Is Audio Computer-Assisted Self-Interview (ACASI) Useful in Risk Behaviour Assessment of Female and Male Sex Workers, Mombasa, Kenya?

BACKGROUND: Audio 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 FINDINGS: We 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/SIGNIFICANCE: About 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

Comparison of characteristics in 139 women in Audio Computer-Assisted Self-Interview (ACASI) and Face-to-Face (FtF) interview, at cohort enrolment, Kenya, 2008.

<p>IQR inter quartile range.</p>1<p>Spearman or kappa statistic.</p>2<p>Included those active in past week: 126 women in ACASI; 125 women in FtF.</p>3<p>Included those not active in past week: 13 women in ACASI; 14 in FtF.</p>4<p>Variable missing for 30 women who completed the study before this question added.</p>5<p>Missing values in 1 woman.</p

Acceptability of Audio Computer-Assisted Self-Interview (ACASI) of 139 women and 259 men, at cohort enrolment, Kenya, 2008.

2<p>Missing values in acceptability questions during start up period (March–April 2006; 22 women and 19 men).</p

Characteristics of Audio Computer-Assisted Self-interview (ACASI)-participating and non-participating study participants, at cohort enrolment, Kenya, 2008.

<p>Characteristics of Audio Computer-Assisted Self-interview (ACASI)-participating and non-participating study participants, at cohort enrolment, Kenya, 2008.</p

A–D: Bland-Altman plots.

<p>The plots show differences between number of regular and casual partners in the last week collected by Audio Computer-Assisted Self-Interview (ACASI) and Face-to-Face interview (FtF) in the same volunteer on the same day, Mombasa, Kenya. The Y-axis presents the difference in partner counts in ACASI and FtF; the X-axis presents the mean number of partners in both methods. Top row: regular partners in the last week in women (A) and men (B); bottom row: casual partners in the last week in women (C) and men (D). Horizontal lines: mean of difference with the 95% limits of agreement. Interpretation figures A and B: ACASI captures a higher number of regular partners in women and men when the average number of regular partners captured in both interview methods is about two or higher. Interpretation figures C and D: For women, the variability between methods is more constant. For men, there is more variation between methods.</p