Storytelling sessions for PrEP/ART education and psychosocial support among expectant serodiscordant couples: results from a pilot feasibility trial in Zambézia Province, Mozambique.

Abstract

Pre-exposure prophylaxis (PrEP) is offered to pregnant HIV-uninfected women in serodiscordant relationships in Mozambique, yet uptake is still low. We conducted a randomized feasibility trial of PrEP education and psychosocial support to serodiscordant expectant couples via three storytelling sessions in two districts within Zambézia Province. Data were collected between December 2020 and December 2022. We recruited 64 couples (31 control and 33 intervention) from two health facilities. We assessed the intervention's effect on psychosocial metrics related to PrEP (stigma, treatment self-efficacy, treatment expectations, relationship satisfaction, social support), retention in clinical services, and participants' acceptability of each storytelling session. Among couples randomized to the intervention, 24 (73%) completed all three sessions. No impact was seen on median medication possession ratio (among women: 74.0% and 73.8% [p = 0.514]; among men: 78.3% and 75.4% [p = 0.543] for control and intervention groups, respectively). Surveys revealed no change in PrEP stigma, treatment self-efficacy, treatment expectations, or relationship satisfaction. In interviews, participants reported increased PrEP knowledge, improved trust, capacity, and motivation to remain adherent to their medications. Some described low PrEP awareness within their communities and suggested community-based educational sessions. In-person narrative-style storytelling could be an acceptable method of conveying PrEP information to serodiscordant couples in rural areas in Mozambique.