This 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.
CHARISMA Toolkit Guide to Implementation and Adaptation
A guide to implementing the CHARISMA intervention, with an overview of tools and resources in the Toolkit, lessons learned from the CHARISMA RCT and guidance on how to adapt CHARISMA for different populations and settings.
Counselor Training Curriculum
Counselor Training Curriculum
A training facilitator’s guide with materials for a 2.5 – 4-day training to equip counselors with the skills needed to implement CHARISMA, including understanding relationship dynamics, IPV and PrEP and how to provide client-centered counseling that promotes women’s agency.
- Counseling Training Presentation A.1 – Introduction to CHARISMA
- Counseling Training Presentation A.3 – Why CHARISMA is Needed
- Counseling Training Presentation H.24 – HEAlthy Relationship Assessment
- Counseling Observation Form
Relationship Assessment (HEART)
A tablet- or paper-based questionnaire that assesses a woman’s relationships with her male partner(s), including identifying women experiencing or at risk of IPV, and recommends which counseling module to use.
- 1. HEART Data Dictionary: This Excel document contains the variable names, item descriptions, response options, and logic for score calculation and module recommendations, the items found in the HEART tool
- 2. HEART REDCap Programming File: This zip file contains the code to set up the HEART in REDCap
- 3. HEART Programmed REDCap Form: This PDF shows how the HEART looks when set up in REDCap
CHARISMA Counseling Manual
The CHARISMA Counseling Manual is a resource to guide counselors through the key steps of the CHARISMA intervention, including the HEART relationship assessment, counseling modules, male partner engagement materials, and referrals to other services. It is part of the larger CHARISMA toolkit designed for counselors who are supporting women using or who would like to use ARV-based HIV prevention methods.
CHARISMA Counseling Job Aid
The CHARISMA Counseling Job Aid is part of the larger CHARISMA toolkit designed for counselors who are supporting women using or who would like to use ARV-based HIV prevention methods. The Job Aid includes key steps and messages for lay counselors to cover in each CHARISMA counseling session, including the HEART relationship assessment, all four counseling modules, male partner packets, and referrals.
The CHARISMA video series demonstrates key concepts about partner communication skills and discussing PrEP with male partners. These videos can be used as part of PrEP counseling or to raise awareness about relationship dynamics and PrEP use.
- Healthy Relationships
- Unhealthy Relationships
- Healthy Partner Communication
- Unhealthy Partner Communication
- Positive PrEP Disclosure
- Negative PrEP Disclosure
Educational Materials for Male Partners
Templates that can be adapted to local contexts and examples of other resources for women to share with their male partners about HIV prevention, oral PrEP, and relationships/
Templates that can be adapted to facilitate referrals to other services (e.g., psychosocial support, social services), especially for those who are experiencing IPV.
CHARISMA Mobile: Developing a digital empowerment counseling resource to help women use PrEP safely
CHARISMA is an empowerment-based, counselor administered intervention designed to help women use PrEP in the face of relationship challenges. CHARISMA was adapted into a mobile-friendly, self-administered website, CHARISMA Mobile. CHARISMA Mobile is funded by Digital Square, a PATH-led initiative funded and designed by USAID, the Bill & Melinda Gates Foundation, and a consortium of other investors.
This brief outlines why and how you can use the CHARISMA Mobile content, and an overview of the development of CHARISMA Mobile.
- CHARISMA Mobile: Developing a digital resource for empowerment counseling — This document summarizes the development of CHARISMA Mobile
- CHARISMA Mobile Printable Flyers: Health facilities and youth-spaces may print and post this flyer to direct young people to CHARISMA Mobile content through the South Africa Department of Health’s B-Wise website. Download version 1 / 2 / 3.
- Guidance: Standard Operating Procedures for Addressing Partner Relationships and Gender-Based Violence in Pre-Exposure Prophylaxis (PrEP) Services
- Generating CHARISMA: development of an intervention to help women build agency and safety in their relationships while using HIV prevention methods. AIDS Educ Prev. 2019;31(5): 433-451. Video & Manuscript
- Social harms in female-initiated HIV prevention method research: state of the evidence. AIDS. 2019;33(14): 2237-2244. Technical brief & Manuscript
- Impact of male partner involvement on women’s adherence to the dapivirine vaginal ring during a phase III trial. AIDS and Behavior. 2019. Manuscript
- Impact of partner-related social harms on women’s adherence to the dapivirine vaginal ring during a phase III trial. J Acquir Immune Defic Syndr. 2018;79(5): 580-589. Manuscript
- PrEP Learning Network Webinar: Results from randomized control trials. Webinar materials: presentation slides, recording, and Q&A resource sheet
- AIDS 2020 workshop recording: “PrEParing providers to address partner dynamics and violence in PrEP services.”
