Peer Navigation Research Articles

Care coordination Experiences of Low-Income Parents of Children and Youth with Special Health Care Needs: An Exploratory Study.

To explore parent perspectives on barriers, facilitators, and priorities related to coordinating care for children and youth with special health care needs (CYSHCN). Thirty-nine parents of Medicaid-eligible CYSHCN participated in focus groups and completed a brief survey about their child's health insurance coverage, access to specialized services, and need for support with service coordination. Survey data were analyzed using descriptive statistics. Focus group data were analyzed by multiple independent coders using an approach that combines inductive reasoning with predetermined coding strategies. Sixty-seven percent of parents reported that they needed care coordination support. Qualitative data were organized into three main themes: the work of caregiving; the impact of caregiving on multiple aspects of parents' lives; and caregivers' needs related to emotional acceptance, service referrals and navigation, and developmental transitions. Findings support importance of services such as medical homes, care coordinators, peer navigators, respite care, and transition planning.

Increasing COVID-19 testing and vaccination among Spanish speakers in the USA: protocol for the development and evaluation of the Nuestra Comunidad Saludable intervention using a group-randomised trial design

IntroductionOur community-based participatory research partnership aims to expand understanding of the social, ethical and behavioural implications of COVID-19 testing and vaccination to inform the development of an integrated intervention that...

Performance Measurement for Opioid Use Disorder Medication Treatment and Care Retention.

Performance Measurement for Opioid Use Disorder Medication Treatment and Care Retention.

Barriers to and facilitators of accessing HIV services for street-involved youth in Canada and Kenya

IntroductionUNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV prevention, testing, and treatment services as Phase I of an implementation study evaluating the use of peer navigators to increase access to HIV services.MethodsSemi-structured interviews, focus group discussions (FGD), and theatre testing were conducted with individuals who identify as SIY, health care providers, and community stakeholders living in Canada (Toronto, Montreal, London) and Kenya (Eldoret, Huruma, Kitale). Data were analyzed using a directed content approach, guided by the socio-ecological model (SEM).ResultsAcross the six sites were 195 participants: 64 SIY, 42 healthcare providers, and 97 community-based stakeholders. Barriers were identified at the societal (e.g. intersectional stigma and discrimination), public policy (e.g., inadequate access to basic needs, legal documentation, lack of health insurance, and limited community-based funding), institutional (e.g. lack of inclusive education and training, inadequate HIV educational outreach, and restrictive service provision), interpersonal (e.g., ineffective communication from healthcare providers), and intrapersonal levels (e.g. lack of trust and associated fear, low perception for healthcare, and lack of self-esteem). These contributed to limited HIV services utilization among SIY. Conversely, numerous facilitators were also identified at the public policy (e.g. affordable HIV services and treatment), institutional (e.g. available and accessible HIV prevention tools, HIV education and awareness programs, and holistic models of care), interpersonal level (e.g., systems navigation support, peer support, and personal relationships), and intrapersonal levels (e.g. self-efficacy) as positively supporting SIY access to HIV services.ConclusionIntersectional stigma was a critical barrier in all sites, and policies and programs that foster welcoming environments for youth from diverse backgrounds and living circumstances may be better able to respond to the HIV service needs of this high risk population. Social support and navigation services were reported to facilitate access to HIV services in all sites.

Lessons learned from a peer support program for individuals seeking substance use recovery

Peer navigation is a model that includes connecting an individual in need of services with a peer who can navigate engagement in clinical treatment services and provide emotional and logistical support that is often unavailable through the traditional system. In the substance use field—where the use of peers is a relatively new phenomenon—peers are individuals with lived experiences who are in recovery themselves. In 2016, a peer program called RECOVERY was implemented in a northeastern U.S. state. This team of peers act as a bridge between a referral source (e.g., police, emergency services, hospital) and treatment facilities. Using semi-structured interviews from the team of peers (N = 5), this paper provides a case study of the implementation process for this peer recovery program. The findings identify potential barriers and facilitators to peer services and offer a feasible approach for implementing peer support programs in substance use settings.

