{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T18:39:43Z","timestamp":1792694383467,"version":"4.5.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"PEPFAR\/USAID","award":["7200AA21CA00011"],"award-info":[{"award-number":["7200AA21CA00011"]}]},{"name":"NIH","award":["R25 DA 031608"],"award-info":[{"award-number":["R25 DA 031608"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["AIDS Behav"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>As pre-exposure prophylaxis (PrEP) options expand, providers play a critical role in supporting clients to select the method that best meets their needs. We examined how client\u2013provider interactions during PrEP choice counselling influenced women\u2019s autonomous decision-making and early continuation on PrEP. CATALYST was a mixed-methods study that delivered an informed choice of oral PrEP, the dapivirine vaginal ring, and injectable cabotegravir among women attending 28 public-sector facilities in Kenya, Lesotho, South Africa, Uganda, and Zimbabwe. We analysed cohort data collected between June 2024 and January 2025 and adapted a family planning Autonomous Decision-Making (ADM) scale into a six-item PrEP-specific measure (PrEP-ADM scale). Factor analysis assessed scale structure, and logistic regression identified factors associated with fully autonomous decision-making (PrEP-ADM score of 18\/18) and refilling PrEP within three months. Twenty-six in-depth interviews explored counselling experiences. Among 2,488 women, 92% reported fully autonomous decision-making. Two subscales were identified: \u201ccommunicating information\u201d and \u201csupporting informed choice\u201d. Women in sero-different partnerships had higher odds of reporting fully autonomous decision-making (adjusted odds ratio [aOR]: 1.63, 95% CI: 1.11\u20132.39), whereas pregnant (aOR: 0.29, 95% CI: 0.17\u20130.47) and breastfeeding women (aOR: 0.46, 95% CI: 0.28\u20130.76) had lower odds. Autonomous decision-making was not associated with PrEP refill. Qualitative findings confirmed clear information exchange and supportive counselling, although pregnant and breastfeeding women described more constrained choices. High levels of perceived autonomous decision-making were observed, though further work is needed to refine these measures and identify the essential elements of informed PrEP choice counselling.<\/jats:p>","DOI":"10.1007\/s10461-026-05309-w","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T05:47:35Z","timestamp":1792648055000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cI Feel Like I Am a Winner:\u201d High Levels of Autonomous Decision-Making Among Women Receiving HIV Pre-Exposure Prophylaxis (PrEP) Choice Counselling in Sub-Saharan Africa"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4535-1694","authenticated-orcid":false,"given":"Ivan","family":"Segawa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0660-0889","authenticated-orcid":false,"given":"Haley","family":"Sisel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5568-1005","authenticated-orcid":false,"given":"Catherine","family":"Kyampire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2730-5683","authenticated-orcid":false,"given":"Rose","family":"Wilcher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7128-4854","authenticated-orcid":false,"given":"Kyria Louis","family":"Charles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6287-5289","authenticated-orcid":false,"given":"Patriciah","family":"Jeckonia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8074-9171","authenticated-orcid":false,"given":"Courtney","family":"McGuire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6901-5026","authenticated-orcid":false,"given":"Amogelang","family":"Kekana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7197-9426","authenticated-orcid":false,"given":"Nicolette","family":"Naidoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9865-8756","authenticated-orcid":false,"given":"Imelda","family":"Mahaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert","family":"Kadama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7401-3758","authenticated-orcid":false,"given":"Elizabeth","family":"Irungu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9005-3549","authenticated-orcid":false,"given":"Virginia","family":"Fonner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the CATALYST study (Catalyzing access to new prevention products to stop HIV)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"key":"5309_CR1","unstructured":"Joint United Nations Programme on HIV\/AIDS. AIDS, crisis and the power to transform: UNAIDS Global AIDS Update 2025, Geneva, 2025. https:\/\/www.unaids.org\/sites\/default\/files\/2025-07\/2025-global-aids-update-JC3153_en.pdf. Accessed 16 Mar 2026."