Page 398 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 3 of 7 Original Research

microscopic examination of wet mount specimen and whiff Results
test for bacterial vaginosis and OSOM® Trichomonas test for
Trichomonas vaginalis were also performed. Demographics and sexual behaviour
There were 50 women enrolled, with a mean age of 22 years
No intervention to reduce VP was mandated in the protocol, (s.d. 2.0). At screening, women reported multiple sexual
but at their discretion, clinicians discussed the topic with partnerships (Table 1), with a mean of one main partner for 49
participants as part of health education that was not required women and 2 casual partners for 48 women in the last 30 days.
to be documented. Seven women reported one new partner in the last 30 days.
The mean ages of main, casual and new partners were similar
Statistical analysis (27.0, 26.0 and 26.8 years, respectively). The average number
of times women had sex in the last 30 days was different by
Statistical analysis was conducted using SAS Enterprise partner type: 15.3 times with their main partner, 10 times with
Guide 6.1 (SAS Institute, Cary, NC). Baseline measures at their casual partner and 3.6 times with a new partner. Women
screening were assessed descriptively for the main, casual reported the nature of their partnerships to be transactional in
and new partners. Continuous measures such as age of 14.3% (n = 7) of main, 41.7% (n = 20) of casual and 66.7% (n = 4)
participant, age of sexual partners and number of sexual of new partnerships. Although 59.6% of women reported that
partners were assessed using means, standard deviations their casual partners were having sex outside of their
(s.d.) and ranges; frequencies and their percentages were partnership, 73.5% of women reported that they did not know
determined for categorical measures such as frequency of if their main partners had other sexual partners.
condom use (categorised as inconsistent if reported as ‘never’
or ‘sometimes’ vs. consistent if reported as ‘always’) and The proportion of women who reported always using
alcohol use. Condom use was not specifically categorised by condoms also varied by partner type: 2.0% (n = 1) with main
transactional versus non-transactional sex acts. partner, 25.0% (n = 12) with casual partners and 42.9% (n = 3)
with new partners. However, condom use increased by the
Frequencies were similarly determined for VP at screening last visit with 20.0% (n = 7/35) of women using condoms with
and the final visit at month 3. Vaginal practices were classified their main partner and 56.0% (n = 9/16) in casual partnerships.
as ‘ever’ or ‘none’ for each recall period, where ‘ever’ referred
to any report of the VP in question regardless of frequency During follow-up, one participant was withdrawn because of
and ‘none’ was defined as never having engaged in that VP. non-adherence to all protocol procedures, one participant
VP, risk behaviours including number of sexual partners, was terminated from the study because of pregnancy and 2
frequency of condom use, transactional sex, and alcohol and participants were lost to follow-up. Missing data occurred
drug use were compared at screening and final visit using intermittently at weeks 1 (n = 1, 2%), 3 (n = 3, 6%), 4 (n = 1,
McNemar’s test. The laboratory GTI test results and 2%), 6 (n = 3, 6%), 8 (n = 3, 6%) and 12 (n = 4, 8%). There were
symptomatic GTIs at enrolment were similarly compared. no incident HIV infections during the study.

The pattern of missing data at each follow-up visit was Vaginal practices
assessed to determine whether it was monotone or
intermittent. A weighted generalised estimating equation Table 2 shows the VP at screening: washing vigorously outside
(GEE) was used to model enrolment factors associated with the vagina (10%), washing with water (44%) or something else
VP during follow-up where the dependent variable was an (32%), using fingers (48%) or something else (28%) to wash
indicator of VP at each visit. Variables from the behavioural inside the vagina, placing traditional medications inside the
risk assessment at enrolment were used as covariates in the vagina (2%) and using tampons (8%). Although specifically
modelling. These included participant age, having a main asked, no women reported using conventional medications,
sexual partner, age of the main partner, having casual paper, cloth, sponges, cotton wool, gel, lubricants, creams
partners, frequency of vaginal sex, consistent or inconsistent including haemorrhoid creams or anything else inside the
condom use with any of the partners, transactional sex, vagina. Compared to screening, at month 3 there were significant
whom they last had sex with among the partner types and declines in women reporting washing inside the vagina with
laboratory-confirmed GTI results. The univariate GEE model water (p < 0.001) or with something else besides water (p < 0.001)
was fitted followed by the multivariate model. Modelling as well as significant reductions in the use of fingers (p < 0.001)
assumed a compound symmetry covariance structure, a or other means (p < 0.001) to wash inside the vagina (Table 2).
binomial distribution for the dependent variable and a logit
link. All the variables with a p-value of < 0.1 at the univariate Overall, each visit was associated with a drop of 0.47
level were considered for entry into the multivariate model (p < 0.001) in the number of participants reporting VP.
followed by application of a stepwise selection procedure.
Genital tract infections
Ethical consideration On the laboratory GTI tests conducted at enrolment,

The study was approved by the University of the 20 (40%) participants had a positive result with 5 (10%)
Witwatersrand Human Research Ethics Committee (Ethics having more than one infection concurrently (4 had two
reference number: 131114). infections and 1 had 3 infections): 4 (8%) had gonorrhoea,

http://www.sajhivmed.org.za 391 Open Access