rheffron@uw.edu.
authors.forename: Renee
authors.identifier: http://orcid.org/0000-0001-6039-0352
authors.initials: R
authors.lastname: Heffron
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Urvi M
authors.initials: UM
authors.lastname: Parikh
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Kerri J
authors.initials: KJ
authors.lastname: Penrose
authors.affiliation: Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA.|Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Nelly
authors.initials: N
authors.lastname: Mugo
authors.affiliation: Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA.|Division of Vaccine and Infectious Disease, Fred Hutch, Seattle, WA, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Donnell
authors.affiliation: Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA.|Department of Epidemiology, University of Washington, Seattle, WA, USA.|Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.|Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA.|Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Mellors
authors.affiliation: Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA.|Department of Epidemiology, University of Washington, Seattle, WA, USA.|Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D041322:Chromosomes, Human, Y; D017280:Condoms / Q000706:statistics & numerical data*; D003268:Contraception Behavior; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D004247:DNA / Q000032:analysis*; D003692:Delayed-Action Preparations; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D016017:Odds Ratio; D012306:Risk; D012725:Sexual Behavior; D012747:Sexual Partners; D014621:Vagina / Q000737:chemistry*; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D004247:DNA; D017258:Medroxyprogesterone Acetate
keywords: Africa; Biomarker; Condoms; DMPA; HIV; Y chromosomal DNA