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Mngomezulu K, Mzobe G, Mtshali A, Baxter C, Ngcapu S. The use of PSA as a biomarker of recent semen exposure in female reproductive health studies. J Reprod Immunol 2021; 148:103381. [PMID: 34563757 DOI: 10.1016/j.jri.2021.103381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022]
Abstract
Semen contains potent soluble proteins, bacteria, viruses, activated immune cells as well as anti- and pro-inflammatory cytokines that may influence the inflammatory response and alter microbial composition of the female genital tract. The presence of semen in the female genital mucosa may be a significant confounder that most studies have failed to control for in their analysis. Prostate-specific antigen (PSA), a protein secreted by the prostate into the urethra during ejaculation, is a well-established biomarker of semen exposure. Several studies have demonstrated discordance between self-reports of sexual behavior and the presence of PSA. Recent semen exposure has been shown to promote pro-inflammatory responses, stimulate the recruitment of activated immune cells and decrease Lactobacilli abundance in the female genital mucosa. As a result, it is important to understand the concordance between self-reported consistent condom use and the presence of semen biomarkers. Furthermore, to ensure that the interpretation of data in clinical studies of the immunological and microbial environment in the female genital mucosa are accurate, it is essential to establish whether semen is present in the vaginal fluid. This review explores the impact of semen exposure on the mucosal microenvironment and assesses the use of the PSA as an objective biomarker of semen exposure to reduce reliance on self-reported sexual intercourse.
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Affiliation(s)
- Khanyisile Mngomezulu
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Gugulethu Mzobe
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Andile Mtshali
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Cheryl Baxter
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Department of Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Sinaye Ngcapu
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Department of Medical Microbiology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
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2
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Zimmerman RS, Mehrotra P, Madden T, Paul R. The Value of Assessing Self-Reported and Biological Indicators of Outcomes in Evaluating HIV Programs. Curr HIV/AIDS Rep 2021; 18:365-376. [PMID: 33993397 DOI: 10.1007/s11904-021-00560-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW In this manuscript, we present recent findings concerning concordance and discrepancy between biological measures and self-reports of these three outcomes of HIV programs: HIV status, adherence to antiretroviral medications (ARVs) and use of and adherence to pre-exposure prophylaxis medication (PrEP), and condom use/unprotected sex. RECENT FINDINGS Recent studies suggest that three successive rapid HIV tests (for those whose first test in positive) might be reasonably inexpensive and valid biological data to collect to combine with self-reports of HIV status, dried blood spots sufficiently affordable to combine with self-reports of adherence to ARVs and use of or adherence to PrEP, and that the discrepancy between self-reports of condom use and biomarkers of unprotected sex may be relatively small in high-income countries. Additional work on assessment of incorrect condom usage and breakage, standardized self-report measures of condom use, and more private data collection methodologies in low-income settings might reduce the recent observed discrepancies even further. Concordance between self-reports of HIV and biomarkers indicating HIV positive status has varied considerably, with much lower rates in low-income countries, where the stigma of HIV is still very high. Recommendation is for combining self-report data with the results of three successive rapid tests for those testing positive. For adherence, again agreement between self-reports and a variety of more objective and/or biological measures is only moderate. Dried blood spots (DBS) may be sufficiently inexpensive in low-resource settings that this may be the best biological method to combine with self-reports. In publications over the last 8 years, the discrepancy between self-reports of condom use and biomarkers for unprotected sex may be even lower than 20% after controlling for other features of the study, particularly in high-income countries. Our results suggest that more careful assessment of incorrect condom use and breakage as reasons other than intentional misreporting should be investigated more carefully and that more private data collection methods such as audio, computer-assisted self-interviewing (ACASI) might be employed more often in low-resource settings to reduce this discrepancy in those settings further. In addition, further analysis of the discrepancy between self-reports of condom use and biomarkers should be conducted of published studies using the correct calculation methods to be more certain of these findings.
