SUPPLEMENT ARTICLE Acceptability of A-CASI by HIV-Positive IDUs in a Multisite, Randomized, Controlled Trial of Behavioral Intervention (INSPIRE) Yuko Mizuno, PhD,* David W. Purcell, JD, PhD,* Sonja Mackenzie, MS,† Karin E. Tobin, PhD,‡ Toni Wunch, MA,§ Julia H. Arnsten, MD, MPH, k and Lisa R. Metsch, PhD¶ for the INSPIRE Study Team Summary: Audio computer-assisted self-interviewing (A-CASI) is now widely used to gather information from many types of research participants, including injection drug users (IDUs). The purpose of this study was to describe how HIV-positive IDUs participating in an intervention trial viewed A-CASI and to identify the characteristics of participants who held unfavorable attitudes toward A-CASI. Using a sample of participants who completed 12-month assessments (n = 821), we found that most (.80%) of the sample held favorable or neutral attitudes toward A-CASI. Approximately 18% said that they would prefer an interview with a person to a computer, 12% said that they did not understand the questions they heard on the computer, and 14% said that the computer made it hard to be open and honest about risk behavior. Multivariate analyses found that participants who were more socially marginalized (with unstable housing and lower sense of empowerment) and had greater physical limitations and lower CD4 cell counts were consistently more likely to report various negative A-CASI attitudes; however, some outcome-specific findings were also noted. Our research supports the feasibility and general acceptability of A-CASI with HIV-positive IDUs, and it suggests further research exploring the associations between A-CASI attitudes and characteristics of disadvantaged populations. Key Words: audio computer-assisted self-interviewing, attitudes, HIV, injection drug use, seropositive (J Acquir Immune Defic Syndr 2007;46:S48–S54) A udio computer-assisted self-interviewing (A-CASI) has gained support for use among researchers who study HIV risk behaviors. Although various versions of automated self- interviewing systems (eg, video-CASI in which study parti- cipants view questions on a computer screen; T-CASI, which is A-CASI adapted for use in telephone surveys) have been developed, 1 A-CASI seems to be most widely used in the field. In A-CASI, study participants sit by themselves at the computer, listen to questions by means of headphones, and enter their responses directly onto the computer. Because interview questions are preprogrammed and prerecorded, A-CASI allows standardization of interview administration (ie, questions are asked in a consistent manner regardless of respondents), and thus eliminates interviewer bias. A-CASI also affords a greater sense of privacy to study participants than face-to-face interviews, because participants are not talking to a live interviewer. Studies have found that compared with face-to-face interviews, A-CASI elicits more reporting of sensitive or stigmatizing behaviors, including HIV sexual and injection risk behaviors. 2–7 Computer-assisted data collection technology also prevents problems such as illegible handwrit- ing, deviations from skip patterns, and the entry of out- of-range values, thus improving data quality and allowing researchers to save time on data entry and cleaning. A-CASI has now been widely used for populations with a range of computer experience, including injection drug users (IDUs). 2,8,9 Some studies, however, suggest that despite its utility, A-CASI may not be the preferred mode of data collection for everyone. For example, Hewitt 10 found that among women who participated in the 1995 National Survey of Family Growth, those who were Hispanic or African American, had lower educational attainment, or were poor were more likely than their counterparts to prefer in-person interviews to A-CASI. In a Brazilian study by Simoes and her colleagues, 9 reporting of problems using the computer was associated with lower educational level. Potdar and Koenig 11 found in their study of young urban men in India that although prevalence of reported risky sexual and other behaviors was higher among college students interviewed through A-CASI than those who were interviewed face-to-face, A-CASI failed to yield higher Received for publication July 20, 2006; accepted August 3, 2007. From the *Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; †Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, CA; ‡Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; §Northrop Grumman, Atlanta, GA; k Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY; and the {Department of Epidemiology and Public Health, Leonard M. Miller School of Medicine, University of Miami, Miami, FL. Supported by the Centers for Disease Control and Prevention and the Health Resources and Services Administration. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. The authors report no conflicts of interest in connection with this article. Correspondence to: Yuko Mizuno, PhD, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop E37, Atlanta, GA 30333 (e-mail: ymizuno@cdc.gov). Copyright Ó 2007 by Lippincott Williams & Wilkins S48 J Acquir Immune Defic Syndr  Volume 46, Supplement 2, November 1, 2007 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.