Assessing the Reporting of Adherence and Sexual Activity in a Simulated Microbicide Trial in South Africa: An Interview Mode Experiment Using a Placebo Gel

Abstract

Misreporting of adherence undermines detection of an association between product use and HIV infection in microbicide trials. This study investigates whether, in a placebo trial, audio computer-assisted self-interviewing (ACASI) produces more accurate reporting of adherence and sexual behavior than a face-to-face interview (FTFI). At three South African clinics, 849 women were enrolled and instructed to use applicators filled with placebo gel; participants were randomly assigned to FTFI or ACASI. Behavioral reports were validated through two biomarkers that detect product usage and unprotected sex. For most behaviors, ACASI generated significantly higher reporting, although differences by interview mode appeared to diminish over time. ACASI participants were more likely to report having had sex without gel, but reported and tested applicators did not indicate greater honesty about gel insertion with ACASI. While comparisons of reported unprotected sex with the validated biomarker revealed more agreement with ACASI than with FTFI, differences were small.

Effectiveness of a community-based positive prevention intervention for people living with HIV who are not receiving antiretroviral treatment: a prospective cohort study

“…Data were entered using Computer-Assisted Personal Interview (CAPI). However, information on more sensitive behaviors was collected by the participants themselves using Audio Computer-Assisted Self-Interview (ACASI); the interviewer left the room after guiding the participant on the technique 19. All response options were color-coded and linked to audio directions in Swahili.…”

Using Biomarkers to Assess the Validity of Sexual Behavior Reporting across Interview Modes among Young Women in Kampala, Uganda

“…Exceptions include an experiment among women in São Paulo, Brazil (Hewett et al 2008), which evaluated sexual behavior reporting in ACASI and FTFI against STI biomarkers and found both that reporting of STI risk behavior was significantly higher in the computerized interview, and that associations between risk behavior and STI infection were stronger in ACASI relative to FTFI. In South Africa, Mensch and colleagues (2011) also observed an ACASI “advantage” over FTFI in a placebo gel microbicide study that tested participants for recent semen exposure. By contrast, Minnis et al (2009) found in Zimbabwe that self-reported sexual activity and condom use were equally problematic in FTFI and ACASI when validated against an objective biomarker of recent unprotected sex.…”

Exploring Discordance Between Biologic and Self-Reported Measures of Semen Exposure: A Qualitative Study Among Female Patients Attending an STI Clinic in Jamaica

“…By virtue of its validity and immediacy, PSA rapid testing can be utilized in other studies of sexual behavior, in conjunction with other quantitative and qualitative methods, to gain additional information about study participants' experiences in real-time. The utilization of PSA and other semen biomarkers help illuminate bias in self-reported data, and can also serve as primary study outcomes [5,22,32]. As this trend continues, it represents a breakthrough for sexual health research.…”

“…Primary strategies used to minimize social-desirability bias include changing the mode of survey administration (e.g., shifting from interview-administered to selfadministered surveys and using computer aids, or ballot box approaches) and changing the characteristics of the interviewer (e.g., matching by gender, age, and ethnicity). These and other strategies have been used to increase the reporting accuracy of sensitive behaviors, with mixed results [2][3][4][5][6][7][8][9]. Additional approaches are needed to help minimize and control for these issues [10,11].…”