},{"key":"5309_CR2","unstructured":"Joint United Nations Programme on HIV\/AIDS. Global HIV and AIDS statistics\u2014fact sheet. https:\/\/www.unaids.org\/en\/resources\/fact-sheet. Accessed 7 Aug 2026."},{"key":"5309_CR3","unstructured":"Joint United Nations Programme on HIV\/AIDS. The urgency of now: AIDS at a crossroads. https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/2024-unaids-global-aids-update_en.pdf. Accessed 7 Aug 2026."},{"key":"5309_CR4","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.18.4.20227","author":"CL Celum","year":"2015","unstructured":"Celum CL, et al Rethinking HIV prevention to prepare for oral PrEP implementation for young African women. J Int AIDS Soc. 2015. https:\/\/doi.org\/10.7448\/IAS.18.4.20227.","journal-title":"J Int AIDS Soc"},{"key":"5309_CR5","unstructured":"World Health Organization. WHO implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection: provider module for oral and long-acting PrEP, 2024. https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/ac4f38b5-99d4-4fad-b32b-ab3a5475b11f\/content. Accessed 7 Aug a2026."},{"key":"5309_CR6","doi-asserted-by":"publisher","unstructured":"McGuire C et al. Oct., PrEP method switching: will it yield greater coverage of HIV protection? Applying lessons learned from family planning to guide future research in the context of PrEP choice. Curr HIV\/AIDS Rep. 2024;21(5):282\u2013292. https:\/\/doi.org\/10.1007\/s11904-024-00704-1.","DOI":"10.1007\/s11904-024-00704-1"},{"issue":"Suppl 2","key":"5309_CR7","doi-asserted-by":"publisher","first-page":"e26115","DOI":"10.1002\/jia2.26115","volume":"26","author":"NM Mgodi","year":"2023","unstructured":"Mgodi NM, et al Advancing the use of long-acting extended delivery formulations for HIV prevention in sub\u2010Saharan Africa: challenges, opportunities, and recommendations. J Int AIDS Soc. 2023;26(Suppl 2):e26115. https:\/\/doi.org\/10.1002\/jia2.26115.","journal-title":"J Int AIDS Soc"},{"key":"5309_CR8","doi-asserted-by":"publisher","unstructured":"Segal K, et al. Equipping providers to offer novel MPTs: developing counseling messages for the dual prevention pill in clinical studies and beyond. Front Reprod Health. 2023;5(1155948). https:\/\/doi.org\/10.3389\/frph.2023.1155948.","DOI":"10.3389\/frph.2023.1155948"},{"issue":"4","key":"5309_CR9","doi-asserted-by":"publisher","first-page":"e269","DOI":"10.1016\/S2352-3018(23)00026-7","volume":"10","author":"KM Williams","year":"2023","unstructured":"Williams KM, et al Defining principles for a choice-based approach to HIV prevention. Lancet HIV. 2023;10(4):e269\u201372. https:\/\/doi.org\/10.1016\/S2352-3018(23)00026-7.","journal-title":"Lancet HIV"},{"key":"5309_CR10","doi-asserted-by":"publisher","unstructured":"Celum C, Grinsztejn B, Ngure K. Preparing for long-acting PrEP delivery: building on lessons from oral PrEP. J Int AIDS Soc. 2023;26(S2). https:\/\/doi.org\/10.1002\/jia2.26103.","DOI":"10.1002\/jia2.26103"},{"key":"5309_CR11","doi-asserted-by":"publisher","first-page":"682689","DOI":"10.3389\/frph.2021.682689","volume":"3","author":"BA Friedland","year":"2021","unstructured":"Friedland BA, Mathur S, Haddad LB The promise of the dual prevention pill: a framework for development and introduction. Front Reprod Health. 2021;3:682689. https:\/\/doi.org\/10.3389\/frph.2021.682689.","journal-title":"Front Reprod Health"},{"issue":"1","key":"5309_CR12","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1186\/s12978-022-01393-y","volume":"19","author":"EC Murphy","year":"2022","unstructured":"Murphy EC, et al Being able to do whatever you wanna do as a woman is important:\u2019 a qualitative exploration of contraception as a frame of reference for HIV prevention with PrEP. Reprod Health. 2022;19(1):92. https:\/\/doi.org\/10.1186\/s12978-022-01393-y.","journal-title":"Reprod Health"},{"issue":"5","key":"5309_CR13","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1007\/s11904-021-00571-0","volume":"18","author":"R Logan","year":"2021","unstructured":"Logan R, Seidman D Lessons learned from longer acting reversible contraception applied to longer acting HIV prevention technologies. Curr HIV\/AIDS Rep. 2021;18(5):483\u20138. https:\/\/doi.org\/10.1007\/s11904-021-00571-0.","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"6","key":"5309_CR14","doi-asserted-by":"publisher","first-page":"1876","DOI":"10.1007\/s10461-025-04656-4","volume":"29","author":"J Chen-Charles","year":"2025","unstructured":"Chen-Charles J, Joseph Davey D, Toska E, Seeley J, Bekker L-G PrEP uptake and utilisation among adolescent girls and young women in sub-Saharan Africa: a scoping review. AIDS Behav. 