1. 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

2. 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

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

4. 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

5. 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

6. 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

7. Coital diary data collection page

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

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

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

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

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

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

14. Acceptability of CD study by level of support

16. 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

17. 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

18. 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

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

20. 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