Protocol for the AKT-MP trial: Access to Kidney Transplantation in Minority Populations

BackgroundKidney transplant (KT) is the optimal treatment for kidney failure (KF), and although completion of KT evaluation is an essential step in gaining access to transplantation, the process is lengthy, time consuming, and burdensome. Furthermore, despite similar referral rates to non-Hispanic Whites, both Hispanic/Latinos and American Indians are less likely to be wait-listed or to undergo KT. MethodsThe Access to Kidney Transplantation in Minority Populations (AKT-MP) Trial compares two patient-centered methods to facilitate KT evaluation: kidney transplant fast track (KTFT), a streamlined KT evaluation process; and peer navigators (PN), a peer-assisted evaluation program that incorporates motivational interviewing. This pragmatic randomized trial will use a comparative effectiveness approach to assess whether KTFT or PN can help patients overcome barriers to transplant listing. We will randomly assign patients to the two conditions. We will track participants’ medical records and conduct surveys prior to their initial evaluation clinic visit and again after they complete or discontinue evaluation. ConclusionOur aims are to (1) compare KTFT and PN to assess improvements in kidney transplant (KT) related outcomes and cost effectiveness; (2) examine how each approach effects changes in cultural/contextual factors, KT concerns, KT knowledge, and KT ambivalence; and (3) develop a framework for widespread implementation of either approach. The results of this trial will provide key information for facilitating the evaluation process, improving patient care, and decreasing disparities in KT.

Aboriginal patients driving kidney and healthcare improvements: recommendations from South Australian community consultations

ObjectiveTo describe the experiences, perceptions and suggested improvements in healthcare identified by Aboriginal patients, families and community members living with kidney disease in South Australia. MethodsCommunity consultations were held in an urban, rural and remote location in 2019 by the Aboriginal Kidney Care Together – Improving Outcomes Now (AKction) project and Kidney Health Australia. Consultations were co‐designed with community members, using participatory action research, Yarning, Dadirri and Ganma Indigenous Methodologies. Key themes were synthesised, verified by community members and shared through formal and community reports and media. ResultsAboriginal participants identified the importance of: family and community and maintaining their wellbeing, strength and resilience; the need for prevention and early detection that is localised, engages whole families and prevents diagnosis shock; better access to quality care that ensures Aboriginal people can make informed choices and decisions about their options for dialysis and transplantation, and; more Aboriginal health professionals and peer navigators, and increased responsiveness and provision of cultural safety care by all kidney health professionals. ConclusionAboriginal community members have strong and clear recommendations for improving the quality and responsiveness of health care generally, and kidney care specifically. Implications for public healthAboriginal people with lived experience of chronic conditions wish to significantly inform the way care is organised and delivered.

Feasibility and Acceptability of a Web-Based Peer Navigation-Psychoeducational HIV Intervention for Women

This study examined feasibility, acceptability, and preliminary effects of a pilot randomized controlled trial (BRIDGES) designed to improve HIV care outcomes among syndemic-affected women living with HIV (WLHA). We enrolled and randomized adult WLHA who were out-of-care or at risk of falling out-of-care and experienced any syndemic condition(s) into BRIDGES ( n = 11) or standard of care ( n = 13). BRIDGES employed peer navigation one-on-one sessions and six weekly 2-h video psychoeducation group sessions. Feasibility and acceptability were assessed through participant quantitative and semistructured interviews. Intention-to-treat analyses were conducted to evaluate the preliminary effects of BRIDGES. BRIDGES was highly feasible and acceptable. Intervention participants demonstrated improved self-reported adherence to antiretroviral therapy at 3 months, and better engagement and retention in care and viral suppression at 12 months compared to control participants. BRIDGES is a promising program to provide syndemic-affected WLHA with the tools needed to mitigate social and structural barriers to HIV care.

Individual level peer interventions for gay and bisexual men who have sex with men between 2000 and 2020: A scoping review.

BackgroundPeer-led interventions are central to the global HIV response for gay and bisexual men who have sex with men [GBMSM]. Since the year 2000, technological advancements in HIV and an increased response to the health disparities faced by GBMSM outside of HIV, have contributed to the expanding scope of their content and delivery. This review sets out to characterise the evidence base for individual level peer interventions for GBMSM, overview approaches to implementing and evaluating them and identify future priorities for their delivery and evaluation.MethodsA scoping review methodology was applied and evaluations of peer programs for GBMSM published in peer reviewed journals were identified via subject heading and keyword searches across five electronic databases. Titles and abstracts were reviewed, and full texts were assessed against eligibility criteria. A coding framework was used to extract data from included studies against intervention implementation and evaluation components.ResultsA total of 38 studies evaluating peer led interventions against effectiveness outcomes were deemed eligible for inclusion and coded into four intervention modalities; peer counselling [n = 6], groupwork programs [n = 15], peer navigation [n = 7] and peer education [n = 10]. Most addressed HIV [n = 32] and across intervention modalities, evaluations demonstrated compelling evidence of significant effect. Intervention effects on broader indicators of psychosocial wellbeing were not extensively evaluated. Expertise regarding the implementation and evaluation of peer interventions addressing HIV among GBMSM ought to be leveraged to expand the scope of peer intervention to meet the diverse health and wellbeing needs of GBMSM.

HIV prevalence, engagement in care, and risk behavior among trans women, San Francisco: Evidence of recent successes and remaining challenges.