2025;29(6):1876\u201396. https:\/\/doi.org\/10.1007\/s10461-025-04656-4.","journal-title":"AIDS Behav"},{"key":"5309_CR15","doi-asserted-by":"publisher","unstructured":"Pleaner M, et al. Introduction and integration of PrEP and sexual and reproductive health services for young people: health provider perspectives from South Africa. Front Reprod Health. 2023;4(1086558). https:\/\/doi.org\/10.3389\/frph.2022.1086558.","DOI":"10.3389\/frph.2022.1086558"},{"key":"5309_CR16","doi-asserted-by":"publisher","first-page":"e64186","DOI":"10.2196\/64186","volume":"14","author":"C Rainer","year":"2025","unstructured":"Rainer C, et al Developing and implementing provider-training and evidence-based tools to support pre-exposure prophylaxis (PrEP) decision-making and increase PrEP adherence among young men who have sex with men: Protocol for the PrEP choice longitudinal cohort study. JMIR Res Protoc. 2025;14:e64186. https:\/\/doi.org\/10.2196\/64186.","journal-title":"JMIR Res Protoc"},{"issue":"8","key":"5309_CR17","doi-asserted-by":"publisher","first-page":"e0309075","DOI":"10.1371\/journal.pone.0309075","volume":"19","author":"M Vera","year":"2024","unstructured":"Vera M, et al I was given PrEP, but had no privacy\u2019: mystery shopper perspectives of PrEP counseling for adolescent girls and young women in Kisumu County, Kenya. PLoS ONE. 2024;19(8):e0309075. https:\/\/doi.org\/10.1371\/journal.pone.0309075.","journal-title":"PLoS ONE"},{"issue":"11","key":"5309_CR18","doi-asserted-by":"publisher","first-page":"e0293586","DOI":"10.1371\/journal.pone.0293586","volume":"18","author":"J Gausman","year":"2023","unstructured":"Gausman J, et al Validation of a measure to assess decision-making autonomy in family planning services in three low- and middle-income countries: The Family Planning Autonomous Decision-Making scale (FP-ADM). PLoS ONE. 2023;18(11):e0293586. https:\/\/doi.org\/10.1371\/journal.pone.0293586.","journal-title":"PLoS ONE"},{"issue":"13","key":"5309_CR19","doi-asserted-by":"publisher","first-page":"1914","DOI":"10.1111\/1471-0528.18124","volume":"132","author":"R Thakar","year":"2025","unstructured":"Thakar R, Gandhi M Reproductive autonomy: women\u2019s health and rights. BJOG. 2025;132(13):1914\u20137. https:\/\/doi.org\/10.1111\/1471-0528.18124.","journal-title":"BJOG"},{"issue":"2","key":"5309_CR20","doi-asserted-by":"publisher","first-page":"e26457","DOI":"10.1002\/jia2.26457","volume":"28","author":"VA Fonner","year":"2025","unstructured":"Fonner VA, et al PrEP choice in the real world: results of a prospective cohort study describing uptake and use patterns of oral PrEP and the dapivirine vaginal ring among women in sub-Saharan Africa. J Int AIDS Soc. 2025;28(2):e26457. https:\/\/doi.org\/10.1002\/jia2.26457.","journal-title":"J Int AIDS Soc"},{"key":"5309_CR21","unstructured":"Project MOSAIC. CATALYST\u2014PrEPWatch. https:\/\/www.prepwatch.org\/catalyst\/. Accessed 8 Aug 2026."},{"key":"5309_CR22","unstructured":"EpiC, Projects RISE. Empathways - PrEPWatch. https:\/\/www.prepwatch.org\/resources\/empathways\/. Accessed 8 Aug 2026."},{"issue":"3","key":"5309_CR23","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1111\/sifp.12069","volume":"49","author":"M Sudhinaraset","year":"2018","unstructured":"Sudhinaraset M, Afulani PA, Diamond-Smith N, Golub G, Srivastava A Development of a person\u2010centered family planning scale in India and Kenya. Stud Fam Plann. 2018;49(3):237\u201358. https:\/\/doi.org\/10.1111\/sifp.12069.","journal-title":"Stud Fam Plann"},{"issue":"5","key":"5309_CR24","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/j.contraception.2021.01.008","volume":"103","author":"C Dehlendorf","year":"2021","unstructured":"Dehlendorf C, et al Development of the Person-Centered Contraceptive Counseling scale (PCCC), a short form of the Interpersonal Quality of Family Planning care scale. Contraception. 2021;103(5):310\u20135. https:\/\/doi.org\/10.1016\/j.contraception.2021.01.008.","journal-title":"Contraception"},{"issue":"2","key":"5309_CR25","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1111\/sifp.12092","volume":"50","author":"K Holt","year":"2019","unstructured":"Holt K, Zavala I, Quintero X, Hessler D, Langer A Development and validation of the client-reported quality of contraceptive counseling scale to measure quality and fulfillment of rights in family planning programs. Stud Fam Plann. 