AIDS and Behavior

, Volume 18, Issue 5, pp 855–861 | Cite as

Effects of Partnership Change on Microbicide Gel Adherence in a Clinical Trial (HPTN 035)

  • Pamina M. Gorbach
  • Clifton W. Kelly
  • Joleen A. Borgerding
  • Gita Ramjee
  • Tchangani Tembo
  • Newton Kumwenda
  • Petina Musara
  • Sarah Roberts
  • Lisa Maslankowski
Original Paper


Use of HIV prevention methods may vary for women by types of sexual partners. In a microbicide safety and effectiveness trial (HPTN 035) differences in adherence to a microbicide study gel were compared between women with new versus ongoing partnerships over time. 1,757 women in the three HPTN 035 trial’s arms completed the Follow-up Partner Status (FPS) questionnaire at their last study visit. Women married at baseline were asked if they had the same husband, new husband or new partner. Unmarried women were asked if they had changed partners or married. Self-reported gel adherence during the last sex act was compared at each quarterly visit between women with ongoing versus new partners. High gel adherence was compared with low gel adherence (85–100 vs. <85 % of last vaginal sex acts reported with gel use, respectively) in multivariable models to assess associations with partner change. Overall 7 % of women (n = 123) reported a new partner and 41 % (51) of those reported a new husband. Median gel adherence was reported to be 100 % in women with ongoing partners and 75 % for women with new partners (p < 0.001). In women reporting no gel use in their last sex act, only 12.5 % of the women with a new partner and none of those with an ongoing partner reported using condoms (p < 0.001). Fewer women with new partners reported using both the gel and condom during the last sex act as compared to women with ongoing partners (median 50 vs. 71.4 %, p < 0.001). After adjusting for age, site, education level, and sexual frequency, women with ongoing partners were more likely to report high gel adherence than those with new partners (AOR 2.5, 95 % CI 1.6, 3.9). This pattern persisted when gel use over time was compared between women with new versus ongoing partners. In the HPTN 035 trial, women with new partners had higher HIV incidence and reported less gel use and higher condom use. Specific counseling and support are needed to help women use potential HIV prevention methods, including microbicides, when they are changing partners.


Adherence Microbicide HIV Partner status 



HPTN 035 was funded by the US National Institutes of Health and designed and implemented by the HPTN and the MTN. HPTN (U01AI46749) has been funded by the National Institute of Allergy and infectious Diseases (NIAID), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institute of Drug Abuse, and National Institute of Mental Health (NIMH). MTN (U01AI068633) has been funded by NIAID, NICHD, and NIMH.


