AIDS and Behavior

, Volume 16, Issue 7, pp 1799–1807 | Cite as

Preference Between Precoital and Daily Use of Duet® and BufferGel in Zimbabwe

  • Ariane van der Straten
  • Elizabeth Montgomery
  • Sue Mavedzenge
  • Petina Musara
  • Helen Cheng
  • Alix Lutnick
  • Cynthia Woodsong
Original Paper

Abstract

Duet® is a microbicide-delivery system and cervical barrier for use daily or precoitally. We conducted a crossover study among 80 Zimbabwean women to explore factors associated with use-regimen preference. Women were assigned in random order to 14 days of precoital and 14 days of daily Duet and BufferGel use. About 51 % of women preferred precoital use, 39 % preferred daily use, and 10 % liked both equally. Overall product adherence during sex was similar for both use-regimens. In multivariable analysis, diaphragm experience was associated with preference for precoital use (AOR 2.80, 95 % CI 1.01–7.76). Reasons for preferring precoital use included use only when needed, cleanliness, and discomfort with daily use. Daily use preference included convenience, discreetness, and being prepared for “sex-on-demand.” Different personal and life circumstances may result in varying use-regimen preferences. Methods that can accommodate both coitally-related and daily use may be advantageous by providing more choice to users.

Keywords

Female-initiated method Microbicide Cervical barrier Acceptability Zimbabwe 

Preferencia entre uso precoito y diario de duet® y buffergel en Zimbabue

Resumen

Duet® es una tecnología de repartir microbicidas y una barrera cervical para uso diario o precoito. Conducimos un estudio cruzado entre 80 mujeres zimbabuenses para explorar factores asociados con la preferencia del uso. Les asignamos al azar a 14 días del uso precoito y a 14 días del uso diario de Duet® y BufferGel. Casi 51 % de muejeres prefieron uso precoito, 39 % prefieron uso diario, y 10 % los dos por igual. Sobre todo, adherirse al producto durante relaciones sexuales fue similar para los dos usos. En un análisis multivariante, experiencia con el diafragma fue asociada con la preferencia del uso precoito (AOR 2.80, 95 % CI 1.01–7.76). Razones por la preferencia del uso precoito incluyeron el uso solo para necesidad, paracer higiénico, y incomodidad con el uso diario. Preferencias para el uso diario inlcuyeron ser conveniente, descreto, y estar preparado para “sexo al dicho.” Es posible que circunstancias personales o de la vida resultan en la variedad de las preferencias del uso. Métodos que se acomodan el uso precoito tal como el uso diario pueden ser ventajosos por proveer más opciones para usuarios.

Notes

Acknowledgments

The authors thank the study participants and acknowledge the contributions of the Zimbabwe study team staff, and the site investigator, Dr. Tsungai Chipato. The team thanks Dr. Thomas Moench of ReProtect, Inc., Baltimore, MD, for reviewing an earlier version of the manuscript, and providing technical support during the trial. This study was supported by the International Partnership for Microbicide.

