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Healthcare Providers’ Perspectives on a Novel Couple-Based HIV Treatment Intervention: A Qualitative Assessment of the Facilitators, Barriers, and Proposed Improvements to Implementation in Zambézia Province, Mozambique

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Abstract

Mozambique has one of the world’s highest HIV/AIDS burdens. Despite significant investment in HIV care and treatment, pregnant and lactating women’s retention in care remains suboptimal. One reason for poor maternal retention is lack of male partner support. We tested an interventional couple-based HIV care and treatment, including joint clinical appointments and couple-based educational and support sessions provided by a health counselor and peer educators, respectively. Healthcare providers delivering care for seroconcordant individuals were interviewed regarding their perspectives on facilitators and barriers to the couple-based intervention implementation. Analysis of interview responses was done using MAXQDA. Results pertaining to providers’ perspectives on implementation and intervention characteristics were organized, interpreted, and contextualized using the Consolidated Framework for Implementation Research (CFIR 2.0), while providers’ suggestions for improvements were coded and organized apart from CFIR. Providers felt the intervention was largely compatible with the local culture, and offered a significant advantage over standard individual-based care by facilitating patient follow-up and reducing wait times by prioritizing couples for services. They also believed it facilitated HIV treatment access through the provision of couple-based counseling that encouraged supportive behaviors towards retention. However, providers reported insufficient privacy to deliver couple-based care at some health facilities and concerns that women in difficult relationships may struggle to meaningfully participate. They suggested providing sessions in alternate clinic settings and offering a limited number of women-only visits. The facilitators and barriers described here contribute to informing the design and implementation of future couple-based interventions to improve HIV care for seroconcordant expectant couples.

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Funding

This research was supported by the United States National Institute of Mental Health grants (R01MH113478-01, F30MH123219-01A1). The authors are solely responsible for this study and this manuscript, and the funder played no role in the study design, data collection, interpretation, or reporting of these results.

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Authors and Affiliations

  1. Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA

    Erin Graves, Hannah L. Brooks & Carolyn M. Audet

  2. Friends in Global Health, Maputo, Mozambique

    Caroline De Schacht

  3. Friends in Global Health, Quelimane, Mozambique

    Almiro Emílio & Ariano Matino

  4. Provincial Health Directorate of Zambézia, Quelimane, Mozambique

    Arifo Aboobacar

  5. Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA

    Carolyn M. Audet

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Contributions

CMA and CDS led the study conception and design. All authors made substantial contributions to the study implementation. AE and AM were primarily responsible for data collection and field supervision. HB and EG were primarily responsible for coding qualitative data. HB led the data synthesis. HB and EG prepared the first draft of the manuscript and all authors reviewed and edited previous manuscript versions. All authors read and approved the final manuscript.

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Correspondence to Erin Graves.

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Study approval (including for the initial protocol and all subsequent protocol amendments) was obtained from the Institutional Health Ethics Committee of Zambézia (Comité Institucional de Bioética para Saúde – Zambézia) (Reference 03/CIBS/17 on 21 April 2017) and the Vanderbilt University Medical Center Institutional Review Board (#170365 on 14 March 2017). The HoPS+ parent study is registered at ClinicalTrials.gov (NCT03149237).

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Graves, E., Brooks, H.L., De Schacht, C. et al. Healthcare Providers’ Perspectives on a Novel Couple-Based HIV Treatment Intervention: A Qualitative Assessment of the Facilitators, Barriers, and Proposed Improvements to Implementation in Zambézia Province, Mozambique. AIDS Behav 28, 1370–1383 (2024). https://doi.org/10.1007/s10461-023-04224-8

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