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1.  Performance of a Rapid Self-Test for Detection of Trichomonas vaginalis in South Africa and Brazil 
Journal of Clinical Microbiology  2013;51(3):1037-1039.
Women participating in studies in Brazil (n = 695) and South Africa (n = 230) performed rapid point-of-care tests for Trichomonas vaginalis on self-collected vaginal swabs. Using PCR as the gold standard, rapid self-testing achieved high specificity (99.1%; 95% confidence interval [CI], 98.2 to 99.6%) and moderate sensitivity (76.7%; 95% CI, 61.4 to 88.2%). These tests may be considered an alternative to syndromic management in resource-poor settings.
PMCID: PMC3592092  PMID: 23325818
2.  Consistency in Women’s Reports of Sensitive Behavior In an Interview Mode Experiment, São Paulo, Brazil 
Inaccurate reporting of sexual behavior creates amisleading picture of individuals’ risk for STI infection. Despite a substantial body of U.S. research on the consistency of self-reports of sensitive behavior, only a few such studies have been conducted in developing countries.
Consistency in the reporting of sexual activity and other sensitive behaviors was assessed among 818 women aged 18–40who enrolled in 2004 in a study examining STI screening and diagnosis in São Paulo, Brazil. Participants were randomized into face-to-face interview and audio computer-assisted self-interview(audio-CASI) groups, and a six-week follow-up interview was conducted using audio-CASI for all participants. Differences between groups were assessed using t tests, and logistic regression analyses were used to estimate the likelihood of inconsistency within the enrollment interview and between the enrollment and follow-up interviews.
Consistency in reporting at the enrollment interview was higher in the face-to-face group than in the audio-CASI group, likely because interviewers prompted women to reconcile discrepant responses, whereas the audio-CASI program did not enforce logical consistency. However, consistency between enrollment and follow-up was significantly lower in the face-to-face group for abortion, marijuana use, transactional sex, coerced sex and number of lifetime sexual partners, because of increased reporting at follow-up using audio-CASI.
Although the analysis of internal consistency at enrollment suggests that computerized interviewing may increase random measurement error, it appears to reduce social desirability bias and encourage higher reporting of sensitive behaviors.
PMCID: PMC2723120  PMID: 19201677
3.  Is representativeness the right question? 
PMCID: PMC3997375  PMID: 24436097
4.  Validity and Reliability of Using a Self-Lavaging Device for Cytology and HPV Testing for Cervical Cancer Screening: Findings from a Pilot Study 
PLoS ONE  2013;8(12):e82115.
Self-sampling could increase cervical cancer screening uptake. While methods have been identified for human papillomavirus (HPV) testing, to date, self-sampling has not provided adequate specimens for cytology. We piloted the validity and reliability of using a self-lavaging device for cervical cytology and HPV testing. We enrolled 198 women in New York City in 2008–2009 from three ambulatory clinics where they received cervical cancer screening. All were asked to use the Delphi Screener™ to self-lavage 1–3 months after clinician-collected index cytological smear (100 normal; 98 abnormal). Women with abnormal cytology results from either specimen underwent colposcopy; 10 women with normal results from both specimens also underwent colposcopy. We calculated sensitivity of self-collected cytology to detect histologically confirmed high grade lesions (cervical intraepithelial neoplasia, CIN, 2+); specificity for histology-negative (CIN 1 or lower), paired cytology negative, or a third cytology negative; and kappa for paired results. One hundred and ninety-seven (99.5%) women self-collected a lavage. Seventy-five percent had moderate to excellent cellularity, two specimens were unsatisfactory for cytology. Seven of 167 (4%) women with definitive results had CIN2+; one had normal and six abnormal cytology results with the self-lavage (sensitivity = 86%, 95% Confidence Interval, CI: 42, 100). The kappa for paired cytology was low (0.36; 95% CI: 0.25, 0.47) primarily due to clinician specimens with atypical squamous cells of undetermined significance (ASC-US) and low grade squamous intraepithelial lesion (LSIL) coded as normal using Screener specimens. However, three cases of HSIL were coded as ASC-US and one as normal using Screener specimens. Seventy-three women had paired high-risk HPV tests with a kappa of 0.66 (95% CI: 0.49, 0.84). Based on these preliminary findings, a larger study to estimate the performance of the Screener for co-testing cytology and HPV or for HPV testing with cytology triage is warranted.
