Computer tool improves HIV risk behavior self-reporting in Africa

By Jeff Sheehy

A computer and headphone self-interviewing system yielded higher self-reports of several key HIV risks behaviors and was the preferred interview method by Zimbabwean women in Africa, according to a study by UCSF researchers.

Known as ACASI, for audio computer-assisted self-interviewing, the system was tested for the first time in a developing country by the UCSF team.

“We struggle with how to ask questions and conduct interviews to get honest answers about sensitive HIV risk behavior.  As one woman said, ‘sometimes you are tempted to lie because you feel shy.’ With ACASI, even though most of the women were using a computer for the first time, they loved the experience and it seems that we obtained more accurate data for some key HIV risks,” said study investigator Alexandra M. Minnis, PhD, epidemiologist with the UCSF Women’ s Global Health Imperative (WGHI).

Minnis presented the findings today (July 29) at the 15th Biennial Congress of the International Society for Sexually Transmitted Diseases in Ottawa, Canada.

With ACASI, study participants listen to questions using headphones and type in simple answers on a laptop computer.  They are taught how to use the computer and are given time to practice before the interview.  In addition, they are able to go back and change responses if they so desire. Only ten percent of the Zimbabwean women in the study had ever used a computer before.

Seventy percent preferred the computer, one percent preferred face to face interviews, and the remainder had no preference. Participants using ACASI reported higher rates of multiple partners in the previous three months and higher use of withdrawal and rhythm methods of contraception than rates reported in face-to-face interviews.  Reports of pregnancy were also higher with ACASI, indicating that women were not using condoms or hormonal methods of contraception.

“ACASI helps skirt the cultural issues that you get in a personal interview. It also helps with social desirability bias.  In a number of instances, I have been presented with ‘immaculate infections’ due to hesitancy in reporting HIV risk behavior in face-to-face interviews. ACASI measures behavior better and is an incredibly valuable tool,” said WGHI’s director and study co-author, Nancy Padian, PhD, UCSF professor of obstetrics, gynecology and reproductive services and director of international programs at the UCSF AIDS Research Institute.

WGHI is a global research program based at the UCSF AIDS Research Institute and UCSF Department of Obstetrics, Gynecology and Reproductive Sciences. Scientists at WGHI conduct research and training related to HIV/AIDS, gender and reproductive health. This research is used to design and rapidly implement practical and effective prevention and treatment strategies for women at risk for or living with HIV.

Study co-authors are Shelly Chitsungo, Angella Muchini and Prisca Nyamapeni, and Tsungai Chipato, MD, University of Zimbabwe professor of obstetrics and gynecology, all at the UZ -UCSF Collaborative Research Programme in Women’s Health, Harare, Zimbabwe; and Charles Morrison, PhD, senior epidemiologist at Family Health International, Research Triangle Park, North Carolina.

Funding for this research was provided by a grant from the National Institute of Child Health and Human Development, National Institutes of Health.