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

Seth Zissette; Elizabeth E Tolley; Andres Martinez; Sarah T Roberts; Thesla Palanee-Phillips; Elizabeth T Montgomery

doi:10.9745/GHSP-D-22-00075

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

Glob Health Sci Pract. 2023 Oct 30;11(5):e2200075. doi: 10.9745/GHSP-D-22-00075. Print 2023 Oct 30.

Authors

Seth Zissette¹, Elizabeth E Tolley², Andres Martinez², Sarah T Roberts³, Thesla Palanee-Phillips^{4

5}, Elizabeth T Montgomery³

Affiliations

¹ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. seth.zissette@emory.edu.
² Behavioral, Epidemiological, & Clinical Sciences, FHI 360, Durham, NC, USA.
³ Women's Global Health Imperative, RTI International, Berkeley, CA, USA.
⁴ Faculty of Health Sciences, School of Public Health, Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.
⁵ Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA.

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Publication types

Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Anti-HIV Agents* / therapeutic use
Counseling
Female
HIV Infections* / drug therapy
HIV Infections* / prevention & control
Humans
Male
Pre-Exposure Prophylaxis*
Social Support
South Africa

Substances

Anti-HIV Agents