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Affiliation(s)
- Rick S Zimmerman
- College of Nursing, Wayne State University, 5557 Cass Ave., 319 Cohn Bldg, Detroit, MI, 48202, USA.
| | - Purnima Mehrotra
- Centre for Social and Behaviour Change, Ashoka University, Rajiv Gandhi Education City, Sonipat, Haryana, India
| | - Tessa Madden
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel Paul
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
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3
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Fiore JR, Zoboli F, Di Stefano M, Fasano M, Alwazzeh MJ, Faleo P, Elamin MOE, Bruno S, Santantonio TA. Inconsistent Use of Condom in Italian HIV-Serodiscordant Heterosexual Couples as Revealed by the Detection of Y Chromosomal (Yc) DNA in Vaginal Swabs. Open AIDS J 2019. [DOI: 10.2174/1874613601913010031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
The prevention of transmission of HIV infection is based on the regular and correct use of condom and studies on transmission rates are generally based on the self-report of condom use.
However, consistent data on different population suggest that this often leads to overreporting possibly due to social desirability. In addition, self-report of condom use does not consider improper use or breakage.
Methods:
Vaginal biomarkers were proposed to detect exposure to semen and among these detection of chromosome Y DNA (Yc) appeared promising in different research settings.
Here, we searched for Yc in vaginal swabs of 33 Italian women, engaged in a regular heterosexual relationship with a HIV serodiscordant partner and reporting a regular use of condom during sexual intercourses.
Results & Discussion:
In 10 (30.3%) women Yc was detected, especially if the infected partner was male and if the couple did not have sons. This is confirmed in Italian heterosexual women and is already demonstrated in other populations: behavioural counselling is not always a valid tool and the self-reported use of condom is not fully reliable.
Conclusion:
Further studies could help in the future to individuate more effective preventive strategies for both HIV and sexually transmitted infections.
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4
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Giguère K, Béhanzin L, Guédou FA, Leblond FA, Goma-Matsétsé E, Zannou DM, Affolabi D, Kêkê RK, Gangbo F, Bachabi M, Alary M. Biological Validation of Self-Reported Unprotected Sex and Comparison of Underreporting Over Two Different Recall Periods Among Female Sex Workers in Benin. Open Forum Infect Dis 2019; 6:ofz010. [PMID: 30746385 PMCID: PMC6364862 DOI: 10.1093/ofid/ofz010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/21/2018] [Accepted: 01/08/2019] [Indexed: 11/23/2022] Open
Abstract
Background Self-reported unprotected sex validity is questionable and is thought to decline with longer recall periods. We used biomarkers of semen to validate self-reported unprotected sex and to compare underreporting of unprotected sex between 2 recall periods among female sex workers (FSW). Methods At baseline of an early antiretroviral therapy and pre-exposure prophylaxis demonstration study conducted among FSW in Cotonou, Benin, unprotected sex was assessed with retrospective questionnaires, and with vaginal detection of prostate-specific antigen (PSA) and Y-chromosomal deoxyribonucleic acid (Yc-DNA). Underreporting in the last 2 or 14 days was defined as having reported no unprotected sex in the recall period while testing positive for PSA or Yc-DNA, respectively. Log-binomial regression was used to compare underreporting over the 2 recall periods. Results Unprotected sex prevalence among 334 participants was 25.8% (50.3%) according to self-report in the last 2 (or 14) days, 32.0% according to PSA, and 44.3% according to Yc-DNA. The proportion of participants underreporting unprotected sex was similar when considering the last 2 (18.9%) or 14 days (21.0%; proportion ratio = 0.90; 95% confidence interval, 0.72–1.13). Among the 107 participants who tested positive for PSA, 19 (17.8%) tested negative for Yc-DNA. Conclusions Underreporting of unprotected sex was high among FSW but did not seem to be influenced by the recall period length. Reasons for discrepancies between PSA and Yc-DNA detection, where women tested positive for PSA but negative for Yc-DNA, should be further investigated.
