{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T02:07:13Z","timestamp":1772849233788,"version":"3.50.1"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T00:00:00Z","timestamp":1640908800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"USAID","doi-asserted-by":"crossref","award":["AID-OAA-A-15-00032"],"award-info":[{"award-number":["AID-OAA-A-15-00032"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["UM1AI068633, UM1AI068615 and UM1AI106707"],"award-info":[{"award-number":["UM1AI068633, UM1AI068615 and UM1AI106707"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institute of Mental Health, all components of the U.S. National Institutes of Health"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Introduction<\/jats:title><jats:p>The CHARISMA intervention, nested within the MTN-025\/HOPE vaginal ring trial in Johannesburg, South Africa, seeks to facilitate women\u2019s use of HIV prevention products by promoting partner dialogue and mitigating intimate partner violence (IPV). We developed \u201cHEART\u201d, a lay counselor-administered relationship assessment tool, for the CHARISMA pilot. The five-scale tool assesses participants\u2019 endorsement of Traditional Values (TV), her HIV Prevention Readiness (HPR) and levels of partner support (PS), abuse and control (PAC), and resistance to HIV prevention (PR), guiding decisions about which of three counselling modules to offer (partner communication\/A; ring disclosure\/B; and IPV prevention\/C).<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>We correlated baseline scores on HEART subscales with a) independent measures of relationship stability, disclosure and IPV to assess construct validity, and b) with specific modules offered to determine how HEART was used in the pilot. We examined changes in HEART scores at three and six months. Finally, we ran separate growth models for each subscale to examine changes in scores, accounting for partnership changes and counseling module(s) received.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Baseline HEART scores correlated as predicted among subscales and with other measures. Reliabilities for four subscales were 0.75 or higher. Women who disclosed study participation and ring use scored higher on PS and lower on PR. Women experiencing IPV scored lower on PS, and higher on PAC and PR. During the pilot, 82% of women received one and 17% received two or more modules; over half received the IPV module. Women with higher PAC and PR scores were more likely to receive the IPV than the communication or disclosure modules. Over time, the TV, PAC and PR scores decreased, and PS score increased. Receiving the IPV module was associated with a decreased PAC score.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>These data offer preliminary evidence for HEART construct and predictive validity and support its further evaluation to guide implementation and monitor the impact of the CHARISMA intervention in a randomized controlled evaluation.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0261526","type":"journal-article","created":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T18:40:03Z","timestamp":1640976003000},"page":"e0261526","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Evidence for use of a healthy relationships assessment tool in the CHARISMA pilot study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9823-3675","authenticated-orcid":true,"given":"Elizabeth 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Baeten","year":"2016","journal-title":"N Engl J Med"},{"issue":"3","key":"pone.0261526.ref004","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1097\/QAI.0000000000000158","article-title":"FEM-PrEP: adherence patterns and factors associated with adherence to a daily oral study product for pre-exposure prophylaxis","volume":"66","author":"AL Corneli","year":"2014","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"11","key":"pone.0261526.ref005","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1016\/S1473-3099(18)30428-6","article-title":"Tenofovir 1% vaginal gel for prevention of HIV-1 infection in women in South Africa (FACTS-001): a phase 3, randomised, double-blind, placebo-controlled trial","volume":"18","author":"S Delany-Moretlwe","year":"2018","journal-title":"Lancet Infect Dis"},{"issue":"6","key":"pone.0261526.ref006","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1056\/NEJMoa1402269","article-title":"Tenofovir-based preexposure prophylaxis for HIV infection among African women","volume":"372","author":"JM Marrazzo","year":"2015","journal-title":"N Engl J Med"},{"key":"pone.0261526.ref007","article-title":"Misreporting of Product Adherence in the MTN-003\/VOICE Trial for HIV Prevention in Africa: Participants\u2019 Explanations for Dishonesty","author":"ET Montgomery","year":"2016","journal-title":"AIDS Behav"},{"key":"pone.0261526.ref008","doi-asserted-by":"crossref","first-page":"18505","DOI":"10.7448\/IAS.16.1.18505","article-title":"Microbicide clinical trial adherence: insights for introduction","volume":"16","author":"C Woodsong","year":"2013","journal-title":"J Int AIDS Soc"},{"issue":"5","key":"pone.0261526.ref009","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1097\/QAI.0000000000000362","article-title":"Perception of HIV risk and adherence to a daily, investigational pill for HIV prevention in FEM-PrEP","volume":"67","author":"A Corneli","year":"2014","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"2","key":"pone.0261526.ref010","doi-asserted-by":"crossref","first-page":"e89118","DOI":"10.1371\/journal.pone.0089118","article-title":"Women\u2019s experiences with oral and vaginal pre-exposure prophylaxis: the VOICE-C qualitative study in Johannesburg, South Africa","volume":"9","author":"A van der Straten","year":"2014","journal-title":"PLoS One"},{"issue":"3","key":"pone.0261526.ref011","doi-asserted-by":"crossref","first-page":"19159","DOI":"10.7448\/IAS.17.3.19159","article-title":"Engaging male partners in women\u2019s microbicide use: evidence from clinical trials and implications for future research and microbicide introduction.","volume":"17","author":"M Lanham","year":"2014","journal-title":"J Int AIDS Soc"},{"issue":"5","key":"pone.0261526.ref012","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1007\/s10461-014-0950-5","article-title":"Male Partner Influence on Women\u2019s HIV Prevention Trial Participation and Use of Pre-exposure Prophylaxis: 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Rethinking PrEP for adolescent girls and young women. IAPAC; June 18, 2019; Miami, FL2019."