References

  1. 1.
    Elias CJ, Coggins C. Female-controlled methods to prevent sexual transmission of HIV. AIDS. 1996;10(Suppl 3):S43–51.PubMedGoogle Scholar
  2. 2.
    Elias CJ, Heise LL. Challenges for the development of female-controlled vaginal microbicides. AIDS. 1994;8(1):1–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Weiss HA, Wasserheit JN, Barnabas RV, Hayes RJ, Abu-Raddad LJ. Persisting with prevention: the importance of adherence for HIV prevention. Emerg Themes Epidemiol. 2008;5:8.PubMedCrossRefGoogle Scholar
  4. 4.
    Abdool Karim SS, Richardson BA, Ramjee G, Hoffman IF, Chirenje ZM, Taha T, et al. Safety and effectiveness of BufferGel and 0.5 % PRO2000 gel for the prevention of HIV infection in women. AIDS. 2011;25(7):957–66.Google Scholar
  5. 5.
    Abdool Karim Q, Abdool Karim SS, Frohlich JA, Grobler AC, Baxter C, Mansoor LE, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329(5996):1168–74.Google Scholar
  6. 6.
    Microbicide Trials Network. MTN statement on decision to discontinue use of tenofovir gel in VOICE, a major HIV prevention study in women. November 25, 2011. http://www.mtnstopshiv.org/node/3909.
  7. 7.
    Masse BR, Boily MC, Dimitrov D, Desai K. Efficacy dilution in randomized placebo-controlled vaginal microbicide trials. Emerg Themes Epidemiol. 2009;6:5.PubMedCrossRefGoogle Scholar
  8. 8.
    van der Straten A, van Damme L, Haberer JE, Bangsberg DR. How well does PREP work? Unraveling the divergent results of PrEP trials for HIV prevention. AIDS. 2012 (Feb 13).Google Scholar
  9. 9.
    Nel AM, Mitchnick LB, Risha P, Muungo LT, Norick PM. Acceptability of vaginal film, soft-gel capsule, and tablet as potential microbicide delivery methods among African women. J Womens Health. 2011;20(8):1207–14.CrossRefGoogle Scholar
  10. 10.
    Kelly CG, Shattock RJ. Specific microbicides in the prevention of HIV infection. J Intern Med. 2011;270(6):509–19.PubMedCrossRefGoogle Scholar
  11. 11.
    Karim QA, Karim SS, Frohlich JA, Grobler AC, Baxter C, Mansoor LE, et al. Effectiveness and Safety of Tenofovir Gel, an Antiretroviral Microbicide, for the Prevention of HIV Infection in Women. Science. 2010 (Jul 19).Google Scholar
  12. 12.
    Malcolm RK, Edwards KL, Kiser P, Romano J, Smith TJ. Advances in microbicide vaginal rings. Antiviral Res. 2010;88(Suppl 1):S30–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Kashuba AD, Patterson KB, Dumond JB, Cohen MS. Pre-exposure prophylaxis for HIV prevention: how to predict success. Lancet. 2011 (Dec 6).Google Scholar
  14. 14.
    Montgomery ET, Woodsong C, Musara P, Cheng H, Chipato T, Moench TR, et al. An acceptability and safety study of the Duet cervical barrier and gel delivery system in Zimbabwe. J Int AIDS Soc. 2010;13:30.PubMedCrossRefGoogle Scholar
  15. 15.
    Padian NS, van der Straten A, Ramjee G, Chipato T, de Bruyn G, Blanchard K, et al. Diaphragm and lubricant gel for prevention of HIV acquisition in southern African women: a randomised controlled trial. Lancet. 2007;370(9583):251–61.PubMedCrossRefGoogle Scholar
  16. 16.
    Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation. J Clin Microbiol. 1991;29(2):297–301.PubMedGoogle Scholar
  17. 17.
    Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983;74(1):14–22.PubMedCrossRefGoogle Scholar
  18. 18.
    Simons-Rudolph A, Woodsong C, Koo H. Modeling the social context of microbicide use. Microb Q. 2008;6(4):1–11.Google Scholar
  19. 19.
    Sahin-Hodoglugil NN, van der Straten A, Cheng H, Montgomery ET, Kacanek D, Mtetwa S, et al. Degrees of disclosure: a study of women’s covert use of the diaphragm in an HIV prevention trial in sub-Saharan Africa. Soc Sci Med. 2009;69(10):1547–55.PubMedCrossRefGoogle Scholar
  20. 20.
    Montgomery ET, Blanchard K, Cheng H, Chipato T, deBruyn G, Ramjee G. Diaphragm and lubricant gel acceptance, skills and patterns of use among women in an effectiveness trial in Southern Africa. Eur J Contracept Reprod Health Care. 2009;14(6):410–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Susser I, Stein Z. Culture, sexuality, and women’s agency in the prevention of HIV/AIDS in southern Africa. Am J Public Health. 2000;90(7):1042–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Ulin PR. African women and AIDS: negotiating behavioral change. Soc Sci Med. 1992;34(1):63–73.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Ariane van der Straten
    • 1
    • 3
  • Elizabeth Montgomery
    • 1
  • Sue Mavedzenge
    • 1
  • Petina Musara
    • 4
  • Helen Cheng
    • 1
  • Alix Lutnick
    • 2
  • Cynthia Woodsong
    • 5
  1. 1.Women’s Global Health ImperativeRTI InternationalSan FranciscoUSA
  2. 2.RTI InternationalSan FranciscoUSA
  3. 3.Center for AIDS Prevention Studies, Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  4. 4.UZ-UCSF Collaborative Research Programme in Women’s HealthHarareZimbabwe
  5. 5.International Partnership for MicrobicidesPaarlSouth Africa

Personalised recommendations