BackgroundTrans women have high HIV prevalence and lag behind 90–90-90 targets for HIV care. In San Francisco in 2017, 96% of trans women were aware of their status, 75% were on antiretroviral therapy, 88% had viral suppression. Initiatives to address gaps include peer navigators, free gender-affirming surgery, and housing. Our study updates HIV prevalence and engagement in care among trans women.MethodsCross-sectional community-based survey of trans women living in San Francisco sampled by respondent-driven sampling, 7/2019–2/2020 (N = 201). Eligibility was: self-identified trans women or other gender and assigned male at birth; living in San Francisco; English/Spanish-speaking; and 18 years or older.ResultsHIV prevalence was 42.3% (95%CI 35.4.-49.4) and associated with having a partner who injected drugs (adjusted odds ratio [AOR] 3.30, 95%CI 1.58–6.90), ever injected drugs (AOR 2.28, 95%CI 1.06–4.89), cost not a barrier to healthcare (AOR 2.63, 95%CI 1.02–6.67), emotional support from family (AOR 2.85, 95%CI 1.43–5.65), and Black/African-American (AOR 2.59, 95%CI 1.16–5.79). Of trans women with HIV, 92.9% were previously diagnosed, 89.9% were on ART, 91.5% reported viral suppression.ConclusionsTrans women met 90–90–90 targets in 2020, at 93–90–92. Interventions need to reach Black/African-American trans women, trans women who inject drugs, and partners of trans women.

Relationships at Work: Integrating the Perspectives of Disability Partners to Enhance a Peer Navigation Intervention.

ObjectiveThe Our Peers-Empowerment and Navigational Support (OP-ENS) community-based participatory research study developed, implemented, and evaluated a peer navigator intervention aimed at improving health and healthcare access among Medicaid beneficiaries with disabilities. Peer navigators are community partners with physical disabilities trained to deliver structured peer support interventions that can address barriers to care. The purpose of this paper is two-fold. First, it explicates the relational work the peer navigators do with peers in delivering the intervention. Second, it illustrates how our community-based participatory approach empowered peer navigators to share their knowledge to refine the intervention.MethodsClinical coordinator team meeting notes, critical incident documentation reports, peer navigator reflections (n = 20) were analyzed thematically to understand the peer navigators' relational work and intervention refinements. Following Labov's 6-stage approach to personal narratives and a collaborative writing process academic, clinical, and disability partners co-wrote descriptive exemplars to showcase these processes.FindingsThrough the manualized OP-ENS intervention process, peer navigators helped peers achieve incremental successes. Peer navigators used their training and personal experiences to engage with peers and forge deep connections and relationships of trust. As a result, peers identified a wide-range of social health concerns, including poverty, social isolation, and racial and disability related discrimination that might otherwise go unaddressed. True to the principles of community-based participatory research, by fostering an equity-focused collaboration and listening to peer navigators, the project team implemented subtle but salient refinements to the intervention. Refinements included an explicit focus on social determinants of health affecting peers' health and wellbeing and supplemental trainings to help peer navigators support peers with significant mental health needs.ConclusionThe peer navigators were intentional and skilled at relationship building, thus complex elements which impact peers' health were addressed. Peer navigators were empowered to communicate their perspectives with the study team, who worked together to strengthen the intervention processes and infrastructure. This atmosphere of trust and collaboration amongst diverse stakeholders was instrumental to OP-ENS' successful implementation. Healthcare systems should consider implementing peer support interventions that are responsive to consumer input to address social determinants of health for persons with disabilities.

Proyecto Compadre: Using Implementation Science to Tailor Peer Navigation for Latino Men in the US-Mexico Border Region.

Latino men who have sex with men (MSM) in San Diego have poor HIV testing and prevention outcomes compared with non-Latino White men. Peer navigation (PN) is a promising evidence-based intervention to reduce disparities but needs tailoring for Latino MSM. Health centers near the US-Mexico border. Using the Exploration, Preparation, Implementation, Sustainment Framework, we conducted mixed-methods implementation science study. In phase I, we conducted interviews with Latino men (n = 15), focus groups with staff (n = 7), and surveys with all to understand the Exploration, Preparation, Implementation, Sustainment factors associated with HIV testing and care linkage. In phase II, we conducted 31 web-based surveys with Latino men and staff to rank intervention and implementation strategies from phase I. Quantitative data were analyzed descriptively, integrated with qualitative data, and reviewed by our community-academic partnership to develop an implementation model. Latino men (N = 15) were 94% Spanish speaking, 67% gay identified, 27% US born, and their suggestions were to have navigators use peer referral to address barriers such as stigma; use the Latino social network to expand reach, leverage social media for peer-led intervention, and disseminate HIV information. Staff (N = 26) were 77% Spanish speaking, 35% gay-identified, 96% trained in cultural competency, and suggested including culturally appropriate HIV educational materials in Spanish, status and identity neutral programs, administrative/supervisorial/training structure for PNs, and PN compensation and team integration. Overall, results emphasized a need for a formalized PN model centered on referrals and using existing Latino community social networks. Findings can be packaged for future implementation of PN programs for Latino MSM.

