CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

936 PREFERENCE AND CHOICE OF MULTIPURPOSE PREVENTION TECHNOLOGIES IN YOUNG AFRICAN WOMEN Ariane van der Straten 1 , Helen Cheng 1 , Kawango Agot 2 , Khatija Ahmed 3 , Rachel Weinrib 1 , Kgahlisho Manenzhe 3 , Fredrick Owino 2 , Alexandra Minnis 1 , for theTrio StudyTeam 1 RTI Intl, San Francisco, CA, USA, 2 Impact Rsr and Development Org, Kisumu, Kenya, 3 Setshaba Rsr Cntr, Pretoria, South Africa Background: Preventing HIV and unintended pregnancies are key health priorities in young African women. We evaluated product preference and choice in a cross-over study of 3 multipurpose prevention technology (MPT) placebo delivery forms: vaginal ring, injections or daily pills. Methods: We enrolled 277 HIV-negative, sexually active, non-pregnant women aged 18-30 in a randomized cross-over study to use each MPT for one month. Participants were provided male condoms at every visit. Participants ranked the 3 products and condoms (from #1 top to #4 bottom), at enrollment and month-3. Next they chose one MPT for an additional 2-month usage period. We examined changes in product ranking between enrollment and month-3 (Wilcoxon signed-rank test), and, in multivariable logistic regression, the relationships of age (<25 vs. 25+) and country with the product ranked #1 at month-3, adjusting for past use of the contraceptive delivery form. Results: Among the 214 participants who have reached their month-3 visit, 109 are from Kenya (51%) and 105 from South Africa, mean age is 23.2 years and 94% currently have a main partner. Product ranking significantly increased between enrollment and month-3 for injections (p<.001) and for ring (p<.001), but decreased for pills (p<.0001) and condoms (p=0.02). At month-3, 63% top-ranked injections, 16% top-ranked pills, 12% top-ranked ring and 9% top-ranked condoms (Figure 1). Age or country were not associated with top-ranking injection or ring at month-3; however, more Kenyans ranked pills as their #1 preference (AOR=2.3, 95% CI 1.1-5.1), compared to South Africans. MPT choice for the usage period mimicked preference ranking: 64% chose injections, 22% chose pills and 14% chose ring. “Ease of use” was the most common reason for choosing any of the three MPT; for injections or ring, infrequent dosing was another common reason, while lack of side effects was cited for pills. Conclusion: Compared to male condoms, an existing MPT, all Trio products ranked similarly or higher. Injections were the top preference for a majority, while pills and rings each were most preferred by fewer than 1 in 5 participants, with some variation by country. MPT ranking changed following actual experience with each product, and it aligned well with product choice. User convenience appeared as paramount for selecting an MPT.

Poster and Themed Discussion Abstracts

937 MODERN CONTRACEPTIVE USE AND UNPROTECTED SEX IN HIGH-RISK HIV-POSITIVE WOMEN IN KENYA Diya Surie 1 , Krista Yuhas 1 , Kate Wilson 1 , Linnet N. Masese 1 , Juma Shafi 2 , John Kinuthia 3 , Walter Jaoko 2 , R. Scott McClelland 1 1 Univ of Washington, Seattle, WA, USA, 2 Univ of Nairobi, Nairobi, Kenya, 3 Kenyatta Natl Hosp, Nairobi, Kenya

Background: As antiretroviral therapy is scaled-up across sub-Saharan Africa, millions of women with HIV can expect to survive through their reproductive years. Modern contraceptives help women prevent unintended pregnancy while allowing them to choose the timing and spacing of childbearing. However, concerns remain that women with HIV who use modern contraceptives may engage in more unprotected intercourse because of their decreased risk of unintended pregnancy. This study evaluated whether modern contraceptive use by high-risk, HIV-positive women was associated with increased frequency of unprotected sex, measured by detection of prostate-specific antigen (PSA) in vaginal secretions and self-reported unprotected sex. Methods: Women who were HIV-positive and reported transactional sex in Mombasa, Kenya were included in this analysis. Pregnant and post-menopausal women were excluded. At enrollment and quarterly follow-up visits, a pelvic speculum examination with collection of vaginal secretions was conducted for detection of PSA. In addition, women were interviewed for current contraceptive methods and sexual risk behavior at enrollment and monthly follow-up visits. We used log-binomial generalized estimating equations regression to test for associations between modern contraceptive use and detection of PSA in vaginal secretions and self-reported unprotected sex. Data from October 1, 2012 through September 30, 2014 were included in this analysis. Results: Overall, 330 women contributed 1,746 quarterly examination visits and 3,868 monthly visits. There was minimal difference in PSA detection at contraceptive-exposed versus contraceptive-unexposed visits (adjusted RR [aRR] 1.16, 95% CI 0.85–1.58). However, self-reported unprotected sex was higher when women used contraceptives (aRR 1.65, 95% CI 1.04–2.63). Conclusion: Modern contraceptives were not associated with increased risk of objective evidence of unprotected sex, but may influence reporting of unprotected sex in this population.

CROI 2017 406