PROGRAM
Microbicides

Audio Computer-assisted Self-interviewing (ACASI) and Microbicides

Population Council researchers and information technology specialists are developing techniques and software for interviewees responding to sensitive questions. These techniques provide greater privacy and confidentiality than answering aloud in face-to-face interviews. Further investigation by the Council and in three studies by the Microbicide Trials Network (MTN) will continue to assess the degree to which greater privacy evokes greater candor in respondents.

A person using an ACASI computer hears prerecorded questions through audio headphones and presses numbers on a numeric keypad or hand-held computer screen to answer them. Both laptop and hand-held computers can be used; if a laptop is used, it can remain open to allow the respondent to read the question along with the voice in the headphones, or it may be closed for complete privacy. Council researchers have found that most participants quickly learn how to use the interview program and prefer the computer over face-to-face interviews.

At the MTN, Council personnel are providing ACASI software for three ongoing and future clinical trials:

• a trial to determine the safety and effectiveness of two different candidate microbicides, with 3,100 sexually active, HIV-negative women participating at seven sites in five countries. At two sites in Malawi, identical interviews—one face-to-face, one ACASI—will be conducted with the same participants to see whether and how much answers differ.

• in collaboration with the International Partnership for Microbicides, an expanded safety and acceptability study of a nonmedicated vaginal ring in 252 sexually active, HIV-negative women participating at one site in India and two in the United States. ACASI will be used throughout the study.

• the first study to compare the safety and efficacy of oral versus topical pre-exposure prophylaxis (PrEP) for prevention of sexual transmission of HIV. Vaginal and Oral Interventions to Control the Epidemic (VOICE) is designed as a five-arm, double-blinded study in which women are first randomized to receive either gel or oral PrEP, and then within each group, randomly assigned to either tenofovir topical gel or placebo gel; or to oral tenofovir, oral Truvada or oral placebo. The study will enroll 4,200 women at 10 sites in several countries. ACASI will be used to ask the questions deemed most sensitive.

The Council itself is conducting an experiment evaluating face-to-face versus computerized interviewing at its three microbicide clinical trial sites in South Africa (where Carraguard® was tested). The study is assessing the accuracy of participants’ self-reported compliance to the agreed-to behavior called for by the study. It is also investigating the reporting of sexual and other risk behaviors, collecting various STI biomarkers for validation of accuracy.

Audio computer-assisted self-interviewing is an exciting new tool for researchers, who need the most accurate information possible in order to draw valid conclusions. There is every reason to expect that ACASI will lend itself to adaptation for many fields, as its use for different reproductive health and microbicide studies demonstrates.

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Duration

2006–ongoing

Population Council researchers

Barbara S. Mensch, Paul C. Hewett

Population Council ACASI developers

Stanley Mierzwa, Stephen Cao

Non-Council collaborators

International Partnership for Microbicides

Microbicide Trials Network

Donors

The William and Flora Hewlett Foundation

US Agency for International Development

US National Institutes of Health
 

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Related Project

• Assessing and Improving the Measurement of Sexual Behaviors

See Also

• "Computerized interviews: More accurate data?" Momentum, December 2005 (full text) (PDF)

• "Our current microbicide trials: Lessons learned and to be learned," Microbicide Quarterly (2006) (PDF)

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