The Effectiveness of Non-Biomedical Interventions for Thriving in HIV-Serodiscordant Relationships: A Mixed-Methods Protocol for a Study in Umguza District,Zimbabwe

Abstract

HIV-serodiscordant couples face significant psychosocial and relational challenges that extend beyond biomedical management. While the role of Antiretroviral Therapy (ART) and Pre-Exposure Prophylaxis (PrEP) is well-established, the effectiveness of non-biomedical, psychosocial interventions in promoting relational thriving and overall well-being is under-researched, particularly in specific cultural contexts. This protocol describes a planned mixed-methods study designed to assess the effectiveness of existing interventions and explore the lived experiences of serodiscordant couples in Umguza District, Zimbabwe. The study will employ a sequential exploratory design comprising three phases: (1) a scoping review of interventions for thriving in serodiscordant relationships in Sub-Saharan Africa; (2) a quantitative cross-sectional survey with approximately 31 serodiscordant couples to map needs and assess perceived intervention effectiveness; and (3) in-depth qualitative interviews with a purposively selected subset of couples (n∼12) and healthcare workers (n∼12) to explore barriers, facilitators, and contextual dynamics. Data integration will occur during the interpretation phase to provide a comprehensive understanding. All participants will provide written informed consent, with stringent measures to ensure confidentiality and data security. Findings will be disseminated through peer-reviewed publications, presentations at relevant academic and community forums, and deposition of anonymised data in a public repository to promote transparency and reuse.

1. Introduction

HIV/AIDS remains a significant public health challenge in Zimbabwe, with a national prevalence of 10.5% and approximately 23,000 new infections reported in 2023 (UNAIDS, 2023). While HIV/AIDS remains a significant health challenge, the situation is further complicated for serodiscordant couples where one partner is HIV-positive, and the other is HIV-negative. For these couples, HIV/AIDS present unique challenges to individuals and couples as they form a distinct group, characterised by differing HIV statuses, yet their lives are intertwined as they pass through the complexities of HIV together (Musinguzi et al., 2020). Serodiscordant couples face an increased risk of HIV transmission to the seronegative spouse in these partnerships. Even with successful preventative measures like Antiretroviral Therapy (ART) and Pre-Exposure Prophylaxis (PrEP), research shows that the risk of transmission among serodiscordant couples is still high (Musinguzi et al., 2020). However, when these preventive measures are regularly implemented, the risk might be significantly decreased (Baeten et al., 2016; Cohen et al., 2011). Despite these developments, obstacles like irregular ART use, social defamation and restricted access to medical care may prevent complete protection (Mthembu et al., 2018).

Advances in biomedical prevention strategies, such as PrEP, ART and Treatment as Prevention (TasP) have provided additional options to reduce transmission risk; however, the challenges and fears of transmission, especially due to irregular or improper use of preventive measures, persist (Moyo & Nunu, 2023, 2024). A study of HIV-1 discordant couples in Sub-Saharan Africa revealed that a significant proportion of HIV-positive cases occur within stable relationships, with serodiscordant seroconversion accounting for approximately two-thirds of cases, posing a high risk of seroconversion (Jones et al., 2023). Serodiscordant couples also encounter additional cultural, social, and economic challenges, hindering HIV prevention efforts. Effective counselling for serodiscordant couples remains limited, contributing to misconceptions and barriers to prevention. Research in countries such as South Africa, Kenya and Uganda has emphasised the importance of culturally tailored interventions that address the social determinants of health and promote gender equity within relationships (Cabral et al., 2018).

