CHARISMA: Empowerment counseling to improve women's ability to use PrEP safely and effectively
The toolkit provides a comprehensive set of tools to support integration of the CHARISMA empowerment counseling intervention into PrEP programs. The intervention is comprised of four steps administered by counselors as part of PrEP service delivery: (1) a relationship assessment, (2) tailored empowerment counseling, (3) information materials for male partners, and (4) referrals to community-based services.
A randomized controlled trial (RCT) conducted in Johannesburg, South Africa, found that CHARISMA was highly acceptable and increased women’s disclosure of PrEP use to male partners by 10%; however, no statistically significant impact on oral PrEP use or experience of IPV was detected. Further analysis of the RCT data and evaluation of CHARISMA are needed to better understand its impact and determine who might benefit most from the intervention.
Though the RCT did not demonstrate a measurable impact on adherence to PrEP or experience of IPV, the CHARISMA intervention tools are being shared because few existing resources address the critical issues of IPV and relationship dynamics as barriers to effective PrEP use. The hope is that the content and approach can be further adapted by toolkit users and evaluated for impact.