CoMSES Catalog

Could misreporting of condom use explain the observed association between injectable hormonal contraceptives and HIV acquisition risk

Authored by Jennifer A Smith, Renee Heffron, Ailsa R Butler, Connie Celum, Jared M Baeten, Timothy B Hallett

Date Published: 2017

DOI: 10.1016/j.contraception.2016.12.003

Sponsors: Bill and Melinda Gates Foundation

Platforms: MATLAB

Model Documentation: Other Narrative

Model Code URLs: Model code not found

Abstract

Objective: Some observational studies have suggested an association between the use of hormonal contraceptives (HC) and HIV acquisition. One major concern is that differential misreporting of sexual behavior between HC users and nonusers may generate artificially inflated risk estimates. Study design: We developed an individual-based model that simulates the South African HIV serodiscordant couples analyzed for HC HIV risk by Heffron et al. (2012). We varied the pattern of misreporting condom use between HC users and nonusers and reproduced the trial data under the assumption that HC use is not associated with HIV risk. The simulated data were analyzed using Cox proportional hazards models, adjusting for the reported level of condom use. Results: If HC users ovelieport condom use more than nonusers, an apparent excess risk could be observed even without any biological effect of HC on HIV acquisition. With 45\% overreporting by HC users (i.e., 9 out of every 20 sex acts reported with condoms are actually unprotected) and accurate condom reporting by nonusers, a true null effect can be inflated to give an observed hazard ratio ((HR) over cap) of 2.0. In a different population with lower overall reported condom use, artificially high (HR) over caps can only be generated if non-HC users underreport condom use. Conclusion: Differential condom misreporting can theoretically produce inflated (HR) over cap values for an association between HC and HIV even without a true association. However, to produce a doubling of HIV risk that is entirely spurious requires substantially different levels of misreporting among HC users and nonusers, which may be unrealistic.

Could misreporting of condom use explain the observed association between injectable hormonal contraceptives and HIV acquisition risk

Abstract

Tags