Impact of level of researcher support on coital diary results and acceptability among women at high risk of HIV in the Microbicides Development Programme feasibility study in Mwanza, Tanzania Caroline Allen, Shelley Lees, Nicola Desmond, Geoff Der, Betty Chiduo, Andrew Vallely, Richard Hayes, David Ross

Background Problems in measuring sexual behaviour in populations at high risk Reliance on self-reporting Desire to hide socially proscribed activities Low literacy in developing countries

Aim Identify valid tools to measure sexual behaviour among women at high risk of HIV infection recruited to a microbicides trial

Objectives Compare reporting of sexual behaviour between pictorial coital diaries (CDs) and face-to-face interviews (FTFIs) Assess which method was more sensitive to level of researcher support Assess whether level of support affected acceptability of CDs

Methods Study population: 1573 women enrolled into the Microbicides Development Programme trial feasibility study in Mwanza, Tanzania, who worked in food or recreational facilities (cooked food vending, bars, restaurants, guesthouses and hotels) Three groups of randomly selected women received differing levels of researcher support

Levels of support Level of support Scheduled weekly CD delivery/ collection at participant’s home or workplace Interview at scheduled weekly visits (recall of previous 7 days). Fieldworkers respond to concerns raised by participants. Unscheduled weekly visit. Fieldworkers check participants are completing CD daily and ask about and help them with concerns. Exit interview (recall of previous 4 weeks) MinimumMediumIntensive X Activity XX XX X XXX

Coital diary data collection page

Comparison: CD vs exit interview Average reported frequencies of behaviours over four weeks

Sex in exchange for money or gifts Percentage of respondents reporting behaviour at least once in four weeks Level of support

Sex with irregular partner Percentage of respondents reporting behaviour at least once in four weeks Level of support

Sex with regular partner Percentage of respondents reporting behaviour at least once in four weeks Level of support

Vaginal sex Percentage of respondents reporting behaviour at least once in four weeks Level of support

Cleaning the vagina Percentage of respondents reporting behaviour at least once in four weeks Level of support

Acceptability of CD study by level of support

In sum Higher reporting on CDs than EIs Differences in reporting by level of support larger on EIs than CDs –Significant on EIs but not CDs for all three partner types CD study more acceptable with higher support –Improved satisfaction, compliance, disclosure, confidentiality

Limitations Reactivity –CDs and FTFIs completed by the same people Low agreement between CDs and FTFIs for some variables –Did respondents understand the same things by FTFI questions and CD pictures? Did respondents really complete CDs every day? Acceptability assessed via FTFI

Conclusion Increasing interest in CDs to record behaviour in developing countries –Have compared with FTFIs –We confirmed higher frequencies on CDs –High level of support assumed necessary –This the 1st study comparing by level of support –Confirms assumption –Pictorial diary attractive, appropriate with less literate populations

CDs may become increasingly useful with growth in number of clinical trials of HIV prevention technologies

Acknowledgements Research participants This research forms part of the Microbicides Development Programme, funded by the UK Department for International Development through the UK Medical Research Council. National Institute for Medical Research, Tanzania African Medical and Research Foundation, Tanzania London School of Hygiene and Tropical Medicine Medical Research Council Social and Public Health Sciences Unit, UK