  1. 1.
    Woodsong C, Alleman P, Musara P, et al. Preventive misconception as a motivation for participation and adherence in microbicide trials: evidence from female participants and male partners in Malawi and Zimbabwe. AIDS Behav. 2012;16(3):785–90.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Karim QA, Baxter C, Karim SA. Topical microbicides—what’s new? J Acquir Immune Defic Syndr. 2013;63(Suppl 2):S144–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Baeten J, Donnell D, Ndase P, et al. ARV PrEP for HIV-1 prevention among heterosexual men and women. . 19th Conference on Retroviruses and Opportunistic Infections (CROI). Seattle 2012.Google Scholar
  4. 4.
    Van Damme L, CorneliA, Ahmed K, et al. The FEM-PrEP trial of emtricitabine/tenofovir disoproxil fumarate (Truvada) among African women. Paper presented at: Conference on Retroviruses and Opportunistic Infections (CROI); 5–8 March, Seattle 2012.Google Scholar
  5. 5.
    Montgomery CM, Lees S, Stadler J, et al. The role of partnership dynamics in determining the acceptability of condoms and microbicides. AIDS Care. 2008;20(6):733–40.PubMedCrossRefGoogle Scholar
  6. 6.
    Mah TL, Halperin DT. Concurrent sexual partnerships and the HIV epidemics in Africa: evidence to move forward. AIDS Behav. 2010;14(1):11–6 (dicussion 34–17).PubMedCrossRefGoogle Scholar
  7. 7.
    Sawers L, Stillwaggon E. Concurrent sexual partnerships do not explain the HIV epidemics in Africa: a systematic review of the evidence. J Int AIDS Soc. 2010;13:34.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Mah TL, Maughan-Brown B. Social and cultural contexts of concurrency in a township in Cape Town, South Africa. Cult Health Sex. 2013;15(2):135–47.PubMedCrossRefGoogle Scholar
  9. 9.
    Onoya D, Reddy P, Sifunda S, et al. Transactional sexual relationships, sexually transmitted infection risk, and condom use among young Black Women in peri-urban areas of the Western Cape Province of South Africa. Women’s health issues : official publication of the Jacobs Institute of. Women’s Health. May-Jun. 2012;22(3):e277–82.Google Scholar
  10. 10.
    Wyrod R, Fritz K, Woelk G, et al. Beyond sugar daddies: intergenerational sex and AIDS in urban Zimbabwe. AIDS Behav. 2011;15(6):1275–82.PubMedCrossRefGoogle Scholar
  11. 11.
    Zembe YZ, Townsend L, Thorson A, Ekstrom AM. “Money talks, bullshit walks” interrogating notions of consumption and survival sex among young women engaging in transactional sex in post-apartheid South Africa: a qualitative enquiry. Glob Health. 2013;9:28.CrossRefGoogle Scholar
  12. 12.
    Pettifor A, Macphail C, Anderson AD, Maman S. ‘If I buy the Kellogg’s then he should [buy] the milk’: young women’s perspectives on relationship dynamics, gender power and HIV risk in Johannesburg, South Africa. Cult Health Sex. 2012;14(5):477–90.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Montgomery ET, Chidanyika A, Chipato T, van der Straten A. Sharing the trousers: gender roles and relationships in an HIV-prevention trial in Zimbabwe. Cult Health Sex. 2012;14(7):795–810.PubMedCrossRefGoogle Scholar
  14. 14.
    Abdool Karim SS, Richardson BA, Ramjee G, 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.PubMedCrossRefGoogle Scholar
  15. 15.
    Abdool Karim Q, Abdool Karim SS, Frohlich JA, 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.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Marrazzo Jea. Pre-exposure prophylaxis for HIV in women: daily oral tenofovir, oral tenofovir/emtricitabine, or vaginal tenofovir gel in the VOICE study (MTN 003). . 20th Conference on Retroviruses and Opportunistic Infections. Atlanta. 2013.Google Scholar
  17. 17.
    Minnis AM, Gandham S, Richardson BA, et al. Adherence and acceptability in MTN 001: a randomized cross-over trial of daily oral and topical tenofovir for HIV prevention in women. AIDS Behav. 2013;17(2):737–47.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New Engl J Med. 2010;363(27):2587–99.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Van Damme LCA, Ahmed K, Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, Malahleha M, Owino F, Manongi R, Onyango J, Temu L, Monedi MC, Mak’Oketch P, Makanda M, Reblin I, Makatu SE, Saylor L, Kiernan H, Kirkendale S, Wong C, Grant R, Kashuba A, Nanda K, Mandala J, Fransen K, Deese J, Crucitti T, Mastro TD, Taylor D, FEM-PrEP Study Group. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367(5):411–22.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Thirumurthy H, Siripong N, Vreeman RC, et al. Differences between self-reported and electronically monitored adherence among patients receiving antiretroviral therapy in a resource-limited setting. Aids. 2012;26(18):2399–403.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Warren SR, Raisch DW, Campbell HM, et al. Medication adherence assessment in a clinical trial with centralized follow-up and direct-to-patient drug shipments. Clin Trials. 2013;10(3):441–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Skoler-Karpoff S, Ramjee G, Ahmed K, et al. Efficacy of Carraguard for prevention of HIV infection in women in South Africa: a randomised, double-blind, placebo-controlled trial. Lancet. 2008;372(9654):1977–87.PubMedCrossRefGoogle Scholar
  23. 23.
    Gorbach PM, Mensch BS, Husnik M, et al. Effect of computer-assisted interviewing on self-reported sexual behavior data in a microbicide clinical trial. AIDS Behav. 2013;17(2):790–800.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Pamina M. Gorbach
    • 1
  • Clifton W. Kelly
    • 2
  • Joleen A. Borgerding
    • 2
  • Gita Ramjee
    • 3
  • Tchangani Tembo
    • 4
  • Newton Kumwenda
    • 5
  • Petina Musara
    • 6
  • Sarah Roberts
    • 7
    • 9
  • Lisa Maslankowski
    • 8
  1. 1.Department of EpidemiologyUniversity of CaliforniaLos AngelesUSA
  2. 2.SCHARPSeattleUSA
  3. 3.HIV Prevention Research UnitSouth African Medical Research CouncilDurbanSouth Africa
  4. 4.Kamuzu Central HospitalTidziwe CentreLilongweMalawi
  5. 5.College of Medicine - Johns Hopkins University Research Project at Queen Elizabeth Central HospitalBlantyreMalawi
  6. 6.Spilhaus Clinical Research SiteHarareZimbabwe
  7. 7.Centre for Infectious Disease Research in ZambiaLusakaZambia
  8. 8.University of PennsylvaniaPhiladelphiaUSA
  9. 9.University of Alabama at BirminghamBirminghamUSA

Personalised recommendations