In Uganda, a study assessed a three-session intervention aimed at improving couple relationship quality and addressing HIV risk factors, particularly concurrent sexual partnerships. The intervention was designed to be culturally relevant and responsive to the specific needs of the community. Studies conducted in Zimbabwe have found that HIV serodiscordant relationships face challenges related to gender power dynamics, as cultural norms often entail men holding power and women being expected to comply and submit (Heise et al., 2019). The importance of culturally sensitive counselling and interventions that take into account the social and cultural settings of serodiscordant couples is highlighted by these studies. Such interventions can help lower misconceptions and preventative barriers by addressing the particular difficulties these couples face, which will eventually improve health outcomes. Community-based approaches, peer support networks, and integration with existing HIV prevention and treatment programs have been highlighted as effective strategies in supporting these couples (Kimera et al., 2024).

Given the need for studies on culturally tailored interventions, this study examines the impact of interventions on thriving in HIV serodiscordant relationships. It explores how these interventions are integrated into people’s lives, their acceptability, and adoption. As interventions must be implemented and adopted to promote thriving rather than just surviving in HIV serodiscordant relationships, Umguza District, located in Matabeleland North Province, Zimbabwe, has a high HIV prevalence rate of 14.3% affecting both rural and semi-urban communities (UNAIDS, 2023). Since the initial negative HIV test, seroconversion rates have declined with time; there were indications of a drop between 2009 and 2019 (Jones et al., 2023). These national statistics demonstrate the continued difficulties in HIV prevention and the necessity of focused interventions that take into account the particular social and cultural circumstances of serodiscordant couples (Mukwenha et al., 2025). The Zimbabwe Population-Based HIV Impact Assessment estimates that the country’s yearly adult new HIV infection rate is 0.38%, or around 31,000 new adult HIV cases annually. (Larney et al., 2015). This protocol outlines a study that will investigate both the effectiveness of existing support structures and the nuanced experiences of serodiscordant couples in this setting to inform better intervention design.

2. Methods/Design

2.1. Research Approach

Three successive stages will be employed in this study to uncover the complex dynamics of serodiscordant relationships and how the interventions in place promote thriving in serodiscordant/serodifferent relationships in the Umguza district. The stages will be scoping review, quantitative approach and qualitative approach. An overview of previous studies will be given by the scoping review, which will help in identifying important trends, knowledge gaps and the effectiveness of ongoing interventions. Empirical data will be gathered using the quantitative approach, with an emphasis on variables including the frequency of HIV transmission, the results of interventions and demographic trends among serodiscordant couples. This phase will guarantee that the study’s conclusions are supported by measurable, unbiased evidence. The qualitative method will investigate the social settings and individual experiences of serodiscordant couples in Umguza, capturing the relational, cultural and emotional components of their lives.

2.2. Stage One: Scoping Literature Review

2.2.1. Review Title

An assessment of the interventions for thriving in HIV sero-discordant relationships. A scoping review in Sub-Saharan Africa.

2.2.2. Methodology

2.2.2.1. Inclusion and Exclusion Criteria

The selection of studies for this review will be guided by the Population, Intervention, Comparison and Outcome (PICO) framework to ensure that the included studies are relevant and informative (Schardt et al., 2007). Studies will be included if they focus specifically on HIV serodiscordant relationships in Sub-Saharan Africa. Eligible studies should report on interventions that promote thriving in HIV serodiscordant relationships, exploring the complex factors that influence the well-being and resilience of these couples in the face of differing HIV statuses. Additionally, included studies have to report on interventions or strategies aimed at supporting serodiscordant couples, providing valuable insights into effective approaches to promoting their health and well-being. Studies will be included if they focus specifically on HIV serodiscordant relationships, exploring the complex factors that influence the well-being and resilience of these couples.

Studies will be excluded if they do not meet these criteria or were published outside the specified time frame of 2010 to 2025. The study will rely on research from 2010, a pivotal year in the history of HIV serodiscordance. The HIV Prevention Trial Network (HPTN) 052 trial, conducted in 2010, was a landmark study that revealed the use of antiretroviral therapy (ART) not only improved the well-being of HIV-positive individuals but also reduced the risk of HIV transmission to their negative partners by 96% (Eshleman et al., 2017). This groundbreaking finding expanded the focus of HIV management beyond treatment to prevention. The period between 2010 and 2025 witnessed significant advancements in HIV treatment, prevention and care, including the introduction of pre-exposure prophylaxis (PrEP) and enhancements to ART. Research conducted from 2010 onwards is highly relevant, as it captures these developments and policy changes, providing valuable insights into current HIV prevention trends and the dynamics of serodiscordant relationships (Cohen et al., 2011; Eshleman et al., 2017; Matthews et al., 2014)).