- CHARISMA photo story: words from CHARISMA clinic and community staff
Daily Oral PrEP, Event-Driven PrEP, PrEP Ring, and CAB PrEP Template Guidelines (English)
The intent of this document is to provide adaptable guidelines to support the development and adoption of national guidelines that align with World Health Organization (WHO) pre-exposure prophylaxis (PrEP) recommendations and guidance, including those for tenofovir disoproxil fumarate (TDF)-based daily and event-driven oral PrEP, the monthly dapivirine vaginal ring (“PrEP ring” or “the ring”), and…
Quality Improvement Brief
The Quality Improvement Collaborative (QIC) is a component of the CATALYST study that refines and makes context-specific improvements to the enhanced service delivery package to make it scalable for delivering PrEP choice. The QIC’s multi-country design enables rich learning and problem-solving by providing QI faculty, advisors, coaches, and teams from all CATALYST countries opportunities to…
Insights Report: Communicating the PrEP Category to AGYW
PrEP Category Positioning Market Research Validation Insights from Kenya, South Africa, and Zimbabwe This report is a comprehensive look at what was learned through validating the positioning direction. It explains the methodology, outlines country-specific reactions to the positioning direction, and distills key findings that were leveraged to adjust and refine the positioning to honor the…
Communicating the PrEP Category to Adolescent Girls and Young Women
This strategy brief is intended for use by implementers working to generate demand for PrEP among AGYW. Drawing on all learnings throughout the positioning process, the brief provides a narrative explanation of how to communicate the PrEP category to AGYW and includes actionable guidance on how best to develop communication that will get the attention…
PrEP Product Awareness, Preferences, and Past Experiences among Transgender Women and Men Who Have Sex with Men in Asia and Australia: The PrEP APPEAL Study
This report provides an overview of PrEP Product Awareness, Preferences, and Past Experiences among Transgender Women and Men Who Have Sex with Men in Asia and Australia (PrEP APPEAL), a survey study in 16 countries and territories in Asia and Australia. The overall goal of PrEP APPEAL was to identify values and preferences about PrEP,…
Adherence, Safety, and Choice of the Monthly Dapivirine Vaginal Ring or Oral Emtricitabine Plus Tenofovir Disoproxil Fumarate for HIV Pre-exposure Prophylaxis among African Adolescent Girls and Young Women: A randomised, open-label, crossover trial
This article from the Lancet HIV assesses product adherence, safety, and choice of oral PrEP compared with the dapivirine ring among adolescent girls and young women in South Africa, Uganda, and Zimbabwe.
Measuring Effects of Counseling to Increase Pre-Exposure Prophylaxis Adherence and Partner Support in South Africa Using the Healthy Relationship Assessment Tool
This article from Global Health: Science and Practice describes the results of a study to investigate the impact of the Healthy Relationships Tool, part of the CHARISMA Toolkit, on PrEP adherence amongst women in Johannesburg, South Africa.
Oral PrEP Value Chain Situation Analysis – Nigeria – 2020
This document provides a value chain situation analysis of oral PrEP in Nigeria as at June 2020.
PrEPare_Morocco: A Successful Community-based PrEP Delivery Demonstration Program for Men who Have Sex with Men and Female Sex Workers in Morocco
This article from AIDS Care describes the first PrEP demonstration project in the Middle East/North Africa region, which aimed to assess the feasibility and acceptability of a community-based PrEP program for female sex workers and gay and bisexual men who have sex with men in Morocco’s highest HIV prevalence cities: Agadir, Marrakech, and Casablanca.
Integrating HIV Preexposure Prophylaxis With Community-Based Syringe Services for Women Who Inject Drugs: Results from the Project SHE demonstration study
This article from Implementation Science describes the results of a demonstration project in Philadelphia, PA, USA to integrate PrEP provision into a syringe services programme for women who inject drugs.