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Affiliation(s)
- Katia Giguère
- Centre de Recherche du CHU de Québec-Université Laval, Canada.,Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada
| | - Luc Béhanzin
- Centre de Recherche du CHU de Québec-Université Laval, Canada.,Dispensaire IST, Centre de Santé Communal de Cotonou 1, Bénin.,École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Bénin
| | - Fernand A Guédou
- Centre de Recherche du CHU de Québec-Université Laval, Canada.,Dispensaire IST, Centre de Santé Communal de Cotonou 1, Bénin
| | | | | | - Djimon M Zannou
- Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Bénin.,Centre National Hospitalier Universitaire HMK de Cotonou, Bénin
| | - Dissou Affolabi
- Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Bénin
| | - René K Kêkê
- Programme Santé de Lutte Contre le Sida, Cotonou, Bénin
| | - Flore Gangbo
- Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Bénin.,Centre National Hospitalier Universitaire HMK de Cotonou, Bénin.,Programme Santé de Lutte Contre le Sida, Cotonou, Bénin
| | | | - Michel Alary
- Centre de Recherche du CHU de Québec-Université Laval, Canada.,Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada.,Institut National de Santé Publique du Québec, Canada
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5
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Desmond N, Nagelkerke N, Lora W, Chipeta E, Sambo M, Kumwenda M, Corbett EL, Taegtemeyer M, Seeley J, Lalloo DG, Theobald S. Measuring sexual behaviour in Malawi: a triangulation of three data collection instruments. BMC Public Health 2018; 18:807. [PMID: 29954360 PMCID: PMC6022416 DOI: 10.1186/s12889-018-5717-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 06/17/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is a need for valid approaches to measure sexual interactions to assess the impact of behavioural interventions and to predict the impact of behaviour changes. Different methods of asking about sexual behaviour often yield conflicting answers and men often report higher levels of heterosexual activity than women. To better understand self-reported sexual behaviour data and how best to collect it, we analyzed data collected as part of a larger project (ST IMPACTS) on the social and behavioural impact of introducing community-level HIV self-testing (HIVST) with counseling (semi-supervised with pre- and generic post-test counseling provided on delivery or collection of test kits) in an urban Malawian setting. METHODS Information on sexual behaviour was collected from HIV self-testers over a three-month period. Three different methods were used: retrospective face-to-face interviews (FTFI); audio computer assisted self-interviews (ACASI) and a prospective coital diary. Both retrospective instruments were used before and after the three-month study period. Frequency and cross-tabulation, as well as scatterplots, were used for exploratory analyses. Chi-square tests were used to test for differences in proportions. Spearman's correlation coefficient was used to explore associations between both continuous and ordinal variables and Wilcoxon's paired sample and Mann-Whitney test was used to test for differences in such variables or between variables. RESULTS There was reasonable agreement between the two retrospective methods although both yielded inconsistent answers e.g. with lower reported numbers of life-time sexual partners at the end than at the beginning of the study period. The diary method elicited higher reported levels of sex with multiple partners than both retrospective instruments which may be due to inadequate recall. Over the study period 37.4% of men and 19.7% of women reported multiple sexual partners using the diary. There was no clear relationship between reported sexual behaviour and HIV status (prevalence 9.6%). CONCLUSIONS Diaries may therefore have higher validity for sensitive behaviour reporting and thus be the preferred method in similar African contexts in measuring sexual behaviours.
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Affiliation(s)
- Nicola Desmond
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK. .,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
| | - Nico Nagelkerke
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Wezzie Lora
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Effie Chipeta
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mwiza Sambo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Moses Kumwenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - Elizabeth L Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | | | - Janet Seeley
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - David G Lalloo
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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6
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Kopp DM, Tang JH, Stuart GS, Miller WC, O'Shea MS, Hosseinipour MC, Bonongwe P, Mwale M, Rosenberg NE. Dual Method Use among Postpartum HIV-Infected and HIV-Uninfected Malawian Women: A Prospective Cohort Study. Infect Dis Obstet Gynecol 2017; 2017:1475813. [PMID: 28804240 PMCID: PMC5540462 DOI: 10.1155/2017/1475813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/04/2017] [Indexed: 11/24/2022] Open
Abstract
Dual method use, use of condoms plus another effective contraceptive method, is important in settings with high rates of unintended pregnancy and HIV infection. We evaluated the association of HIV status with dual method use in a cohort of postpartum women. Women completed baseline surveys in the postpartum ward and telephone surveys about contraceptive use 3, 6, and 12 months later. Nonpregnant women who completed at least one follow-up survey were eligible for this secondary analysis. Prevalence ratios were calculated using generalized estimating equations. Of the 511 sexually active women who completed a follow-up survey, condom use increased from 17.6% to 27.7% and nonbarrier contraceptive use increased from 73.8% to 87.6% from 3 to 12 months after delivery. Dual method use increased from 1.0% to 18.9% at 3 to 12 months after delivery. Dual method use was negligible and comparable between HIV-infected and HIV-uninfected women at 3 months but significantly higher among HIV-infected women at 6 months (APR = 3.9, 95% CI 2.2, 7.1) and 12 months (APR = 2.7, 95% CI 1.7, 4.3). Dual method use was low but largely driven by condom use among HIV-infected women at 6 and 12 months after delivery.
