# Presentation: 669880

## FROM THE CLINICAL TOOLBOX: ACASI FOR DATA COLLECTION

- Anna Maria Simoes, MD, MSc.
- Health Department, Government of Rio de Janeiro State
- Oswaldo Cruz Foundation

## International collaboration

- CENTRA-RIO – Health Department RJ State Government
- 		Dr. Anna Simoes
- Oswaldo Cruz Foundation
- 		Dr. Francisco Bastos
- Center for Studies of Addiction – University of Pennsylvania
- 		Dr. David Metzger

## OBJECTIVES

- to implement a new technology of data collection, the audio computer assisted self interview (ACASI), and to assess its feasibility and acceptability.
- To compare, in a randomized trial, the ACASI versus IAQ (interviewer administrated questionnaire).
- To identify factors that are associated with the ability of the treatment program to engage drug users, especially those at high risk.

## Slide 4

## The randomized trial comparing 

**NEW ADMISSIONS IN CENTRA-RIO**

**ACASI**

**FACE-TO-FACE**

**STD/HIV COUNSELING BLOOD SAMPLE **

**BLOOD TEST RESULT**

**(+) REFERRAL FOR STD/HIV TREATMENT**

**The randomized trial comparing **
**the two methods**

**RANDOMISED 1:1**

## *p<0.05; OR=Odds ratio; † AOR= Adjusted odds ratio, results from a logistic regression analysis controlling for gender, age, education level, race and marital status

| 

DRUGS | ACASI
% affirmative answer

no (%) | FACE-TO-FACE
% affirmative answer
no (%) | 

OR | 

AOR† | 

95%CI |
| --- | --- | --- | --- | --- | --- |
| Alcohol | 326 (88.6) | 322(87.5) | 1.10 | 1.18 | 0.74,2.01 |
| Marijuana | 153(41.6) |        132(35.9) | 1.27 | 1.35 | 0.97,1.88 |
| Cocaine (snorted) | 223(60.6) | 185(50.3) | 1.52 | 1.63* | 1.18,2.25 |
| Cocaine IV | 32(8.7) | 4(1.1) | 8.66 | 8.60* | 2.99,24.76 |
| Heroin IV | 7(1.9) | 0(0) | - | - | - |
| Crack | 26(7.1) | 13(3.5) | 2.07 | 2.11* | 1.04,4.24 |
| Amphetamine (oral) | 15(4.1) | 1(0.3) | 15.57 | 15.73* | 2.05,120.34 |
| Benzodiazepines | 92(25.0) | 53(14.4) | 1.98 | 1.92* | 1.31,2.82 |
| Opioides (oral) | 70(19.0) | 39(10.6) | 1.98 | 1.93* | 1.25,2.98 |
| Cough syrup  | 37(10.1) | 1(0.3) | 40.85 | 40.85* | 5.37,292.70 |
| Hallucinogens | 22(6.0) | 6(1.6) | 3.81 | 3.81* | 1.47,9.31 |

***p<0.05; ****OR=Odds ratio; † AOR= Adjusted odds ratio, results from a logistic regression analysis controlling for gender, age, education level, race and marital status**

## *p<0.05; OR=Odds ratio; † AOR= Adjusted odds ratio, results from a logistic regression analysis controlling for gender, age, education level, race and marital status

|  | 
ACASI
% affirmative answer

no (%) | FACE-TO-FACE
% affirmative answer
 no (%) | 

OR | 

AOR† | 

95%CI |
| --- | --- | --- | --- | --- | --- |
| Sexually active  | 332(90.2) | 338(91.8) | 0.81 | 0.79 | 0.47,1.35 |
| Number of  partners ≥ 2 | 172(51.8) | 178(52.7) | 0.96 | 0.91 | 0.65,1.27 |
| MSM | 39(12.6) | 18(5.7) |  2.37* |   2.52* | 1.38,4.61 |
| Sex for drugs | 67(18.2) | 40(10.9) |  1.82* |  1.88* | 1.20,2.94 |
| Drugs for sex | 75(20.4) | 60(16.3) | 1.31 | 1.30 | 0.87,1.93 |
| Money for sex | 97(26.4) | 74(20.1) |  1.42* | 1.37 | 0.95,1.98 |
| Sex with HIV+ | 10(2.7) | 9(2.4) | 1.11 | 1.32 | 0.51,3.42 |
| Inconsistent  
condom use | 
279(83.0) | 
260(78.5) | 
1.33 | 
1.34 | 
0.90,2.01 |
| Concern about being exposed to HIV | 
231(61.0) | 
213(58.4) |   
1.37* | 
1.32 | 
0.96,1.82 |
| Had been tested HIV | 149(42.9) | 167(45.9) |  0.88 | 0.85 | 0.6,1.2 |

***p<0.05; ****OR=Odds ratio; † AOR= Adjusted odds ratio, results from a logistic regression analysis controlling for gender, age, education level, race and marital status**

## CONCLUSIONS

**First study with ACASI in Brazil.**
**Consistent with USA studies.**
**Data suggest similar factors influence reporting socially undesirable behavior in different cultural setting.**
**The important role of the ACASI in collecting data necessary for program planning and development.**
** **

## FESEABILITY STUDYProblems using computer (n=268)

## CONCLUSIONS

**Participants felt that protects privacy.**
**Participants felt that people would be more honest reporting to computer.**
**No significant association were found related to sexual risk, drug use and preference **

**CONCLUSIONS**

## GEO-BEHAVIORAL STUDY

**GIS (home addresses and CENTRA-RIO location)**
**ACASI (demographics, drug use and sexual risk behavior**

## Slide 12

## RESULTS

**In univariate analyses, failure to engage in treatment was associated with demographic, drug use risk and distance characteristics:**
**	****	****under age 35 (p=.01)**
**	****	****male (p=.06)**
**	****	****no secondary education (p=.06)**
**	****	****alcohol use (p<.05)**
**	****	****marijuana use (p<.05)**
**	****	****oral opiate use (p<.05)**
**	****	****use of multiple drugs (p<.05)**
**	****	****no prior HIV test (p=.05)**
**	****	****having mutiple sex risk (p=.06)**
**	****	****living further than 5,000 meters from the program (p<.01)**
**	****	**

## RESULTS

**In adjusted logistic regression analyses, failure to engage in treatment was independently associated with:**
**	****	**
**	****	****	****Under 36 years of age****	****	****	**
**oral opiate use**
**	****	****	****living further than 5,000 meters from the ****	****	****program****	****	**

## IMPLICATIONS

**The impact of the present findings are especially important considering the need to encourage comprehensive prevention programs for drugs users in Brazil fully integrating prevention and care.**