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Post-prostatic massage fluid/urine is acceptable and feasible as a method to assay HIV shedding
S. Graham1,2,3,4, J. Krieger1, P. Githua2, L. Wamuyu2, S. Wale2, K. Ramko2, K. Mandaliya5, N. Peshu2, E. Sanders2,6, R. Coombs1
1University of Washington, Seattle, Washington, United States, 2Kenya Medical Research Institute, Kilifi, Kenya, 3University of Nairobi, Nairobi, Kenya, 4University of Toronto, Toronto, Ontario, Canada, 5Coast Provincial General Hospital, Mombasa, Kenya, 6University of Oxford, Oxford, United Kingdom
Background: Sampling the male genitourinary tract is necessary to investigate HIV-1 infectivity. Collecting semen specimens by masturbation has proven difficult in many settings. Practical alternative methods with high acceptability are needed. We evaluated the acceptability and feasibility of urine collected after a prostatic massage versus semen collected by masturbation in a Kenyan clinic.
Methods: HIV-1-seropositive men were recruited to provide genitourinary samples at quarterly study visits. Men were asked to observe 48 hours of sexual abstinence before sampling. At each visit, a clinician performed prostatic massage until expressed prostate secretions (EPS) were visualized, then post prostate massage fluid/urine (post-PMF/U) was collected. Participants provided semen specimens one week later. An audio computer assisted self-interview (ACASI) occurred after each sample collection to evaluate adherence to instructions, acceptability, and current genitourinary symptoms.
Results: Of 45 men enrolled, 5 (11%) were lost to follow-up and one withdrew to move from the area. Post-PMF/U was successfully obtained at 95 of 118 post-PMF/U visits (81%), and with EPS obtained at 60 (63%) of successful post-PMF/U collections. Semen was submitted at 96 follow-up visits (81%). Thirty-four men (76%) provided both samples, 5 (11%) only semen, 3 (7%) only post-PMF/U, and 3 (6%) produced neither. Men reported adherence to the prescribed 48-hour abstinence period at 91% of post-PMF/U collections and 98% of semen collections. In ACASI, more men expressed reservations about the acceptability of post-PMF/U versus semen (12 vs. 5) and more experienced some discomfort (12 vs. 2), but all men said they would provide both samples again.
Conclusions: Post-PMF/U and semen collections were acceptable to this population of Kenyan men. Retention was high, and all participants stated they would provide each sample again. Collection of post-PMF/U is both acceptable and feasible as an alternative to semen collection for studies of male HIV-1 infectivity.
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