Open Access Research

Long-term consistent use of a vaginal microbicide gel among HIV-1 sero-discordant couples in a phase III clinical trial (MDP 301) in rural south-west Uganda

Andrew Abaasa1*, Angela Crook2, Mitzy Gafos2, Zacchaeus Anywaine1, Jonathan Levin1, Symon Wandiembe1, Ananta Nanoo3, Andrew Nunn2, Sheena McCormack2, Richard Hayes4 and Anatoli Kamali1

Author Affiliations

1 MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda

2 MRC Clinical Trials Unit, London, UK

3 Wits Reproductive Health and HIV Institute (WRHI) University of the Witwatersrand, Johannesburg, South Africa

4 London School of Hygiene and Tropical Medicine, London, UK

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Trials 2013, 14:33  doi:10.1186/1745-6215-14-33

Published: 1 February 2013

Abstract

Background

A safe and effective vaginal microbicide could substantially reduce HIV acquisition for women. Consistent gel use is, however, of great importance to ensure continued protection against HIV infection, even with a safe and effective microbicide. We assessed the long-term correlates of consistent gel use in the MDP 301 clinical trial among HIV-negative women in sero-discordant couples in south-west Uganda.

Methods

HIV-negative women living with an HIV-infected partner were enrolled between 2005 and 2008, in a three-arm phase III microbicide trial and randomized to 2% PRO2000, 0.5% PRO2000 or placebo gel arms. Follow-up visits continued up to September 2009. The 2% arm was stopped early due to futility and the 229 women enrolled in this arm were excluded from this analysis. Data were analyzed on 544 women on the 0.5% and placebo arms who completed at least 52 weeks of follow-up, sero-converted or became pregnant before 52 weeks. Consistent gel use was defined as satisfying all of the following three conditions: (i) reported gel use at the last sex act for at least 92% of the 26 scheduled visits or at least 92% of the visits attended if fewer than 26; (ii) at least one used applicator returned for each visit for which gel use was reported at the last sex act; (iii) attended at least 13 visits (unless the woman sero-converted or became pregnant during follow-up). Logistic regression models were fitted to investigate factors associated with consistent gel use.

Results

Of the 544 women, 473 (86.9%) were followed for at least 52 weeks, 29 (5.3%) sero-converted and 42 (7.7%) became pregnant before their week 52 visit. Consistent gel use was reported by 67.8%. Women aged 25 to 34 years and those aged 35 years or older were both more than twice as likely to have reported consistently using gel compared to women aged 17 to 24 years. Living in a household with three or more rooms used for sleeping compared to one room was associated with a twofold increase in consistent gel use.

Conclusion

In rural Uganda younger women and women in houses with less space are likely to require additional support to achieve consistent microbicide gel use.

Trial registration

Protocol Number ISRCTN64716212

Keywords:
HIV; Vaginal microbicides; Consistent gel use; Adherence; Sero-discordant couples; Phase III trial; Microbicides Development Programme (MDP)