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Affiliation(s)
- Dawn M. Kopp
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
- UNC Department of Obstetrics & Gynecology, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Jennifer H. Tang
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
- UNC Department of Obstetrics & Gynecology, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Gretchen S. Stuart
- UNC Department of Obstetrics & Gynecology, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - William C. Miller
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
- UNC Department of Epidemiology, 135 Dauer Drive, Chapel Hill, NC 27599, USA
- Division of Epidemiology, Ohio State University, 1841 Neil Avenue, Columbus, OH 43210, USA
| | - Michele S. O'Shea
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Mina C. Hosseinipour
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
- UNC Department of Medicine, 125 MacNider Hall, Chapel Hill, NC 27599, USA
| | - Phylos Bonongwe
- Department of Obstetrics & Gynaecology, Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi
| | - Mwawi Mwale
- Bwaila Hospital, Lilongwe District Health Office, Lilongwe, Malawi
| | - Nora E. Rosenberg
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
- UNC Department of Epidemiology, 135 Dauer Drive, Chapel Hill, NC 27599, USA
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7
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Woolf-King SE, Muyindike W, Hobbs MM, Kusasira A, Fatch R, Emenyonu N, Johnson MO, Hahn JA. Vaginal Prostate Specific Antigen (PSA) Is a Useful Biomarker of Semen Exposure Among HIV-Infected Ugandan Women. AIDS Behav 2017; 21:2141-2146. [PMID: 27224979 DOI: 10.1007/s10461-016-1433-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The practical feasibility of using prostate specific antigen (PSA) as a biomarker of semen exposure was examined among HIV-infected Ugandan women. Vaginal fluids were obtained with self-collected swabs and a qualitative rapid test (ABAcard®p30) was used to detect PSA. Trained laboratory technicians processed samples on-site and positive PSA tests were compared to self-reported unprotected vaginal sex (UVS) in the last 48 h. A total of 77 women submitted 126 samples for PSA testing at up to three study visits. Of these samples, 31 % (n = 39/126) were PSA positive, and 64 % (n = 25/39) of the positive PSA samples were accompanied by self-report of no UVS at the study visit the PSA was collected. There were no reported difficulties with specimen collection, storage, or processing. These findings provide preliminary data on high levels of misreported UVS among HIV-infected Ugandan women using practically feasible methods for PSA collection and processing.
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Affiliation(s)
- Sarah E Woolf-King
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
| | - Winnie Muyindike
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Marcia M Hobbs
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adrine Kusasira
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Nneka Emenyonu
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
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8
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Snead MC, Wiener J, Ewumi S, Phillips C, Flowers L, Hylton-Kong T, Medley-Singh N, Legardy-Williams J, Costenbader E, Papp J, Warner L, Black C, Kourtis AP. Prevalence and risk factors associated with STIs among women initiating contraceptive implants in Kingston, Jamaica. Sex Transm Infect 2017; 93:503-507. [PMID: 28476913 DOI: 10.1136/sextrans-2016-052963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/30/2017] [Accepted: 04/18/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is limited information on rates of STIs in Jamaica due to syndromic management and limited aetiological surveillance. We examined the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) and characteristics associated with STIs among sexually active women who participated in a randomised trial of a progestin implant initiation in Jamaica (the Sino-Implant Study (SIS)). METHODS SIS was a randomised trial conducted in Kingston, Jamaica, from 2012 to 2014 to evaluate whether initiation of the Sino-Implant (II) led to more unprotected sex among women ages 18-44 years. Data collected included self-reported demographic, sexual behaviour information; and vaginal swabs collected at baseline, 1-month and 3-month follow-up visits for a biomarker of recent semen exposure (prostate-specific antigen (PSA)) and for STIs. We examined associations between STIs and PSA, demographics, sexual behaviour and insertion of an implant, with a repeated-measures analysis using generalised estimating equations (SAS Institute, V.9.3). RESULTS Remnant vaginal swabs from 254 of 414 study participants were tested for STIs. At baseline, 29% of participants tested for STIs (n=247) had laboratory-confirmed CT, 5% NG, 23% TV and 45% any STI. In a repeated-measures analysis adjusted for study arm (immediate vs delayed implant insertion), those with PSA detected did not have an increased prevalence of any STI (prevalence ratio (PR)=1.04 (95% CI 0.89 to 1.21)), whereas prevalence decreased for each 1-year increase in age (PR=0.98 (95% CI 0.97 to 0.99)). Immediate implant insertion was not associated with increases in any STI in subsequent visits (PR=1.09 (95% CI 0.94 to 1.27)). CONCLUSIONS Although the prevalence of laboratory-confirmed STIs was high, the immediate initiation of a contraceptive implant was not associated with higher STI prevalence rates over 3 months. TRIAL REGISTRATION NUMBER NCT01684358.