Trial Registration NCT00702208
PMCID: PMC3869665  PMID: 24376516
5.  Awareness and Interest in Intrauterine Contraceptive Device Use among HIV-Positive Women in Cape Town, South Africa 
Objective. To assess awareness of and interest in intrauterine contraceptive device (IUCD) use among HIV-positive women in Cape Town, South Africa. Design. Cross-sectional survey. Methods. HIV-positive women aged 18 through 45 years presenting for care at a primary health care clinic in Cape Town, South Africa participated in this study. Consented participants completed a staff-administered questionnaire in a private setting. Descriptive statistics were generated. Comparisons between demographic and reproductive health-related variables and IUCD awareness and interest were performed with multiple logistic regression. Analyses for IUCD interest excluded women with prior surgical sterilization. Results. Of 277 HIV-positive women, 37% were aware of the IUCD; awareness was independently associated with greater age (adjusted odds ratio (AOR) = 1.15, 95%; confidence interval (CI): 1.10–1.20) and not switching contraceptive methods in the last year (AOR = 2.45, 95% CI: 1.03–5.83). Following an IUCD information session, 86% of women (n = 206/240) were interested in IUCD use. IUCD interest was inversely associated with age (AOR = 0.91, 95% CI: 0.86–0.97) and marginally positively associated with current menstrual bleeding pattern complaints (AOR = 2.14, 95% CI: 0.98–4.68). Conclusions. Despite low levels of method awareness, HIV-positive women in this setting are frequently interested in IUCD use, indicating need for programming to expand method access.
PMCID: PMC3388580  PMID: 22778537
6.  Using Sexually Transmitted Infection Biomarkers to Validate Reporting of Sexual Behavior within a Randomized, Experimental Evaluation of Interviewing Methods 
American Journal of Epidemiology  2008;168(2):202-211.
This paper examines the reporting of sexual and other risk behaviors within a randomized experiment using a computerized versus face-to-face interview mode. Biomarkers for sexually transmitted infection (STI) were used to validate self-reported behavior by interview mode. As part of a parent study evaluating home versus clinic screening and diagnosis for STIs, 818 women aged 18−40 years were recruited in 2004 at or near a primary care clinic in São Paulo, Brazil, and were randomized to a face-to-face interview or audio computer-assisted self-interviewing. Ninety-six percent of participants were tested for chlamydia, gonorrhea, and trichomoniasis. Reporting of STI risk behavior was consistently higher with the computerized mode of interview. Stronger associations between risk behaviors and STI were found with the computerized interview after controlling for sociodemographic factors. These results were obtained by using logistic regression approaches, as well as statistical methods that address potential residual confounding and covariate endogeneity. Furthermore, STI-positive participants were more likely than STI-negative participants to underreport risk behavior in the face-to-face interview. Results strongly suggest that computerized interviewing provides more accurate and reliable behavioral data. The analyses also confirm the benefits of using data on prevalent STIs for externally validating behavioral reporting.
PMCID: PMC3290925  PMID: 18525081
biological markers; computing methodologies; condoms; data collection; regression analysis; sexual behavior; sexually transmitted diseases; social desirability
7.  Agreement between Self- and Clinician-Collected Specimen Results for Detection and Typing of High-Risk Human Papillomavirus in Specimens from Women in Gugulethu, South Africa▿  
Journal of Clinical Microbiology  2007;45(6):1679-1683.
We assessed the agreement in detection of high-risk human papillomavirus (HPV), as well as specific HPV types, between self- and clinician-obtained specimens for 450 women over 18 years of age attending a community health center in Gugulethu, South Africa. Both self-collected swabs and tampons had high agreement with clinician-obtained brushes when the Roche Reverse Line Blot Assay (RLBA) was used (for swabs, 86% concordance, with a kappa statistic [κ] of 0.71; for tampons, 89% concordance, with κ of 0.75). Agreement was lower, although still fair, with the Digene Hybrid Capture 2 test (HC2), with κ higher for swabs than for tampons (for swabs, 81% concordance, with κ of 0.61; for tampons, 82% concordance, with κ of 0.55). Low-risk HPV types were nearly two times more common in self-collected specimens than in clinician-collected specimens tested by RLBA. All 15 women diagnosed with high-grade lesions by cytology tested positive for high-risk HPV with clinician-collected specimens tested by RLBA and HC2, while 11 out of 15 tested positive with self-collected specimens by HC2 and 5 out of 6 tested positive by RLBA. Self-collected specimens can provide valid specimens for HPV testing using nucleic acid amplification tests, although a few cytological abnormalities may be missed.
PMCID: PMC1933028  PMID: 17409209

Results 1-7 (7)