Effect of a storytelling intervention on the retention of serodiscordant couples in ART/PrEP services at antenatal clinic in Namacurra province in Zambézia, Mozambique

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

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.

The Effect of Stigma on Family Planning and HIV Pre-exposure Prophylaxis Decisions of Young Women Accessing Post-Abortion Care in Kenya

Adolescent girls and young women (AGYW) in Eastern and Southern Africa face parallel epidemics of unintended pregnancy and HIV. Their sexual health decisions are often dominated by intersecting stigmas. In an implementation science project integrating delivery of daily, oral pre-exposure prophylaxis (PrEP) for HIV prevention into 14 post-abortion care (PAC) clinics in Kenya, we enrolled a subset of PrEP initiating AGYW (aged 15 to 30 years) into a research cohort. Utilizing log binomial models, we estimated the effect of PrEP stigma on PrEP continuation (measured via self-report and urine assay for tenofovir) and abortion stigma on contraceptive initiation. Between April 2022 and February 2023, 401 AGYW were enrolled after initiating PrEP through their PAC provider, of which 120 (29.9%) initiated highly-effective contraception. Overall, abortion and PrEP stigmas were high in this cohort. Abortion stigma was more prevalent among those that were adolescents, unmarried, and reported social harm. Among 114 AGYW returning for the month 1 follow-up visit, 83.5% reported continuing PrEP and 52.5% had tenofovir detected. In this subset, higher levels of PrEP stigma were significantly associated with greater likelihood of PrEP adherence, but not PrEP continuation. For abortion stigma, greater scores in the subdomain of isolation were significantly associated with greater likelihood of initiating a highly-effective contraception, while greater scores in the subdomain of community condemnation were significantly associated with reduced likelihood of initiating a highly-effective contraception. Given the burden of stigma documented by our work, PAC settings are a pivotal space to integrate stigma-informed counseling and to empower young women to optimize contraceptive and PrEP decisions.