2019;50(2):137\u201358. https:\/\/doi.org\/10.1111\/sifp.12092.","journal-title":"Stud Fam Plann"},{"issue":"1","key":"5309_CR26","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1007\/s11904-025-00751-2","volume":"22","author":"F Saidi","year":"2025","unstructured":"Saidi F, Hosseinipour MC, Chi BH Long-acting injectable antiretroviral drugs for pregnant and breastfeeding women: current advances, challenges, and future directions. Curr HIV\/AIDS Rep. 2025;22(1):44. https:\/\/doi.org\/10.1007\/s11904-025-00751-2.","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"1","key":"5309_CR27","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.contraception.2017.09.005","volume":"97","author":"C Dehlendorf","year":"2018","unstructured":"Dehlendorf C, Henderson JT, Vittinghoff E, Steinauer J, Hessler D Development of a patient-reported measure of the interpersonal quality of family planning care. Contraception. 2018;97(1):34\u201340. https:\/\/doi.org\/10.1016\/j.contraception.2017.09.005.","journal-title":"Contraception"},{"issue":"10","key":"5309_CR28","doi-asserted-by":"publisher","first-page":"e0258542","DOI":"10.1371\/journal.pone.0258542","volume":"16","author":"E Rousseau","year":"2021","unstructured":"Rousseau E, et al Adolescent girls and young women\u2019s PrEP-user journey during an implementation science study in South Africa and Kenya. PLoS ONE. 2021;16(10):e0258542. https:\/\/doi.org\/10.1371\/journal.pone.0258542.","journal-title":"PLoS ONE"},{"key":"5309_CR29","doi-asserted-by":"publisher","unstructured":"Celum CL, et al. HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J Int AIDS Soc. 2019;22. https:\/\/doi.org\/10.1002\/jia2.25298.","DOI":"10.1002\/jia2.25298"},{"key":"5309_CR30","unstructured":"World Health Organization. Differentiated and simplified pre-exposure prophylaxis for HIV prevention: update to WHO implementation guidance. Technical Brief. 2022. https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/403d040e-e4d4-43e2-8501-04c0de6eaa8b\/content. Accessed 23 May 2026."}],"container-title":["AIDS and Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10461-026-05309-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10461-026-05309-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10461-026-05309-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T18:02:51Z","timestamp":1792692171000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10461-026-05309-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,22]]},"references-count":30,"alternative-id":["5309"],"URL":"https:\/\/doi.org\/10.1007\/s10461-026-05309-w","relation":{},"ISSN":["1090-7165","1573-3254"],"issn-type":[{"value":"1090-7165","type":"print"},{"value":"1573-3254","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,22]]},"assertion":[{"value":"12 September 2026","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 October 2026","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"After manuscript submission but prior to publication, Virginia Fonner became an employee of ViiV Healthcare and holds stock ownership in the company. ViiV Healthcare manufactures CAB PrEP, one of the products used in this study. Dr. Fonner was not employed by ViiV Healthcare during study implementation or analysis. The other authors have no competing interests to declare that are relevant to the content of this article.","order":1,"name":"Ethics","label":"Competing Interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study involved human participants and was approved by the following institutional and national ethics committees: Lesotho National Health and Research Ethics Committee; Johns Hopkins Bloomberg School of Public Health Institutional Review Board; University of the Witwatersrand Human Research Ethics Committee; University of the Free State Health Sciences Research Ethics Committee; South African National Health Research Database; National HIV\/AIDS Research Committee of Uganda; Uganda National Council for Science and Technology; and the Medical Research Council of Zimbabwe. The study was conducted in accordance with the ethical principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","label":"Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":4,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Declarations"}}]}}