Jeremy Sugarman1, Li Lin2, Jared M Baeten3, Thesla Palanee-Phillips4, Elizabeth R Brown5, Flavia Matovu Kiweewa6, Nyaradzo M Mgodi7, Gonasagrie Nair8, Samantha Siva9, Damon M Seils10, Kevin P Weinfurt2. 1. a Berman Institute of Bioethics and Department of Medicine , Johns Hopkins University , Baltimore , Maryland , USA. 2. b Department of Population Health Sciences , Duke University School of Medicine , Durham , North Carolina , USA. 3. c Global Health, Epidemiology, and Medicine , University of Washington , Seattle , Washington , USA. 4. d Wits Reproductive Health and HIV Institute, University of the Witwatersrand , Johannesburg , South Africa. 5. e Vaccine and Infectious Disease and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center and Department of Biostatistics , University of Washington , Seattle , Washington , USA. 6. f MUJHU Research Collaboration , Kampala , Uganda. 7. g University of Zimbabwe College of Health Sciences Clinical Trials Research Centre , Harare , Zimbabwe. 8. h Desmond Tutu HIV Centre , University of Cape Town , Cape Town , South Africa. 9. i HIV Prevention Research Unit , South African Medical Research Council , Durban , South Africa. 10. j Duke Clinical Research Institute , Durham , North Carolina , USA.
Abstract
BACKGROUND: Some HIV prevention research participants may hold a "preventive misconception" (PM), an overestimate of the probability or level of personal protection afforded by trial participation. However, these reports typically rely upon small, retrospective qualitative assessments that did not use a standardized approach. METHODS: We administered a measure of PM called PREMIS, during Microbicide Trials Network 020-A Study to Prevent Infection with a Ring for Extended Use, a large, multicenter, placebo-controlled, phase III trial evaluating the safety and efficacy of a dapivirine vaginal ring among women at risk for HIV infection in Malawi, South Africa, Uganda, and Zimbabwe. The maximum follow-up period was 2.6 years. RESULTS:One thousand two hundred sixty-one respondents completed PREMIS at their month 3 visit (M3); 2085 at their month 12 visit (M12); and 1010 at both visits. Most participants expressed high expectations of personal benefit (EPB) and that at least one of the rings used in the trial would reduce the risk of getting HIV (expectation of maximum aggregate benefit or EMAB). There was a moderate positive correlation between EPB and EMAB at M3 (r = .43, 95% CI: .37, .47) and M12 (r = .44, 95% CI: .40, .48). However, there was variability among sites in the strength of the relationship. There was no relationship between either expectation variable and condom use, adherence, or HIV infection. CONCLUSIONS: A majority of trial participants expressed some belief that their risk of HIV infection would be reduced by using a vaginal ring, which may signal PM. However, such beliefs were not associated with adherence, condom use, or subsequent HIV infection, and there was variability across sites. Further work is needed to understand these findings.
RCT Entities:
BACKGROUND: Some HIV prevention research participants may hold a "preventive misconception" (PM), an overestimate of the probability or level of personal protection afforded by trial participation. However, these reports typically rely upon small, retrospective qualitative assessments that did not use a standardized approach. METHODS: We administered a measure of PM called PREMIS, during Microbicide Trials Network 020-A Study to Prevent Infection with a Ring for Extended Use, a large, multicenter, placebo-controlled, phase III trial evaluating the safety and efficacy of a dapivirine vaginal ring among women at risk for HIV infection in Malawi, South Africa, Uganda, and Zimbabwe. The maximum follow-up period was 2.6 years. RESULTS: One thousand two hundred sixty-one respondents completed PREMIS at their month 3 visit (M3); 2085 at their month 12 visit (M12); and 1010 at both visits. Most participants expressed high expectations of personal benefit (EPB) and that at least one of the rings used in the trial would reduce the risk of getting HIV (expectation of maximum aggregate benefit or EMAB). There was a moderate positive correlation between EPB and EMAB at M3 (r = .43, 95% CI: .37, .47) and M12 (r = .44, 95% CI: .40, .48). However, there was variability among sites in the strength of the relationship. There was no relationship between either expectation variable and condom use, adherence, or HIV infection. CONCLUSIONS: A majority of trial participants expressed some belief that their risk of HIV infection would be reduced by using a vaginal ring, which may signal PM. However, such beliefs were not associated with adherence, condom use, or subsequent HIV infection, and there was variability across sites. Further work is needed to understand these findings.
Entities:
Keywords:
HIV prevention research; Preventive misconception; attitudes; ethics; informed consent
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