Abstract
BackgroundAudio computer-assisted self-interview (ACASI) may elicit more frequent reporting of socially sensitive behaviours than face-to-face (FtF)-interview. However, no study compared responses to both methods in female and male sex workers (FSW; MSW) in Africa.Methodology/Principal FindingsWe sequentially enrolled adults recruited for an HIV-1 intervention trial into a comparative study of ACASI and FtF-interview, in a clinic near Mombasa, Kenya. Feasibility and acceptability of ACASI, and a comparative analysis of enrolment responses between ACASI and FtF on an identical risk assessment questionnaire were evaluated. In total, 139 women and 259 men, 81% of eligible cohort participants, completed both interviews. ACASI captured a higher median number of regular (2 vs. 1, p<0.001, both genders) and casual partners in the last week (3 vs. 2, p = 0.04 in women; 2 vs. 1, p<0.001 in men). Group sex (21.6 vs. 13.5%, p<0.001, in men), intravenous drug use (IDU; 10.8 vs. 2.3%, p<0.001 in men; 4.4 vs. 0%, p = 0.03 in women), and rape (8.9 vs. 3.9%, p = 0.002, in men) were reported more frequently in ACASI. A surprisingly high number of women reported in ACASI that they had paid for sex (49.3 vs. 5.8%, p<0.001). Behaviours for recruitment (i.e. anal sex, sex work, sex between males) were reported less frequently in ACASI. The majority of women (79.2%) and men (69.7%) felt that answers given in ACASI were more honest. Volunteers who were not able to take ACASI (84 men, and 37 women) mostly lacked reading skills.Conclusions/SignificanceAbout 1 in 5 cohort participants was not able to complete ACASI, mostly for lack of reading skills. Participants who completed ACASI were more likely to report IDU, rape, group sex, and payment for sex by women than when asked in FtF interview. ACASI appears to be a useful tool for high risk behaviour assessments in the African context.
Highlights
Audio computer-assisted self-interview (ACASI), which is known to capture some sensitive behaviours more reliably in high risk populations in developed nations [1], has not been evaluated in populations recruited for HIV-1 prevention trials in Africa
There were no differences in key risk behaviour comparisons established in FtF interview between participating and non-participating men
Risk behaviour assessed in FtF-interview between nonACASI and ACASI participants was not different in men; but women unable to use ACASI more frequently reported anal sex in the previous 3 months, and a higher number of recent casual partners
Summary
Audio computer-assisted self-interview (ACASI), which is known to capture some sensitive behaviours more reliably in high risk populations in developed nations [1], has not been evaluated in populations recruited for HIV-1 prevention trials in Africa. As such populations are purposefully selected for presumed ‘high-risk’ behaviour, interviewer attitudes may impact socially desirable responses of the interviewee, especially because socially stigmatised behaviours such as male same sex behaviour, or anal sex practice, are rarely assessed in Africa [2,3]. No study compared responses to both methods in female and male sex workers (FSW; MSW) in Africa
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