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

2020 ◽  
Author(s):  
Ellen Wilson ◽  
L. Danielle Wagner ◽  
Thesla Palanee-Phillips ◽  
Sarah T. Roberts ◽  
Elizabeth E. Tolley ◽  
...  
Keyword(s):  
Pilot Study ◽  
Hiv Prevention ◽  
Positive Impact ◽  
Male Partner ◽  
Study Participant ◽  
Lessons Learned ◽  
Vaginal Microbicides ◽  
Clinic Staff ◽  
Counseling Intervention ◽  
Exposure Prophylaxis

Abstract Background: Women may need or seek male partner approval to {Malow, 2000 #18}{Malow, 2000 #18}{Malow, 2000 #18}{Malow, 2000 #18}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.Methods: In a pilot study with 95 female participants in Johannesburg, South Africa, lay counselors assessed participants’ relationship(s) with their male partner(s) and barriers or facilitators to HIV prevention method use, and then provided tailored, interactive counseling. We conducted study participant surveys and clinic staff interviews to evaluate CHARISMA’s feasibility and acceptability.Results: 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 stated that it was generally feasible to implement. Based on these promising preliminary findings, the project team is currently conducting a randomized controlled trial in which participants are receive either the standard of care for IPV screening and referral (control arm) or the CHARISMA intervention.Conclusions: Clinic staff felt strongly that the length and intensity of CHARISMA were necessary for participants to begin to trust the counselors enough to be open and honest about problems in their relationships, and to begin to overcome the normalization of intimate partner violence. The length and intensity of CHARISMA may not be feasible in some settings, but a shorter 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 self-administer the intervention through a computer rather than requiring a counselor. Lessons learned from the pilot study may be relevant to others developing interventions supporting women’s use of oral PrEP or vaginal microbicides.

scholarly journals Acceptability and feasibility of the CHARISMA counseling intervention to support women’s use of pre-exposure prophylaxis: results of a pilot study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ellen K. Wilson ◽  
◽  
L. Danielle Wagner ◽  
Thesla Palanee-Phillips ◽  
Sarah T. Roberts ◽  
...  
Keyword(s):  
Pilot Study ◽  
Hiv Prevention ◽  
Male Partner ◽  
Study Participant ◽  
Delivery Mode ◽  
Vaginal Microbicides ◽  
Lay Counselors ◽  
Counseling Intervention ◽  
Exposure Prophylaxis

Abstract Background 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. Methods 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. Results 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. Conclusions 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.

scholarly journals Lessons Learned from Longer Acting Reversible Contraception Applied to Longer Acting HIV Prevention Technologies

2021 ◽  
Author(s):  
Rachel Logan ◽  
Dominika Seidman
Keyword(s):  
Hiv Prevention ◽  
Reproductive Health ◽  
Sexual Health ◽  
Lessons Learned ◽  
Reproductive Justice ◽  
Holistic View ◽  
Marginalized Communities ◽  
Exposure Prophylaxis

Abstract Purpose of Review This review describes lessons learned from longer acting contraception and employs a reproductive justice lens to inform expansion of emerging HIV prevention technologies. Recent Findings Reproductive justice is a framework that advocates for the promotion of universal sexual and reproductive freedoms, particularly among historically marginalized communities. This framework takes a holistic view of individuals and sees the interconnections between sexual health, reproductive health, and overall health. Employing a sexual and reproductive justice perspective is essential to understanding and helping to mitigate the role intersecting structural, sexual, and reproductive oppressions, including those demonstrated through promotion of longer acting contraception, and can critically inform rollout of future prevention technologies, such as longer acting HIV pre-exposure prophylaxis. Summary This review highlights the need for researchers, clinicians, and policymakers to apply lessons learned from contraception and specifically focuses on principles of reproductive justice to offer expanding HIV prevention options.

scholarly journals Male Partner Influence on Women’s HIV Prevention Trial Participation and Use of Pre-exposure Prophylaxis: the Importance of “Understanding”

2014 ◽  
Vol 19 (5) ◽  
pp. 784-793 ◽  
Author(s):  
Elizabeth T. Montgomery ◽  
Ariane van der Straten ◽  
Jonathan Stadler ◽  
Miriam Hartmann ◽  
Busisiwe Magazi ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Male Partner ◽  
Prevention Trial ◽  
Trial Participation ◽  
Partner Influence ◽  
Exposure Prophylaxis

scholarly journals Integrating Pre-Exposure Prophylaxis Delivery in Public Health Family Planning Clinics: Lessons Learned From a Programmatic Implementation Project in Kenya

