Choice period counselling for dapivirine vaginal ring and truvada in MTN-034 study; experiences of counsellors at MU-JHU CRS site Kampala, Uganda


BACKGROUND: Adolescents Girls and Young Women (AGYW) in Uganda are typically not empowered to make their own choices in many matters related to sexual and reproductive health. The MTN-034/REACH study involves AGYW who were randomized to either the Dapivirine vaginal ring or oral Truvada. At the end of a one-year crossover period after using both products, participants are offered an opportunity to select a product of their choice or neither product for a final 6-month choice period. We will explore the practices and experiences of counselors to prepare for the choice period of this study where there is no random assignment.
METHODS: Two training sessions were held for counsellors to prepare them for the choice period, during which counselling manuals and peer rating tools of counselling sessions were reviewed to identify best practices to be adopted to prepare participants for visits during the choice period. Additionally, counsellors held 4 meetings at the site with other study staff and they brainstormed on strategies of how to best deliver the information about 'choice'. Notes were taken of the best practices and experiences were documented in the counselling reports.
RESULTS: The team adopted pre-choice counselling in individual or group sessions as the main strategy to prepare AGYW for the choice period. During these sessions, the counsellors use skills that include: active listening, empathy, being non-judgmental as they answer questions and provide information in an unbiased manner about the ring and Truvada. Counsellors have learnt that it is hard for AGYW to make a choice and sometimes they request that the team makes a choice for them. The counseling team however, empowered participants to make informed choices and supported their decisions. AGYW should not be rushed to make decisions but rather be motivated as they tend to oscillate from option to option before making a final decision. Participants were also given the option of choosing neither product and informed about other available HIV prevention methods like condoms. AGYW appreciated the counselling and support provided.
CONCLUSIONS: Participants felt empowered to make the best HIV prevention choices and counsellors learnt that providing appropriate information while maintaining impartiality is key.