Adherence to Rectal Microbicide Use Among Mainly Ethnic Min - PowerPoint Presentation

Slide1

Adherence to Rectal Microbicide Use Among Mainly Ethnic Minority Young MSM:Lessons from a 3-month Placebo Gel Trial at 3 US sites

Alex Carballo-Diéguez, Ph.D

.

Columbia University, NYC, USSlide2

Background

In the USA, young men who have sex with men (YMSM), especially those who are ethnic minorities, have high prevalence and incidence of HIV

Many report inconsistent condom use for receptive anal intercourse (RAI)

Rectal

microbicides

(RM

) could be an alternative if if efficacious and

consistently used

(adherence)Slide3

Research question

“

How

frequently would YMSM with a

history of

condomless

RAI apply

a gel

prior

to

RAI in their everyday lives?

” Slide4

Study Procedures

We recruited MSM ages 18-30 in 3 USA sites

Baseline assessment of sexual risk behavior

Delivery of 40 applicators prefilled with 4mL HEC (

hydroxyethylcellulose

) gel

Applicators to be used within 90 minutes prior to RAI over 12 weeks

Follow up interview at week 12Slide5

3 measures of sexual behavior and gel use

Interactive Voice Response System (IVRS

)

to report

RAI and gel use

weekly

U

sed

and unused applicators

returned to

clinic at 6 and 12 weeks

Web-based CASI

completed at the end of 12 weeks with questions

on gel use with

RAISlide6

Participant Demographics N=95

Mean (SD)

Range

Age

23.2 years (3.2)

18-30

Education

1

4.6 (1.1)

2-7

N

%Race/Ethnicity White/European American3436% Latino/Hispanic4648% Black/African American910% Mixed/Other66%Sexual identity self-label Gay/Homosexual8186% Bisexual1314%

1

Measured on a 7-point scale (4=partial college).Slide7

Sexual Behavior prior 3 months

N=95

1

Baseline

Follow-up

Median; Range

Median; Range

t (

df

)

p

Number of male partners 23; 1-702; 0-403.82(92)<.001Frequency of receptive anal intercourse (RAI) 27; 1-9212; 0-70nsFrequency of unprotected RAI (URAI) 23; 1-952; 0-602.96(92).004N(%)Had URAI with partner of serodiscordant or unknown status29 (31%)

1

Some variables have missing data; percentages are of those with non-missing data.

2

Variables log-transformed prior to t-tests due to skewed distributions.Slide8

Discrepancy of gel use measuresSlide9

Gel use during sexOverall, participants

used gel

on about

4 out of 5

RAI

occasions

Based on CASI (N=83):

Median 12 occasions RAI

82.4% adherence to gel use with RAI

Based on IVRS (N=88)

Median 10.5 occasions RAI

87.9% adherence to gel use with RAISlide10

Factors associated with adherence

Correlated factors

Liking the gel

Sexual enjoyment with gel

Positive partner reaction to gel

Likelihood of future use of gel if

effectiveSlide11

Sexual enjoyment

97% felt gel made RAI feel better or not different

37% better

60% no difference

3% worse

76% felt penetration was easier with gel

“It provided better lubrication inside of the rectum

than regular

lubricant usage.”Slide12

Reasons for not using the gel (n=40)

N(%)

I did not have the gel with me

34 (85%)

I forgot

19 (48%)

I did not want to use the gel

5 (13%)

My sexual partner did not want me to use the gel

4 (10%)

The gel was messy

4 (10%)I did not like how the gel felt inside me 2 ( 5%)Slide13

Reasons for not using gel

Not having gel on hand

“

I forgot the stuff at home, and I had sex, like it was an unexpected one. That’s why I couldn’t use it.

”

“I was just waking up and the gel was in another room and my partner wanted to have sex right away.” Slide14

Reasons for not using gel

Forgetting

“I had the gel with me in the same room, I was ready to use it and we got into foreplay, and by the time we were having anal sex I forgot about the gel.”Slide15

Reasons for not using gel

Problems with discreet usage/not wanting to use gel

“Some of the time I didn’t want to tell someone that I had to use it, and I wasn’t able to discreetly use it.

”

“[The partner] was from online, but I didn’t just feel comfortable using that with him. I just thought it would be weird to just whip that out.”Slide16

Reasons for not using the gel

Applicator portability/not having gel on hand

“It was not something planned. So, the gel was not on hand…I’m not going to put that syringe in my pocket just in case something happens.”Slide17

Microbicide Gel Applicators

Rectal Microbicide Applicator

12.6 cm long

2.6 cm barrel diameter

0.5 cm tip circumference

Vaginal Microbicide Applicator

11.9 cm long

1.5 cm barrel diameter

4.1 cm tip circumference

Photo courtesy of: Microbicide Trials Network,

University of Pittsburgh and Magee-

Womens Research InstituteSlide18

Conclusions

Ethnically diverse young MSM with a history of unprotected RAI showed

high adherence

to gel use.

Different

self-report methods provided convergent results.Slide19

RecommendationsAdherence to product use could potentially be enhanced

by:

improving

portability

improving

motivation and partner negotiation skills

a

nd facilitating

the development of routines to counteract

forgetfulness Slide20

LimitationsA product of

known efficacy

could have different uptake than the placebo used in this study.Slide21

Acknowledgements

Rebecca Giguere

1

José Bauermeister

2

Curtis Dolezal

1

Timothy Frasca

1

Cheng-

Shiun

Leu1 NICHDJuan Valladares1Irma Febo3Ross Cranston4Kenneth Mayer5Ian McGowan41 Columbia University and NY State Psychiatric Institute, New York, NY USA2 University of Michigan School of Public Health, Ann Arbor, MI USA3 University of Puerto Rico Medical Sciences Campus, San Juan, PR USA4 University of Pittsburgh School of Medicine, Pittsburgh, PA USA5 The Fenway Institute, Fenway Health, Boston, MA USASlide22

Questions?

ac72@columbia.edu