Client-Centered Adherence Counseling with Adherence Measurement Feedback to Support Use of the Dapivirine Ring in MTN-02
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ORIGINAL PAPER
Client‑Centered Adherence Counseling with Adherence Measurement Feedback to Support Use of the Dapivirine Ring in MTN‑025 (The HOPE Study) Iván C. Balán1 · Rebecca Giguere1 · Cody Lentz1 · Bryan A. Kutner1 · Clare Kajura‑Manyindo1,2,3 · Rose Byogero4 · Florence Biira Asiimwe4 · Yvonne Makala5 · Jane Jambaya6 · Nombuso Khanyile7 · Diane Chetty8 · Lydia Soto‑Torres9 · Ashley Mayo10 · Nyaradzo M. Mgodi11 · Thesla Palanee‑Phillips12 · Jared M. Baeten13
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Fostering adherence and open communication about adherence challenges is key to harnessing the potential of biomedical HIV prevention products. We describe the counseling intervention and objective adherence measure feedback process implemented to support adherence to the dapivirine vaginal ring among participants in four sub-Saharan countries and present findings on the counselors’ likeability and acceptability of the intervention. Most counselors (N = 42; 86%) liked Options counseling “very much” and during in-depth interviews (N = 22), reported that the intervention reshaped their adherence counselling approach by emphasizing understanding participants’ experiences using the ring, which facilitated open discussion of adherence challenges. Counselors found that reframing residual drug level (RDL) discussions from the “adherence” to “protection” perspective encouraged adherence among consistent users and facilitated decisions to switch to a different HIV prevention approach among infrequent users. Among counselors, 24% said participants “liked it very much” while 26% said that participants “liked it a little” possibly due to two main complaints: perceived repetitiousness of sessions and variability in the RDL assay, which at times resulted in unexpected low RDLs. Keywords Adherence biomarker · Counseling · HIV prevention · Adherence · Non-confrontational Resumen Fomentar la adherencia y la comunicación abierta sobre los desafíos con la adherencia es clave para aprovechar el potencial de los productos biomédicos de prevención del VIH. Describimos la intervención de consejería y el proceso de compartir los resultados de medidas objetivas de adherencia con participantes en cuatro países subsaharianos para apoyar la adherencia * Iván C. Balán [email protected] 1
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HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA Department of Counseling, Montclair State University, Montclair, NJ, USA
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CAPRISA Clinical Trials Unit for AIDS/Tuberculosis Prevention and Treatment, Durban, South Africa
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Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA FHI360, Durham, USA
Makerere University – Johns Hopkins University Research Collaboration CRS, Kampala, Uganda
University of Zimbabwe – University of California San Francisco Collaborative Research Program, Harare, Zimbabwe
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University of North Car
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