FHI 360, Behavioral, Epidemiological and Sciences, Durham, NC, United States of America.
Maternal and Child Health Dept, University of North Carolina, Chapel Hill, NC, United States of America.
PLoS One. 2021 Dec 31;16(12):e0261526. doi: 10.1371/journal.pone.0261526. eCollection 2021.
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).
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.
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.
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.
CHARISMA 干预措施嵌套在南非约翰内斯堡的 MTN-025/HOPE 阴道环试验中，旨在通过促进伴侣间的对话和减轻亲密伴侣暴力（IPV）来促进女性使用 HIV 预防产品。我们为 CHARISMA 试点开发了“HEART”，这是一种由非专业顾问管理的关系评估工具。该五分量表评估参与者对传统价值观（TV）的认可程度、她的 HIV 预防准备情况（HPR）以及伴侣支持（PS）、虐待和控制（PAC）和对 HIV 预防的抵制（PR）水平，指导决定提供三种咨询模块中的哪一种（伴侣沟通/A；环披露/B；和 IPV 预防/C）。
我们将 HEART 子量表的基线得分与 a）独立的关系稳定性、披露和 IPV 衡量标准相关联，以评估结构有效性，以及 b）与提供的特定模块相关联，以确定 HEART 在试点中的使用方式。我们检查了三个月和六个月时 HEART 分数的变化。最后，我们为每个子量表运行了单独的增长模型，以检查分数的变化，同时考虑到伙伴关系的变化和接受的咨询模块。
HEART 子量表的基线得分在预测中呈相关性，与其他衡量标准也呈相关性。四个子量表的可靠性为 0.75 或更高。披露研究参与和戒指使用情况的女性在 PS 上得分更高，在 PR 上得分更低。经历过 IPV 的女性在 PS 上得分较低，在 PAC 和 PR 上得分较高。在试点期间，82%的女性接受了一个模块，17%的女性接受了两个或更多模块；超过一半的女性接受了 IPV 模块。PAC 和 PR 得分较高的女性更有可能接受 IPV 模块，而不是沟通或披露模块。随着时间的推移，TV、PAC 和 PR 分数下降，PS 分数上升。接受 IPV 模块与 PAC 分数下降有关。
这些数据为 HEART 的结构和预测有效性提供了初步证据，并支持进一步评估，以指导实施并监测 CHARISMA 干预在随机对照评估中的影响。
