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.
Download the CHARISMA Toolkit Overview
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
Perception of PrEP-related Stigma in PrEP Users: Results from the ANRS-PREVENIR cohort
This journal article from HIV Medicine explored how stigma has played a role and been a major barrier in uptake and adherence of oral PrEP.
Shaping and Strengthening Markets for a New Era of Choice-based HIV/SRH Programming: Lessons from HIV & FP product introduction Report
This report was from the BioPIC Think Tank, Shaping and Strengthening Markets for a New Era of Choice-based HIV/SRH Programming: Lessons from HIV & FP product introduction. As new HIV prevention products move closer to entering the market, there is an opportunity to design choice-based programs that apply lessons and successes from HIV and FP…
Important Steps for PrEP Uptake Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil
This journal article from PLOS ONE analyzed the PrEP uptake process and factors associated with daily oral PrEP initiation among adolescent men who have sex with men and transgender women in Brazil.
HIV Care Providers’ Familiarity, Concerns, and Attitudes About HIV PrEP in Colombia: Insights From the PrEP-Col-Study
This journal article from AIDS Care examined PrEP awareness and familiarity, comfort with PrEP-related activities, perceived barriers for PrEP implementation, concerns, and attitudes in Colombia.
Shaping and Strengthening Markets for a New Era of Choice-based HIV/SRH Programming: Lessons from HIV & FP product introduction Slides
These slides were featured at the BioPIC Think Tank, Shaping and Strengthening Markets for a New Era of Choice-based HIV/SRH Programming: Lessons from HIV & FP product introduction. As new HIV prevention products move closer to entering the market, there is an opportunity to design choice-based programs that apply lessons and successes from HIV and…
Uptake and Continuation of HIV Pre-Exposure Prophylaxis Among Women of Reproductive Age in Two Health Facilities in Kisumu County, Kenya
This article from Journal of the International AIDS Society follows the uptake and continuation of oral PrEP among women 15–49 years in two health facilities in Kisumu County, Kenya.
Addressing the Need for a Preexposure Prophylaxis Monitoring and Evaluation Implementation Guide: Experience From Zambia
The HIV care continuum comprises well-defined steps and indicators. In contrast, indicators along the preexposure prophylaxis (PrEP) cascade are still in the early stages of implementation. Monitoring and evaluation (M&E) of PrEP services is critical to optimizing PrEP uptake and adherence during periods of HIV risk. We provide an overview of global indicators for PrEP,…
Special Issue of the PrEP1519 Brazil Study
Cadernos de Saúde Pública released a special issue of the PrEP1519 study using baseline data. Click here more details. For a full breakdown of the free journal articles, please see below. Combination HIV prevention for adolescent men who have sex with men and adolescent transgender women in Brazil: vulnerabilities, access to healthcare, and expansion of…
Guidance: Standard Operating Procedures for Addressing Partner Relationships and Gender-Based Violence in Pre-Exposure Prophylaxis (PrEP) Services
Standard Operating Procedure Guidance Evidence has shown that intimate partner violence (IPV) may act as a barrier to accessing HIV services, including PrEP services. IPV is associated with lower PrEP uptake and adherence and increased PrEP interruption among cisgender women. Although cisgender women have made up the majority of participants in research on PrEP and…
Salient Beliefs and Intention to Use Pre-Exposure Prophylaxis Among Pregnant and Breastfeeding Women in Zambia: Application of the theory of planned behaviour
This article from Global Public Health shares the outcomes of beliefs and intentions to use PrEP amongst pregnant and lactating cisgender women in Zambia.