HEART Administration
ABUSE
In addition to other CHARISMA activities, trained lay counselors administered the HEART to all treatment group participants at enrollment. The original HEART contained 41 items across 5 scales: (1) Traditional Values, (2) Partner Support, (3) Partner Abuse and Control, (4) Partner Resistance to HIV Prevention, and (5) HIV Prevention Readiness. Based on subsequent psychometric analysis, we reduced the number of items in some scales.Summary of HEART Scales Used in the CHARISMA PrEP Adherence Counseling Intervention, Johannesburg, South AfricaAbbreviations: CHARISMA, Community Health clinic model for Agency in Relationships and Safer Microbicide Adherence; HEART, Healthy Relationship Assessment Tool; PrEP, pre-exposure prophylaxis.The HEART was administered electronically by a counselor via a tablet. For each scale, a score was automatically calculated for each participant by averaging her item responses. Those scores were then compared to calibrated cut-points indicating “risk zones” that were then used to recommend counseling modules. For example, a Partner Abuse and Control score in a high-risk zone would direct to an automated recommendation for the participant to receive a module addressing IPV.Final study visits for some CHARISMA participants took place January–April 2020, coinciding with the imposition of lockdown risk mitigation strategies to manage the COVID-19 epidemic in South Africa. Rather than bringing in the remaining study participants for full CHARISMA RCT exit visits, some final participants received an abbreviated set of procedures that did not include final administration of the HEART.