2.2.2.2. Search Strategy

A comprehensive search strategy will be employed to identify relevant studies for this review, searching databases such as PubMed, Scopus, Google Scholar, Web of Science, PsycINFO, and CINAHL. The search terms used will be a combination of keywords and phrases, including (“HIV serodiscordant” OR “HIV discordant” OR “serodiscordant couples” OR “serodifferent couples”), (“thriving” OR “resilience” OR “well-being” OR “quality of life”), and (“interventions” OR “strategies” OR “programs” OR “services”).

2.2.2.3. Methods of Review

A scoping review methodology will be used in this review to find, assess, and compile the body of research on thriving in HIV-serodiscordant relationships. A thorough search of the primary databases will be conducted to identify relevant research. After the search results have been screened for eligibility, the full texts of the papers that fit the inclusion criteria will be acquired and thoroughly reviewed. To provide a clear synthesis of the evidence, the data will be collected, assessed, and presented narratively in relation to the review question.

2.2.3. Data Extraction and Synthesis

The extraction of data will be performed using Cochrane Review Manager (RevMan), which is a specified tool that enables systematic data arrangement and synthesis. RevMan will enable structured extraction of key study characteristics, including author details, year of publication, study location, objectives, methodology, key findings, and conclusions (Farquhar & Marjoribanks, 2018). Two independent reviewers will screen titles/abstracts and full texts. The extracted data will be further categorised based on themes and emerging patterns relevant to the research questions. Thematic analysis will involve identifying persistent ideas, grouping them into subthemes, and refining them into key themes that reflect key findings across the included studies. Following the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA-ScR. The final synthesised findings will be structured using tables, charts, and thematic maps to improve clarity and easy interpretation of the results. A full scoping review data extraction form is attached as supplementary file 1 as Part A.

2.2.4. Quality Assessment

The quality of the included studies will be assessed based on established criteria, such as study design, sample size and selection, data collection methods, and analytical techniques. Each study will be evaluated for its consistency and relevance to the review’s objectives. Discrepancies in quality will be resolved through discussion to ensure that the final assessment reflects a thorough and accurate evaluation of the studies. This quality assessment process ensures that only high-quality studies are included in the review, contributing to the reliability and validity of the synthesised findings. This procedure guarantees that only high-quality research will be included in the review, with quality ratings determined using the PRISMA-ScR framework.

2.3. Stage Two: Quantitative Survey

2.3.1. Study Setting and Population

Umguza District is located in the southern part of Matabeleland North Province, Zimbabwe. The district falls under farming region 5, which is characterised by low rainfall and frequent food shortages. Umguza is known for its artisanal mining, and recurring gold rushes have contributed to a sharp rise in HIV cases in the area. The district is made up of fifteen wards and is governed by the Umguza Rural District Council. In addition, ten rural health facilities serve a population of around one hundred and four thousand four hundred and thirty-seven individuals. The district has a population of seventy-three thousand four hundred and eleven (73,411) people in rural areas and thirty-one thousand and twenty-six (31,026) people in urban areas, with a population density of forty-three (43) people per square kilometre (ZIMSTAT, 2022). The target population is sero-discordant couples in the Umguza district from twenty-two (22) health facilities. There is a total of 22 health facilities, and the target population for health workers will be 22. In the same vein, the total number of serodiscordant couples in the study area is fifty-five.

2.3.2. Sampling and Sample Size Calculation

A census approach will be used where possible, aiming to enrol all eligible couples. Based on an estimated population of 55 couples, which is a fairly small number, all couples will be invited to participate.

