Using Synthesised Narrative Exploration to generate contextually grounded insights for HIV prevention, testing and care programming in Mozambique

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Abstract Evidence-informed situation analyses are critical for HIV programming, yet primary data collection is often resource-intensive and time-consuming. Approaches that leverage existing evidence while generating locally grounded insights are needed to inform context-appropriate interventions. We applied the Synthesised Narrative Exploration (SNE) approach in two districts in Inhambane province, southern Mozambique, to inform an HIV project through assessing key dynamics affecting HIV prevention, treatment, and care for women and children. SNE combines structured synthesis of existing country-specific literature with qualitative validation and contextualisation through focus group discussions and semi-structured interviews. Findings from 16 peer-reviewed studies and two national reports were synthesised into short narratives and discussed with 83 community members and key stakeholders. Qualitative data were thematically analysed and validated through community and stakeholder consultations. Study participants confirmed many well-documented barriers across the maternal and infant HIV care cascade and added local insights. Known pre-pregnancy barriers such as limited preconception HIV testing and low ART uptake were confirmed, while strong fertility expectations, low levels of pregnancy planning, gendered decision-making, and fear of partner abandonment following HIV status disclosure were highlighted as factors shaping engagement with HIV services. The participants confirmed barriers during pregnancy reported in earlier studies, including delayed antenatal care initiation and limited male partner involvement, and added the role of household power hierarchies, particularly the influence of mothers-in-law, in shaping HIV testing, disclosure, and ART adherence. Widely documented postpartum disengagement from care was explained by difficulties sustaining non-disclosure and the loss of socially acceptable reasons for continued clinic attendance. The participants proposed locally grounded strategies to address the barriers, including strengthened couple counselling and engagement of influential family members such as mothers-in-law. By integrating existing evidence in a qualitative enquiry, SNE enables efficient generation of contextually rich insights directly relevant to intervention design, offering an approach for strengthening HIV programmes.

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