CHOMA

The study aims to evaluate two primary outcomes among young South African women after a 3-month period:

1. Comparing the proportion of young South African women who exhibit good adherence to PrEP (determined by tenofovir levels detected in a point-of-care urine assay) between those receiving the Youth Friendship Bench SA in addition to standard-of-care mental health services and those receiving standard-of-care mental health services alone.
2. Comparing the proportion of young South African women with decreased symptoms of common mental disorders (assessed via SRQ-20 scores) between those receiving the Youth Friendship Bench SA along with standard-of-care mental health services and those receiving standard-of-care services alone.

The primary outcome for PrEP adherence is defined as the proportion of individuals with PrEP adherence at Month 3, characterized by tenofovir concentrations of 1500 ng/mL or higher in urine as measured using a point-of-care assay. Additionally, we will assess the short-term impact of the Youth Friendship Bench SA intervention on PrEP adherence at the Week 4 visit using the urine point-of-care assay.

For mental health-related outcomes, the primary outcome is the proportion of individuals with reduced symptoms of common mental disorders as indicated by SRQ-20 scores.

CHOMA Continuum Abstract

Combining HIV Prevention Options With Mental Health Service Delivery For Adolescent Girls (CHOMA): Results Of A Pilot Hybrid Effectiveness-Implementation Randomized Trial

Jennifer Velloza, Nomhle Ndimande-Khoza, Lisa Mills, Nicole Poovan, Elizabeth Sherwin, Carrie Mathew, Zinhle Sokhela, Ruth Verhey, Dixon Chibanda, Sybil Hosek, Connie Celum, Sinead Delany-Moretlwe. Presenting author email jennifer.velloza@ucsf.edu

Background: Adolescent girls and young women (AGYW) at risk of HIV frequently have symptoms of common mental disorders (CMD) that are associated with lower PrEP adherence. We conducted a pilot effectiveness-implementation trial (CHOMA) to evaluate whether an evidence-based mental health intervention adapted for PrEP delivery (“Youth Friendship Bench SA”) could address CMD and PrEP adherence among South African AGYW.

Methods: CHOMA was conducted in Johannesburg from April 2023 – February 2024. We enrolled AGYW (18-25 years) initiating PrEP with elevated CMD symptoms (Self-Reporting Questionnaire 20-item [SRQ-20] ≥7). Participants were randomized to intervention (five problem-solving counseling sessions, one group session, optional remote counseling) or standard-of-care. Follow-up occurred at Weeks 2, 4, 8, and 12. Co-primary outcomes were recent PrEP use (positive urine point-of-care tenofovir assay) and reduced CMD symptoms (SRQ-20 score <7) at Week 12. A secondary outcome was Acceptability of Intervention Measure (AIM) mean score (range=1-4).

Results: Of 116 AGYW enrolled, the median age was 21 (IQR: 20-23) years and median SRQ-20 score was 9 (IQR: 7-10). We retained 68% through Week 12. Enrollment SRQ-20 score was not associated with Week 12 PrEP adherence or retention. At Week 4, 29/36 (80.6%) participants in the intervention and 25/41 (61.0%) in the standard-of-care had recent PrEP use (RR=1.40; 95% CI=1.03-1.89; p=0.03), but this was not sustained through Week 12 (RR=0.88; 95% CI=0.64-1.22; p=0.44). CMD symptoms did not differ by arm at Week 4 or 12, although the proportion with SRQ-20 scores <7 increased overall between Weeks 4 (30.2%) and 12 (44.8%; p<0.01). Mean AIM score was 3.5.

Conclusions: We saw a short-term intervention effect on PrEP adherence at Week 4 and reductions in SRQ-20 symptoms in both arms. Although intervention acceptability was high, retention was challenging, indicating that longer-term mental health and PrEP support interventions are needed to improve integrated service delivery among AGYW.

Latest Update – November 2024

Mental Health Matters in HIV Prevention: The CHOMA Study’s Impact on PrEP Adherence for Young Women