2.3.3. Data Collection Tools and Methods

2.3.3.1. Questionnaires

A structured questionnaire has been developed using Kobo to gather data on the specific needs of serodiscordant couples and the impact of existing interventions in Umguza district. The questionnaire incorporates validated scales, including portions of the HIV Stigma Scale and relationship satisfaction measures, alongside study-specific items. The tool has been translated into IsiNdebele and pre-tested with 5 couples in a neighbouring district, with refinements made based on feedback. The final version covers: socio-demographics, clinical history, relationship dynamics, knowledge and use of interventions (ART/PrEP adherence support, counselling, peer groups), and perceived effectiveness using Likert-scale items. A complete questionnaire is attached as supplementary file 1 as Part B.

2.3.3.2. Quantitative Data Analysis

Data will be analysed using STATA version 18. Descriptive statistics will summarise all variables. Inferential analyses (e.g., Chi-square tests, logistic regression) will explore associations between variables (e.g., between service utilisation and reported well-being scores).

2.4. Stage Three: Qualitative Method

The study will also explore the barriers and factors that influence the success of these interventions. Key areas, including relationship dynamics, coping strategies, obstacles to the effectiveness of interventions and access to healthcare services, will be the focus of the interviews. To maintain concentration while enabling participants to freely express their opinions, a semi-structured interview guide will be employed. With the participants’ permission, the majority of interviews will be audio recorded and safely saved for analysis on a password-protected computer and in the cloud. To find important patterns, trends and connections in the data, thematic analysis was used.

2.4.1. Study Setting and Sampling

The study will be conducted in all 22 health facilities of Umguza District. The target population will be all identified HIV-serodiscordant couples (estimated N=55) registered for care or support within these facilities and key informants (nurses, counsellors, village health workers) from the study facilities. Purposive sampling will be employed to select around 10-15 serodiscordant couples from the Phase 2 sample to ensure diversity in age, gender, location (rural/urban), and relationship duration; and 10-15 healthcare workers (nurses, counsellors, village health workers) from the study facilities. The number of participants will be guided by the principle of data saturation.

2.4.2. Data Collection Method and Tools

Separate, semi-structured interview guides have been developed for couples and providers. The guides were developed through an iterative process involving the research team, with input from community health workers to ensure cultural appropriateness and relevance. Questions focus on relationship dynamics, coping strategies, barriers to intervention effectiveness, and access to healthcare services. The guides will be piloted with two couples and two healthcare workers in a neighbouring district. Couple interviews may be conducted jointly or individually based on participant preference. All interviews will be conducted in IsiNdebele or English, audio-recorded with permission, and transcribed verbatim, with translation performed for analysis where needed. The complete interview guides are attached as supplementary file 1 as Part C. The potential informants will be contacted through phone calls and professional networks. The communication will explain the research purpose and benefits of informants’ participation, provide a clear overview of the study and emphasise the importance of their insights. The interviews will be conducted separately, and a notebook and tape recorder (with their consent) will be used to record all the relevant information. The list of intended key informants and the rationale for selecting them is presented in Table 1.

2.4.3. Qualitative Data Analysis

Thematic analysis following the approach by Braun and Clarke (2019) will be conducted using NVivo software. This will involve familiarisation, systematic coding, theme generation, and refinement. Strategies to ensure trustworthiness will include peer debriefing among the research team, member checking of summaries with participants, and maintaining a reflexive journal.

2.5. Data Integration

Following the sequential design, findings from Phase 2 (quantitative) will inform the development of the interview guides for Phase 3 (qualitative). During final analysis, quantitative and qualitative datasets will be integrated using a “following a thread” approach. For instance, a quantitative finding on low service utilisation will be explored in-depth using the qualitative themes on barriers. Joint displays will be used to visually represent integrated findings.

