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Objective Measurement of Inaccurate Condom Use Reporting Among Women Using Depot Medroxyprogesterone Acetate for Contraception

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Abstract

Observational analyses have suggested that women using the injectable contraceptive depot medroxyprogesterone acetate (DMPA) may have heightened risk of acquiring HIV. However, those analyses were potentially confounded by sexual behavior, with possible differential condom use and reporting by women using DMPA versus no contraception. In a cross-sectional study, we measured the presence of a biomarker of recent condomless sex (Y chromosomal [Yc] DNA) in vaginal swabs from HIV-uninfected African women who had an HIV-infected partner and reported 100 % condom use. Half of the samples tested were from women reporting DMPA and half were from women using no contraception. Among 428 specimens tested (213 from DMPA users and 215 from women using no contraception), 32.0 % had Yc DNA detected, with a mean of 193 copies/10,000 human cells (range 0.1–8201). The frequency of detection did not differ by contraceptive use: 34.2 % of DMPA users versus 29.8 % of women using no contraception, adjusted odds ratio 1.3 (95 % confidence interval 0.9–2.0). These results suggest that inaccurate reporting of condom use by DMPA users may not account for the heightened risk of HIV acquisition among DMPA users in some observational studies

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Acknowledgments

The authors thank the couples who participated in this study and the teams at the study sites for work on data collection and management. The authors acknowledge the Director, KEMRI for support.

Partners PrEP Study Team

University of Washington Coordinating Center and Central Laboratories: Connie Celum (principal investigator, protocol co-chair), Jared M. Baeten (medical director, protocol co-chair), Deborah Donnell (protocol statistician), Robert W. Coombs, Lisa Frenkel, Craig W. Hendrix, Jairam Lingappa, M. Juliana McElrath.

Study sites and site principal investigators

Eldoret, Kenya (Moi University, Indiana University): Kenneth Fife, Edwin Were; Kabwohe, Uganda (Kabwohe Clinical Research Center): Elioda Tumwesigye; Jinja, Uganda (Makerere University, University of Washington): Patrick Ndase, Elly Katabira; Kampala, Uganda (Makerere University): Elly Katabira, Allan Ronald; Kisumu, Kenya (Kenya Medical Research Institute, University of California San Francisco): Elizabeth Bukusi, Craig Cohen; Mbale, Uganda (The AIDS Support Organization, CDC-Uganda): Jonathan Wangisi, James Campbell, Jordan Tappero; Nairobi, Kenya (University of Nairobi, University of Washington): James Kiarie, Carey Farquhar, Grace John-Stewart; Kenya Medical Research Institute, Nairobi, Kenya: Nelly Rwamba Mugo; Tororo, Uganda (CDC-Uganda, The AIDS Support Organization): James Campbell, Jordan Tappero, Jonathan Wangisi. Data management was provided by DF/Net Research, Inc. (Seattle, USA) and site laboratory oversight was provided by Contract Laboratory Services (University of the Witwatersrand, Johannesburg, South Africa).

Funding

Eunice Kennedy Shriver National Institute of Child Health & Human Development of the US National Institutes of Health (Grants R21HD074439 and R00HD076679); Bill and Melinda Gates Foundation (Grant OPP47674). The content is solely the responsibility of the authors and does not necessarily reflect the views of the study funders.

Author information

Authors and Affiliations

  1. Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA

    Renee Heffron, Nelly Mugo, Deborah Donnell, Connie Celum & Jared M. Baeten

  2. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Renee Heffron, Connie Celum & Jared M. Baeten

  3. Department of Medicine, University of Washington, Seattle, WA, USA

    Connie Celum & Jared M. Baeten

  4. Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Urvi M. Parikh, Kerri J. Penrose & John W. Mellors

  5. Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA

    John W. Mellors

  6. Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA

    John W. Mellors

  7. Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya

    Nelly Mugo

  8. Division of Vaccine and Infectious Disease, Fred Hutch, Seattle, WA, USA

    Deborah Donnell

Authors
  1. Renee Heffron
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  2. Urvi M. Parikh
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  4. Nelly Mugo
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  5. Deborah Donnell
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  8. Jared M. Baeten
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Consortia

Partners PrEP Study Team

  • Connie Celum
  • , Jared M. Baeten
  • , Deborah Donnell
  • , Robert W. Coombs
  • , Lisa Frenkel
  • , Craig W. Hendrix
  • , Jairam Lingappa
  • , M. Juliana McElrath
  • , Kenneth Fife
  • , Edwin Were
  • , Elioda Tumwesigye
  • , Patrick Ndase
  • , Elly Katabira
  • , Allan Ronald
  • , Elizabeth Bukusi
  • , Craig Cohen
  • , Jonathan Wangisi
  • , James Campbell
  • , Jordan Tappero
  • , James Kiarie
  • , Carey Farquhar
  • , Grace John-Stewart
  •  & Nelly Rwamba Mugo

Corresponding author

Correspondence to Renee Heffron.

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Conflicts of Interest

All authors declare no conflicts of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Research Involving Human Participants and/or Animals

All procedures performed were in accordance with the ethical standards of the University of Washington institutional review board, national research ethics committees for each study site, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Heffron, R., Parikh, U.M., Penrose, K.J. et al. Objective Measurement of Inaccurate Condom Use Reporting Among Women Using Depot Medroxyprogesterone Acetate for Contraception. AIDS Behav 21, 2173–2179 (2017). https://doi.org/10.1007/s10461-016-1563-y

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  • DOI: https://doi.org/10.1007/s10461-016-1563-y

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