Evidence for use of a healthy relationships assessment tool in the CHARISMA pilot study

Abstract

Introduction The CHARISMA intervention, nested within the MTN-025/HOPE vaginal ring trial in Johannesburg, South Africa, seeks to facilitate women’s use of HIV prevention products by promoting partner dialogue and mitigating intimate partner violence (IPV). We developed “HEART”, a lay counselor-administered relationship assessment tool, for the CHARISMA pilot. The five-scale tool assesses participants’ endorsement of Traditional Values (TV), her HIV Prevention Readiness (HPR) and levels of partner support (PS), abuse and control (PAC), and resistance to HIV prevention (PR), guiding decisions about which of three counselling modules to offer (partner communication/A; ring disclosure/B; and IPV prevention/C). Methods We correlated baseline scores on HEART subscales with a) independent measures of relationship stability, disclosure and IPV to assess construct validity, and b) with specific modules offered to determine how HEART was used in the pilot. We examined changes in HEART scores at three and six months. Finally, we ran separate growth models for each subscale to examine changes in scores, accounting for partnership changes and counseling module(s) received. Results Baseline HEART scores correlated as predicted among subscales and with other measures. Reliabilities for four subscales were 0.75 or higher. Women who disclosed study participation and ring use scored higher on PS and lower on PR. Women experiencing IPV scored lower on PS, and higher on PAC and PR. During the pilot, 82% of women received one and 17% received two or more modules; over half received the IPV module. Women with higher PAC and PR scores were more likely to receive the IPV than the communication or disclosure modules. Over time, the TV, PAC and PR scores decreased, and PS score increased. Receiving the IPV module was associated with a decreased PAC score. Conclusions These data offer preliminary evidence for HEART construct and predictive validity and support its further evaluation to guide implementation and monitor the impact of the CHARISMA intervention in a randomized controlled evaluation.

Changes in relationships, HIV risk, and feelings towards PrEP: findings from a qualitative explanatory study among participants in the CHARISMA intervention trial

“…All participants also received access to ‘male partner packets’, which offered materials on PrEP to be shared with male partners with ‘opt-out’ delivery for intervention arm participants and ‘opt-in’ delivery for control-arm participants. Additional details on the development and content of the HEART and counselling intervention, as well as trial procedures and results are described elsewhere [ 8 , 10 , 17 , 18 ].…”

Development of a relationship counselling website to identify and mitigate risk of intimate partner violence in the context of women’s PrEP use

“…The facilitator walked the participant through the mobile beta version step by step, asking for feedback on the usability and functionality of the intervention, including what the participant liked and did not like about each feature. Similar to a cognitive interview process, participants were asked to describe their thoughts, feelings, and ideas about the mobile content as they moved through the intervention starting with administration of a relationship quiz (called the HEAlthy Relationship Tool or “HEART” [ 31 , 32 ]) followed by the counseling module content that was recommended based on their relationship circumstance. In addition, close-ended questions assessed the design and functionality of the mobile site (e.g., performance, ease of use, navigation, gestural design, graphic design) as well as opinions about the site style and format, comprehension of the content, concerns around confidentiality and safety, and the potential usefulness of the intervention.…”

Measuring Effects of Counseling to Increase Pre-Exposure Prophylaxis Adherence and Partner Support in South Africa Using the Healthy Relationship Assessment Tool

“…This pilot produced promising results for the initial validation of the tool. [20][21][22][23] After conducting this pilot, a randomized controlled trial (RCT) to test the effectiveness of CHARISMA on a broader scale was established. During this RCT, we conducted further validation of the HEART to assess its impact in larger-scale settings.…”