Determinants of intravaginal practices among HIV-infected women in Zambia using conjoint analysis

Alcaide, María L.; Cook, Ryan; Chisembele, Maureen; Malupande, Emeria; Jones, Deborah L.

doi:10.1177/0956462415585447

Cited by 6 publications

(4 citation statements)

References 19 publications

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“…Hypothetical vaccine acceptability was addressed in six studies [37, 40, 43, 44, 49, 85], finding that efficacy was a major driving influence on acceptability among adults in the US [85] and general populations, MSM, and transgender people in Thailand [43, 44, 49]. Other studies included patient preferences for genital herpes treatment and the risk of HIV [36], accepting a kidney from donors at risk of HIV [42], male circumcision [50], HIV prevention services for women who have been raped [35], and intravaginal practices among women in Zambia that may increase their risk of acquiring HIV [57, 58].…”

Section: Resultsmentioning

confidence: 99%

Stated-preference research in HIV: A scoping review

et al. 2019

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Discrete choice experiments (DCE), conjoint analysis (CA), and best-worst scaling (BWS) are quantitative techniques for estimating consumer preferences for products or services. These methods are increasingly used in healthcare research, but their applications within the field of HIV research have not yet been described. The objective of this scoping review was to systematically map the extent and nature of published DCE, CA, and BWS studies in the field of HIV and identify priority areas where these methods can be used in the future. Online databases were searched to identify published HIV-related DCE, CA and BWS studies in any country and year as the primary outcome. After screening 1,496 citations, 57 studies were identified that were conducted in 26 countries from 2000–2017. The frequency of published studies increased over time and covered HIV themes relating to prevention (n = 25), counselling and testing (n = 10), service delivery (n = 10), and antiretroviral therapy (n = 12). Most studies were DCEs (63%) followed by CA (37%) and BWS (4%). The median [IQR] sample size was 288 [138–496] participants, and 74% of studies used primary qualitative data to develop attributes. Only 30% of studies were conducted in sub-Saharan Africa where the burden of HIV is highest. Moreover, few studies surveyed key populations including men who have sex with men, transgender people, pregnant and postpartum women, adolescents, and people who inject drugs. These populations represent priorities for future stated-preference research. This scoping review can help researchers, policy makers, program implementers, and health economists to better understand the various applications of stated-preference research methods in the field of HIV.

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Section: Resultsmentioning

confidence: 99%

Stated-preference research in HIV: A scoping review

et al. 2019

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“…6,7 CA has been applied in health care settings to evaluate preferences for treatment, 8 fertility desires among HIV-infected women, 9 willingness to seek HIV testing, 10 and reasons for engagement in IVPs among Zambian women. 11 The Women's and Sexual Health (WASH) intervention was found to decrease engagement in IVPs among HIV-infected Zambian women. 12,13 However, the mechanism by which the WASH intervention influenced IVPs, i.e.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influencing the importance of health, partners, and hygiene among Zambian women

et al. 2017

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Intravaginal practices (IVPs) are common in Zambia and are usually practiced for hygiene, partner pleasure, and health. IVPs are associated with HIV acquisition, changes in the vaginal flora, and bacterial vaginosis (BV), making it important to understand the decision-making process behind IVP engagement. The Women's and Sexual Health (WASH) intervention decreased IVP engagement among HIV-infected Zambian women, though change in reasons for engagement has not been assessed. We used conjoint analysis (CA) to quantify the decision-making process of IVP engagement and evaluated how the WASH intervention impacted these factors. Participants were N = 84 women (37 ± 8 years old) randomized to WASH (n = 46) or standard of care plus (SOC+; n = 38) who completed demographic measures and a CA questionnaire at baseline, six months, and 12 months to quantify the importance placed on hygiene, partner pleasure, and health. The importance placed on health increased from baseline to six months (15.5 versus 25.1; p < 0.001) and from baseline to 12 months (15.5 versus 50.5; p < 0.001), and was higher in SOC+ at six months (19.9 versus 30.3; p = 0.003). Hygiene importance decreased from baseline (63.6) to six months (50.3), and from baseline to 12 months (26.1), and was higher in the experimental arm at six months (56.1) compared to SOC+ (44.6; p = 0.029). Importance placed on partner pleasure did not change over time in either group. Findings suggest that both groups exhibited an increase in the importance placed on health and a decrease on hygiene importance for IVP engagement, suggesting that SOC+ may be sufficient to promote attitude changes that may facilitate IVP discontinuation and may prove to be more cost effective by using fewer monetary resources. Findings highlight the potential of interventions to influence attitudes toward IVPs and provide novel avenues for research to improve the design and conduct of interventions aimed at reducing IVPs among Zambian women and contribute to HIV prevention efforts.

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“…Vaginal insertion of prescribed medications may also be considered an IVP but is not accounted for in this study. IVPs are used by nearly 60% of Black women versus approximately 30% of Whites, are typically the result of cultural norms or misperceptions about appropriate vaginal cleansing practices, and are associated with younger ages of sexual debut (Alcaide et al, 2016; Chandra et al, 2005; Low et al, 2011; Ness et al, 2003). The purpose of IVPs is to cleanse, dry, and/or tighten the vagina for hygienic or sex-related reasons (Esber et al, 2016).…”

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confidence: 99%

Exploring the Vaginal Microbiome and Intravaginal Practices in Postmenopausal Women

Daniel

Tsementzi

et al. 2021

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Background: Evidence suggests that intravaginal practices (IVPs) women use to cleanse their vagina or enhance sexual pleasure may be associated with unhealthy changes in the vaginal microbiome (VM). However, the effects of these practices in postmenopausal women are unknown. Objectives:The objective of this pilot study was to characterize the VM communities of postmenopausal women, identify types and frequency of IVPs, and explore associations between the VM and IVPs in postmenopausal women.Methods: We analyzed the VM data of 21 postmenopausal women in Atlanta, Georgia, from vaginal swabs collected at a routine gynecological visit. 16S rRNA gene sequencing in the V3-V4 region was used to characterize the VM. In addition, we described the IVPs of these women, identified by using our newly developed instrument: the Vaginal Cleansing Practices Questionnaire. The associations between the VM and IVPs were explored by comparing the alpha diversities, beta diversities, and the relative abundances at both the community level and individual genus level. Results:The most abundant known bacterial genus found in the VM samples was Lactobacillus (35.7%), followed by Prevotella (21.4%). Eleven women (52%) reported using at least one type of IVP since menopause. The most common type of IVP was soap and water to clean inside the vagina. The use of IVPs was not associated with any alpha diversity metric, including Shannon index, inverse Simpson index, and Chao1 index; beta diversity metric, including Bray-Curtis and Jaccard distances; nor relative abundances at the community and individual genus level. Sociodemographic factors were also not associated with any alpha diversity metric.Discussion: Clinicians must assess IVPs and other vaginal and sexual hygiene practices of women of all ages to educate and promote healthy behaviors. More than half of the postmenopausal women in this pilot study use IVPs. Understanding the reasoning behind participants' use of IVPs and their perceptions of the possible effects of these practices will require further research. Although the small sample did not show associations with the VM, more extensive studies are warranted.

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Determinants of intravaginal practices among HIV-infected women in Zambia using conjoint analysis

Cited by 6 publications

References 19 publications

Stated-preference research in HIV: A scoping review

Stated-preference research in HIV: A scoping review

Influencing the importance of health, partners, and hygiene among Zambian women

Exploring the Vaginal Microbiome and Intravaginal Practices in Postmenopausal Women

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