},{"issue":"Suppl 4","key":"pone.0261526.ref014","doi-asserted-by":"crossref","first-page":"e25298","DOI":"10.1002\/jia2.25298","article-title":"HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery","volume":"22","author":"CL Celum","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"pone.0261526.ref015","article-title":"Persistence of oral pre-exposure prophylaxis (PrEP) among adolescent girls and young women initiating PrEP for HIV prevention in Kenya","author":"J de Dieu Tapsoba","year":"2020","journal-title":"AIDS Care"},{"issue":"9","key":"pone.0261526.ref016","doi-asserted-by":"crossref","first-page":"e1002885","DOI":"10.1371\/journal.pmed.1002885","article-title":"Integrating preexposure prophylaxis delivery in routine family planning clinics: A feasibility programmatic evaluation in Kenya","volume":"16","author":"KK Mugwanya","year":"2019","journal-title":"PLoS 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Uganda","volume":"77","author":"A Cabral","year":"2018","journal-title":"J Acquir Immune Defic Syndr."},{"key":"pone.0261526.ref020","article-title":"Intimate partner violence and adherence to HIV pre-exposure prophylaxis (PrEP) in African women in HIV serodiscordant relationships: A prospective cohort study","author":"ST Roberts","year":"2016","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"5","key":"pone.0261526.ref021","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1521\/aeap.2019.31.5.433","article-title":"Generating CHARISMA: Development of an Intervention to Help Women Build Agency and Safety in Their Relationships While Using PrEP for HIV Prevention","volume":"31","author":"M Hartmann","year":"2019","journal-title":"AIDS Educ Prev"},{"issue":"12","key":"pone.0261526.ref022","doi-asserted-by":"crossref","first-page":"e0242881","DOI":"10.1371\/journal.pone.0242881","article-title":"Development and initial validation of a simple tool to screen for partner support or opposition to HIV prevention product use","volume":"15","author":"EE Tolley","year":"2020","journal-title":"PLoS One"},{"issue":"17","key":"pone.0261526.ref023","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1001\/jama.1997.03540410035027","article-title":"Accuracy of 3 brief screening questions for detecting partner violence in the emergency department","volume":"277","author":"KM Feldhaus","year":"1997","journal-title":"JAMA"},{"issue":"5","key":"pone.0261526.ref024","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1891\/vivi.2005.20.5.529","article-title":"The composite abuse scale: further development and assessment of reliability and validity of a multidimensional partner abuse measure in clinical settings","volume":"20","author":"K Hegarty","year":"2005","journal-title":"Violence Vict"},{"issue":"9\/10","key":"pone.0261526.ref025","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1023\/A:1025665907856","article-title":"Psychological Abuse Among College Women in Exclusive Hetersexual Dating Relationships","volume":"36","author":"RB Pipes","year":"1997","journal-title":"Sex Roles"},{"issue":"7\u20138","key":"pone.0261526.ref026","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1023\/A:1007051506972","article-title":"Measuring Sexual Relationship Power in HIV\/STD Research.","volume":"42","author":"J Pulerwiz","year":"2000","journal-title":"Sex Roles"},{"issue":"6","key":"pone.0261526.ref027","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1080\/17441692.2012.672581","article-title":"Constructs of power and equity and their association with contraceptive use among men and women in rural Ethiopia and Kenya","volume":"7","author":"R Stephenson","year":"2012","journal-title":"Glob Public Health"},{"key":"pone.0261526.ref028","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1186\/1471-244X-14-180","article-title":"Validation of the multi-dimensional scale of perceived social support (MSPSS) and the relationship between social support, intimate partner violence and antenatal depression in Malawi","volume":"14","author":"RC Stewart","year":"2014","journal-title":"BMC Psychiatry"},{"key":"pone.0261526.ref029","unstructured":"Montgomery ET, Roberts ST, Reddy K, Tolley EE, Hartmann MW, Ellen, Mathebula F, et al. Impact of the \u2019Charisma\u2019 Intervention Pilot on Partner Disclosure, IPV, and Adherence. Conference on Retroviruses and Opportunitstic Infections; March 8\u201311, 2020; Boston, Massacusetts2020. p. 1015."},{"key":"pone.0261526.ref030","first-page":"262","volume-title":"Scale development: theory and applications","author":"RF DeVellis","year":"2017","edition":"4"},{"issue":"1","key":"pone.0261526.ref031","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1186\/s12905-021-01262-z","article-title":"Acceptability and feasibility of the CHARISMA counseling intervention to support women\u2019s use of pre-exposure prophylaxis: results of a pilot study","volume":"21","author":"EK Wilson","year":"2021","journal-title":"BMC Womens Health"},{"issue":"2","key":"pone.0261526.ref032","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1177\/0886260506295814","article-title":"Using indirect questions to detect intimate partner violence: the SAFE-T questionnaire","volume":"22","author":"JL Fulfer","year":"2007","journal-title":"J Interpers Violence"},{"issue":"1\u20132","key":"pone.0261526.ref033","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1080\/17441692.2015.1047391","article-title":"Stigma, shame and women\u2019s limited agency in help-seeking for intimate partner violence","volume":"11","author":"J McCleary-Sills","year":"2016","journal-title":"Glob Public Health"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0261526","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T02:22:08Z","timestamp":1700014928000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0261526"}},"subtitle":[],"editor":[{"given":"Karine","family":"Dub\u00e9","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,12,31]]},"references-count":33,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0261526","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,31]]}}}