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Affiliation(s)
- Margaret Christine Snead
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeffrey Wiener
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Christi Phillips
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Flowers
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Jennifer Legardy-Williams
- Office of Science and Integrated Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - John Papp
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolyn Black
- Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Athena P Kourtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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9
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Norwood MS, Hughes JP, Amico KR. The validity of self-reported behaviors: methods for estimating underreporting of risk behaviors. Ann Epidemiol 2016; 26:612-618.e2. [PMID: 27566912 DOI: 10.1016/j.annepidem.2016.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 07/22/2016] [Accepted: 07/31/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE When individuals underreport risk behaviors, data gathered from public health research and practice will underestimate risk. To date, there is little guidance on if or how reports can be adjusted to better reflect true levels of a risk behavior in a given cohort, sample or, by extension, population. METHODS We develop the underreporting correction factor (UCF), which can be used to correct estimates of the prevalence of a risk behavior using self-report of the behavior and a specific (but not necessarily sensitive) biomarker. The UCF rests on three assumptions: (1) there is no overreporting of the behavior, (2) the biomarker can only be acquired if the person engages in the behavior, and (3) the presence of the biomarker does not affect reporting of the behavior. We investigate the sensitivity of the UCF to violation of these assumptions and develop confidence intervals for the UCF and the corrected prevalence of the behavior. RESULTS The UCF is most sensitive to the second assumption (biomarker perfectly specific). We apply the UCF to estimates of sexual risk behaviors in various settings using a variety of biomarkers. CONCLUSIONS Implementation of the UCF corrects for underreporting and more accurately quantifies risk in cohorts.
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Affiliation(s)
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
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10
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Abstract
We used data from a prospective study of 300 women attending a sexually transmitted infection clinic in Kingston, Jamaica, to compare participant self-report of recent semen exposure to actual semen exposure measured by prostate-specific antigen in vaginal swabs. Underreporting of semen exposure was significantly more frequent at follow-up than baseline, suggesting that the accuracy of reports of sexual behavior may vary over time.
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11
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Evaluation of serum-based cancer biomarkers: A brief review from a clinical and computational viewpoint. Crit Rev Oncol Hematol 2015; 93:103-15. [DOI: 10.1016/j.critrevonc.2014.10.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 08/07/2014] [Accepted: 10/01/2014] [Indexed: 12/26/2022] Open
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12
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Snead MC, Black CM, Kourtis AP. The use of biomarkers of semen exposure in sexual and reproductive health studies. J Womens Health (Larchmt) 2014; 23:787-91. [PMID: 25268551 DOI: 10.1089/jwh.2014.5018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Biomarkers of semen exposure have been used in studies investigating the safety and efficacy of barrier methods of contraception. They have been used as objective indicators of semen exposure when studying sexual behaviors and in human immunodeficiency virus/sexually transmitted infection research interventions where participants are advised to avoid unprotected sex. Semen biomarkers have also been used to assess or validate self-reported sexual behaviors or condom use in reproductive health settings. Prostate-specific antigen (PSA) and Y chromosome DNA (Yc-DNA) have each been evaluated in the past as semen biomarkers and are the most widely used in the field. While both are considered reliable for evaluating exposure to semen, each has unique characteristics. In this report, we summarize the literature and provide some considerations for reproductive health researchers who are interested in using PSA or Yc-DNA as semen biomarkers. We also synthesize our previous published work on the optimal conditions of collecting and storing specimens and assay performance in the presence of other vaginal products that may influence various assays. Semen biomarkers are innovative and promising tools to further study and better understand women's reproductive and sexual health and behavior. More research is needed to better understand the strengths, limitations, and optimal performance conditions of specific assays in vivo.
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Affiliation(s)
- Margaret Christine Snead
- 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia
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