Generating CHARISMA: Development of an Intervention to Help Women Build Agency and Safety in Their Relationships While Using PrEP for HIV Prevention

Abstract

This article describes the development of the Community Health clinic model for Agency in Relationships and Safer Microbicide Adherence intervention (CHARISMA), an intervention designed to address the ways in which gender norms and power differentials within relationships affect women's ability to safely and consistently use HIV pre-exposure prophylaxis (PrEP). CHARISMA development involved three main activities: (1) a literature review to identify appropriate evidence-based relationship dynamic scales and interventions; (2) the analysis of primary and secondary data collected from completed PrEP studies, surveys and cognitive interviews with PrEP-experienced and naïve women, and in-depth interviews with former vaginal ring trial participants and male partners; and (3) the conduct of workshops to test and refine key intervention activities prior to pilot testing. These steps are described along with the final clinic and community-based intervention, which was tested for feasibility, acceptability, and preliminary effectiveness in Johannesburg, South Africa.

Development and initial validation of a simple tool to screen for partner support or opposition to HIV prevention product use

“…As described elsewhere [26], we reviewed the scientific and gray literature to identify validated scales or other tools that measured various aspects of intimate relationships [27], including agency [28], social support, as well as partner abuse and violence [29]. We gave precedence to scales or tools used in African contexts.…”

“I think everybody should take it if they’re doing drugs, doing heroin, or having sex for money”: A qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program

“…In addition, PrEP interest and motivation were impacted by various factors in uencing the decision to consider PrEP initiation or comfort with partner use. Given ndings from quantitative studies on gender norms and power differentials (44), it is plausible that women may disregard PrEP uptake for fear that the notion of mentioning it to sex partners may contribute to a partner's suspicion of in delity. This could in uence a woman's ability to use PrEP safely and reliably.…”

Acceptability and Feasibility of the CHARISMA Counseling Intervention to Support Women’s Use of Pre-Exposure Prophylaxis

“…The length and intensity of CHARISMA may not be feasible in some settings, but a shorter, less-intensive version of the intervention may not offer as much support as women and staff need. One possible approach to reduce the burden on clinic staff would be to have some or all components of the intervention self-administered through a computer rather than requiring a counselor [17,[21][22][23][24]. Between a quarter and a third of participants reported that they would strongly prefer to have CHARISMA selfimplemented on a computer, so this could be a good option for at least some women.…”

“…The MTN-025/HOPE study, which began in mid-2016, offered women who had participated in the MTN-020/A Study to Prevent Infection with a Ring for Extended Use (ASPIRE) phase III clinical trial of the dapivirine ring an opportunity to continue to use the ring in the context of an open label extension study on safety and adherence. [17] We sought to evaluate the feasibility and acceptability of CHARISMA as implemented during the pilot study to inform further re nement and testing of the intervention.…”