Patterns of concurrent condom and microbicide use in the MDP 301 trial, Johannesburg.
Introduction: First generation vaginal microbicides are envisaged to be approximately 40% efficacious in preventing sexually transmitted infections (STIs) and HIV, considerably less than condoms, raising concerns of 'condom migration'. We describe condom use in a microbicide trial and discuss its implications for dual use in the general population. Methods: In-depth interviews (IDI) with a sub-set of female MDP 301 participants took place at months 1, 6 and 12. Participants not included in the IDI sample joined in focus group discussions (FGD). Amongst other issues these discussions and interviews explored condom and gel use. Thematic analysis was used to code and analyse data using Nvivo2. Quantitative analysis was done using STATA 8.2. Proportions were reported with 95% CI. Results: There were 259 IDI and 13 FGD analysed. IDI recorded 1245 sex acts over 12 months. Self-reported gel use was 80% (77-83), 82% (78-86) and 73% (66-79) at month 1, 6 and 12, respectively (p-value=0.026). Condom use was 80% (77-83), 86% (81-89) and 80% (74-86) at month 1, 6 and 12 respectively (p-value=0.045). Concurrent condom and gel use was attributed to a desire to adhere to trial procedures, prevent STI/HIV, and protect partners from gel side effects. Many women who previously had difficulties using condoms reported that the gel improved penetration with a condom. Condom use was also motivated by regular HIV and STI testing and health education. Few participants reported a decline in condom use due to the availability of other forms of contraception, and the belief that the gel was efficacious. Discussion: These findings do not support condom migration with microbicide use. Although our evidence is limited to a trial context in which there are strong motivations for condom use, our data provides some indication that microbicides and condoms may be viewed as compatible, therefore encouraging dual condom and gel use.
Mntambo, A.Q. Patterns of concurrent condom and microbicide use in the MDP 301 trial, Johannesburg. Presented at Microbicides 2008, New Delhi, India, 24-27 February 2008. (2008)