2021 ◽  
Vol 3 ◽  
Author(s):  
Kenneth K. Mugwanya ◽  
John Kinuthia
Keyword(s):  
Family Planning ◽  
Hiv Prevention ◽  
Implementation Strategies ◽  
Hiv Infections ◽  
Lessons Learned ◽  
African Women ◽  
Data Systems ◽  
Prep Implementation ◽  
Exposure Prophylaxis ◽  
Delivery Models

Sexually active African women are a priority population for HIV prevention due to the disproportionately high frequency of new HIV infections. Family planning (FP) clinics offer an already trusted platform that can be used to reach women for HIV prevention services, including pre-exposure prophylaxis (PrEP). In the recent PrEP Implementation in Young Women and Adolescent (PrIYA program), we piloted PrEP implementation in FP clinics in Kisumu, Kenya, and demonstrated that it was possible to integrate PrEP provision in FP systems with a program-dedicated staff. In this perspective, we describe experiences and strategies employed to introduce PrEP implementation in FP clinics and lessons learned. We identified the following lessons for PrEP introduction in FP clinics in Kenya: (1) possible to integrate and generate high enthusiasm for PrEP delivery in FP clinics but persistence on PrEP is a challenge, (2) involvement of national and regional stakeholders is critical for buy-in, contextualization, and sustainability, (3) delivery models that do not integrate fully with existing staff and systems are less sustainable, (4) creatinine testing at PrEP initiation may not be necessary, (5) fully integrated HIV and FP data systems need to be developed, and (6) incorporating implementation science evaluation is important to understand and document effective implementation strategies. In summary, integration of HIV prevention and FP services provides an opportunity to promote one-stop women-centered care efficiently. However, a broader focus on delivery models that utilize existing staff and novel strategies to help women identify their own risk for HIV are needed to ensure greater success and sustainability.

scholarly journals Evaluating the Feasibility of Implementing an HIV Prevention Intervention for Incarcerated African American Men: Lessons Learned From a Pilot Study

2020 ◽  
Vol 21 (5) ◽  
pp. 822-830
Author(s):  
Carlos C. Mahaffey ◽  
Danelle Stevens-Watkins ◽  
A. Kathleen Burlew ◽  
Myles D. Moody ◽  
Paris B. Wheeler ◽  
...  
Keyword(s):  
African American ◽  
Pilot Study ◽  
Hiv Prevention ◽  
African American Men ◽  
Setting Time ◽  
Lessons Learned ◽  
Future Research ◽  
Prison Setting ◽  
Hiv Intervention ◽  
Culturally Adapted

This pilot study evaluated the feasibility of implementing an evidence-based, culturally adapted HIV intervention with substance-using African American men in a prison setting. We recruited 60, soon-to-be released African American male prisoners from a larger study ( N = 211) to be randomly selected for participation in the group-based HIV intervention, Real Men Are Safe–Culturally Adapted (REMAS-CA). Participants who were not selected for participation in the intervention received standard Centers for Disease Control and Prevention HIV prevention counseling education, provided during participant assessment in the larger study. Nearly all of the participants who were selected to participate (87%) completed the REMAS-CA intervention. To examine feasibility, data were collected about any revisions made to the HIV intervention components for the prison setting, time needed to implement the program in full, details of implementing the intervention to ensure participation and maintain retention, and participant perception of the intervention. Revisions to the intervention included reducing the number of sessions from five to three, modifying the protocol language based on the setting, and removing six activities deemed inappropriate and/or unallowable by the prison officials. The cultural considerations and intervention, overall, were well received by the participants. However, several revisions made specific to the prison and its administration could affect the potential effectiveness of the intervention. Future research is needed to determine the effectiveness of REMAS-CA among this community.

Women and HIV in the Twenty-First Century: How Can We Reach the UN 2030 Goal?

2018 ◽  
Vol 30 (3) ◽  
pp. 213-224 ◽  
Author(s):  
Ann O'Leary
Keyword(s):  
Hiv Prevention ◽  
Behavioral Interventions ◽  
Male Partner ◽  
Female Condom ◽  
First Century ◽  
Aids Epidemic ◽  
Highly Active ◽  
Women And Hiv ◽  
Exposure Prophylaxis ◽  
Modern Era

Women have always been part of the HIV/AIDS epidemic. As with other populations affected by HIV, for many years the only prevention strategy available was behavior change. Behavioral interventions for women were developed and evaluated, with some success. Because women did not control the use of male condoms, efficacious interventions needed to build skills for partner negotiation. Woman-controlled technologies such as the female condom and vaginal spermicide were unable to solve the problem of male control of the condom and enable the development of safe methods for women to protect themselves. The modern era of HIV prevention has produced biomedical solutions based on highly active retroviral chemoprophylaxis, which can be hidden from the male partner and thus eliminate his possible negative reactions. Pre-exposure prophylaxis holds promise for HIV prevention among women. This article reviews the literature on HIV prevention for women, including both successes and challenges.

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