2.6. Study Timeline

The study will be conducted over 12 months following protocol approval. Phase 1 (Scoping Review) will be conducted from March to June 2026, including database searches, screening, data extraction, and synthesis. Phase 2 (Quantitative Survey) will involve participant recruitment and data collection from July to August 2026, followed by data entry and analysis from September to October 2025. Phase 3 (Qualitative Interviews) will be conducted in November 2026, with transcription and thematic analysis in December 2026. Data integration and interpretation will occur from January to February 2027.

2.7. Ethics and Dissemination

2.7.1. Ethical and Safety Considerations

Ethical approval has been obtained from the National University of Science and Technology Institutional Review Board (Ref: NUST/IRB/2025/078). Written informed consent will be obtained from all participants. Consent forms will explicitly detail issues of confidentiality, voluntary participation, and the right to withdraw. All data will be anonymised. Identifiers will be removed from transcripts and surveys. Digital recordings will be stored on password-protected, encrypted devices and servers. Particular care will be taken in reporting qualitative findings to prevent deductive disclosure of participants in this small community. Participants reporting distress will be referred to appropriate counselling services. Interviews will be conducted in private settings to ensure safety and confidentiality.

2.7.2. Dissemination Plan

The findings of this research will be disseminated through several channels to maximise its impact on both academic and public health practice. The primary results will be submitted for publication in peer-reviewed international journals within the fields of public health. Furthermore, key findings will be presented at relevant national and local meetings to share insights with the communities. To promote transparency and data reusability, the anonymised dataset during the analysis will be deposited in a publicly accessible data repository, such as Zenodo, upon completion of the study.

3. Discussion

The results of this study may have a positive impact on the quality of life for both individuals and couples in serodiscordant relationships. This will be achieved through investigating how interventions affect social and emotional dynamics; this study seeks to close a significant research gap in this field. The findings of the study may offer important new understandings of the complex problems that serodiscordant couples encounter, such as the relational and emotional dynamics that affect them. Through evaluating the effects of interventions for thriving in HIV serodiscordant relationships, this study may help guide the creation of proper support systems for these couples. The lives of individuals and couples, especially those in serodiscordant relationships, can be significantly impacted by the stigma and prejudice around HIV. Participation in this study may be challenging for some people because they fear stigma, discrimination, or confidentiality violations. Others might find it difficult to freely discuss their relationship dynamics or reveal their HIV status. This study will handle these sensitive subjects with care and respect, taking the required measures to guarantee confidentiality and anonymity. The results of this study may ultimately have significant outcomes for raising the standard of living for both individuals and couples in serodiscordant relationships, improving their general happiness and well-being.

4. Limitations

Participants may under-report stigmatised behaviours. This will be mitigated by ensuring privacy, building rapport, and using experienced, trained interviewers. Findings may be specific to the Umguza District. However, a thick description of the context will be provided to allow for transferability judgments.

5. Conclusion

This protocol outlines a comprehensive mixed-methods study designed to address a critical gap in HIV care by investigating the effectiveness of non-biomedical interventions and the lived experiences that promote thriving among serodiscordant couples in Umguza District, Zimbabwe. The anticipated findings will provide a nuanced understanding of the psychosocial needs, barriers, and facilitators within this population. Ultimately, this research is intended to directly inform the development and implementation of more holistic, culturally tailored support programs, thereby contributing to improved well-being, strengthened relationships, and enhanced HIV prevention outcomes for serodiscordant couples in similar high-prevalence, resource-limited settings.

Supplemental Material

Supplemental Material - The Effectiveness of Non-Biomedical Interventions for Thriving in HIV-Serodiscordant Relationships: A Mixed-Methods Protocol for a Study in Umguza District, Zimbabwe

Supplemental Material for The Effectiveness of Non-Biomedical Interventions for Thriving in HIV-Serodiscordant Relationships: A Mixed-Methods Protocol for a Study in Umguza District, Zimbabwe by Gugulethu Ncube, Perez Livias Moyo, Taremba Chirigo in International Journal of Qualitative Methods.