Women's Global Health Imperative, RTI International, San Francisco, CA, USA.
RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA.
BMC Womens Health. 2021 Mar 25;21(1):126. doi: 10.1186/s12905-021-01262-z.
Women may need or seek male partner approval to safely and consistently use oral antiretroviral pre-exposure prophylaxis (PrEP) or vaginal microbicides. We developed CHARISMA, a counseling intervention to support women's relationships and their ability to consistently use HIV prevention products.
In a pilot study with 95 female participants in Johannesburg, South Africa, lay counselors implemented CHARISMA, assessing participants' relationship(s) with their male partner(s) and barriers or facilitators to HIV prevention method use, and then providing tailored, interactive counseling. We conducted study participant surveys and clinic staff interviews to evaluate CHARISMA's feasibility and acceptability.
The CHARISMA pilot study indicates that a two-session relationship counseling intervention with 6-month follow-up to support women's ability to safely and effectively use vaginal microbicides was generally acceptable and feasible. Most participants thought CHARISMA was relevant, helpful, and about the right length, and that it had a positive impact on their relationships with their partners and their product use. Staff estimated that the intervention took 1.5-2 h to implement at enrollment and 45 min to an hour for the month 1 visit. They thought that overall CHARISMA was generally feasible to implement.
Findings from this study suggest several lessons learned that may be relevant to others developing interventions supporting women's use of oral PrEP or vaginal microbicides. The use of lay counselors instead of nurses to deliver counseling appeared to be successful, but the counselors experienced significant stress from hearing about participants' traumatic experiences and required emotional support to avoid burnout. Although staff and participants felt that having multiple intervention sessions over time was valuable, a similar level of intensity may not be feasible in other settings. Further research is needed to determine an intervention delivery mode and follow-up period that optimally balances participant needs and clinic resources. Male engagement was a challenge, as it has been in previous studies of vaginal microbicides. Alternative strategies to reach men that do not require them to come to the clinic or rely on their female partners may be more effective.
女性在安全且持续使用口服抗逆转录病毒暴露前预防（PrEP）或阴道杀微生物剂时，可能需要或寻求男性伴侣的认可。我们开发了 CHARISMA，这是一种咨询干预措施，旨在支持女性的关系及其持续使用艾滋病毒预防产品的能力。
在南非约翰内斯堡的一项有 95 名女性参与者的试点研究中，非专业顾问实施了 CHARISMA，评估参与者与男性伴侣的关系以及使用艾滋病毒预防方法的障碍或促进因素，然后提供量身定制的互动咨询。我们进行了研究参与者的调查和诊所工作人员的访谈，以评估 CHARISMA 的可行性和可接受性。
CHARISMA 试点研究表明，支持女性安全有效地使用阴道杀微生物剂的两阶段关系咨询干预措施，加上 6 个月的随访，通常是可以接受且可行的。大多数参与者认为 CHARISMA 是相关的、有帮助的，而且长度恰到好处，对他们与伴侣的关系和产品使用产生了积极影响。工作人员估计，该干预措施在入组时需要 1.5-2 小时，在第 1 个月就诊时需要 45 分钟到 1 小时。他们认为 CHARISMA 总体上是可行的。
这项研究的结果表明，有几点经验教训可能与其他支持女性使用口服 PrEP 或阴道杀微生物剂的干预措施有关。使用非专业顾问而不是护士提供咨询似乎是成功的，但顾问因听到参与者的创伤经历而感到压力很大，需要情感支持以避免倦怠。尽管工作人员和参与者认为随着时间的推移多次干预会议很有价值，但在其他环境中可能无法实现类似的强度。需要进一步研究，以确定一种干预交付模式和随访期，以最佳平衡参与者的需求和诊所资源。男性参与是一个挑战，就像以前的阴道杀微生物剂研究一样。可能需要寻找替代策略来接触男性，而不需要他们去诊所或依赖他们的女性伴侣。
