Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Behavioral, Epidemiological, & Clinical Sciences, FHI 360, Durham, NC, USA.
Glob Health Sci Pract. 2023 Oct 30;11(5). doi: 10.9745/GHSP-D-22-00075.
In response to the diverse roles and strong influence that male partners may have in women's decisions and ability to use HIV prevention products, we previously developed the counselor-administered Healthy Relationship Assessment Tool (HEART). This tool helps counselors tailor pre-exposure prophylaxis (PrEP) adherence support counseling to women's relationship dynamics with their sexual partners, suggesting modules for counselors to deliver. In this study, we examined the extent to which counselors used the HEART to guide the delivery of intervention modules and whether changes in subsequent HEART scores reflected the counseling module(s) received.
We conducted this study during a randomized controlled trial of the Community Health clinic model for Agency in Relationships and Safer Microbicide Adherence (CHARISMA) counseling intervention in Johannesburg, South Africa. Trained lay counselors administered the HEART to intervention group participants at enrollment (n=203) and at 3- and 6-month follow-up visits between October 2018 and April 2021. The HEART auto-calculated participants' response scores to recommend relevant counseling modules. We compared the mean scores for the 5 HEART scales across groups receiving different counseling modules. We also assessed changes in scale scores over time by the counseling module received.
Although counselors could override HEART counseling module recommendations based on additional knowledge of participants' cases, they consistently agreed with the HEART recommendations. The HEART also triggered the sorting of women into counseling modules that they were positioned to successfully leverage. Additionally, participants' HEART scores changed over time in predictable ways based on the type of counseling module received.
Overall, the tool performed as predicted and was consistent with past validation efforts of the HEART, indicating that the HEART may provide an efficient means to tailor women's counseling to address relationship-related challenges to PrEP adherence.
鉴于男性伴侣在女性决策和使用 HIV 预防产品方面可能扮演多样化的角色并具有强大影响力，我们之前开发了咨询师主导的健康关系评估工具（HEART）。该工具帮助咨询师根据女性与性伴侣的关系动态调整暴露前预防（PrEP）依从性支持咨询，为咨询师提供建议模块。在这项研究中，我们考察了咨询师使用 HEART 指导干预模块交付的程度，以及随后 HEART 评分的变化是否反映了所接受的咨询模块。
我们在南非约翰内斯堡开展的关系中的代理机构和更安全杀微生物剂依从性的社区健康诊所模式（CHARISMA）咨询干预的随机对照试验中进行了这项研究。经过培训的非专业咨询师在 2018 年 10 月至 2021 年 4 月期间在入组时（n=203）和 3 个月和 6 个月随访时为干预组参与者施测 HEART。HEART 自动计算参与者的反应得分，以推荐相关咨询模块。我们比较了接受不同咨询模块的各组的 5 个 HEART 量表的平均得分。我们还评估了根据所接受的咨询模块，量表得分随时间的变化。
尽管咨询师可以根据对参与者病例的额外了解来推翻 HEART 咨询模块建议，但他们始终与 HEART 建议一致。HEART 还可以将女性归入她们能够成功利用的咨询模块中。此外，参与者的 HEART 评分随着时间的推移会根据所接受的咨询模块类型以可预测的方式发生变化。
总体而言，该工具的表现符合预期，与 HEART 的过去验证工作一致，表明 HEART 可能为根据关系相关挑战调整女性咨询以促进 PrEP 依从性提供一种有效的方法。