PrEP Uptake in North Carolina: Innovative Strategies for Reducing Barriers.

Pre-exposure prophylaxis (PrEP) is a biomedical HIV innovation designed to reduce HIV transmission. Unfortunately, PrEP uptake is suboptimal within many communities in the US South. Innovative interventions that integrate evidence-based strategies (e.g., mHealth and peer navigation through cyber health educators) are needed to increase PrEP uptake in North Carolina.

Web-Based Peer Navigation for Men with Prostate Cancer and Their Family Caregivers: A Pilot Feasibility Study.

This study assessed the feasibility, acceptability and potential effects of True North Peer Navigation (PN)—a web-based peer navigation program for men with prostate cancer (PC) and their family caregivers. A one-arm, pre-post pilot feasibility study was conducted at two cancer centres in Canada. Participants were matched through a web-app with a specially trained peer navigator who assessed needs and barriers to care, provided support and encouraged a proactive approach to health for 3 months. Descriptive statistics were calculated, along with paired t-tests. True North PN was feasible, with 57.9% (84/145) recruitment, 84.5% (71/84) pre-questionnaire, 77.5% (55/71) app registration, 92.7% (51/55) match and 66.7% (34/51) post-questionnaire completion rates. Mean satisfaction with Peer Navigators was 8.4/10 (SD 2.15), mean program satisfaction was 6.8/10 (SD 2.9) and mean app usability was 60/100 (SD 14.8). At 3 months, mean ± SE patient/caregiver activation had improved by 11.5 ± 3.4 points (p = 0.002), patient quality of life by 1.1 ± 0.2 points (p < 0.0001), informational support by 0.4 ± 0.17 points (p = 0.03), practical support by 0.5 ± 0.25 points (p = 0.04) and less need for support related to fear of recurrence among patients by 0.4 ± 19 points (p = 0.03). The True North web-based peer navigation program is highly feasible and acceptable among PC patients and caregivers, and the associated improvements in patient and caregiver activation are promising. A randomized controlled trial is warranted to determine effectiveness.

HIV Health literacy beyond the biomedical model: an innovative visual learning tool to highlight the psychosocial complexities of care

ABSTRACT The HIV care continuum represents a linear clinical pathway from testing to viral suppression; however, it does not capture the psychosocial complexities of contemporary HIV care. We developed an innovative and appealing visual learning resource to extend the scope of HIV health literacy beyond biomedical constructs. Based on the lived experiences of recently diagnosed people living with HIV in Queensland, the “Journeys through the HIV Care Continuum” Map presents the continuum as a complex journey incorporating challenges such as poor health literacy, health service access and stigma alongside facilitators to care, including emotional and peer support. Designed for audiences who may not access academic literature, the Map can be used to facilitate conversations between recently diagnosed people living with HIV and peer navigators, and as a learning tool for health professionals, carers and students. The Map highlights opportunities to support PLHIV in meaningful ways that will reduce stigma and promote care access.

Peer Navigators for the Health Needs of People of Color With Serious Mental Illness.

People with serious mental illness die up to 20 years younger than others in the same age group, with people of color showing even earlier death. The social disadvantages experienced by this group-for example, poverty, criminal legal involvement, and immigration-are further determinants of this disparity. Peer health navigators (PHNs) are people with experiences of recovery who may share a racial-ethnic background, history of poverty, experience with criminal legal systems, or immigration status with current patients and who assist in practical and timely tasks that help people engage with fragmented health systems. This column describes the PHN practice, including the putative components that define it.

Perspectives of structurally marginalised patients attending contextually tailored and integrated care practices in Canada: a focused ethnography study

ObjectivesTo better understand the experience of patients attending community-based primary healthcare practices (CBPHCPs) aimed at improving equity and access to primary care for underserved patients, which have been implemented locally...

An outbreak of SARS-CoV-2 infections among people living with HIV and its successful containment—Taiwan, May to August 2021

In Taiwan, 14,308 locally acquired COVID-19 cases among customers and employees in Sexy Tea shops were the first cases from May 9–August 28, 2021 (weeks 19–34). Nine weeks after the community spread of COVID-19 began, the proportion of people living with HIV (PLHIV) among the COVID-19 patients peaked at 35.7%, affecting 192 HIV patients, while the prevalence of HIV infection was 0.15%. In addition to a nationwide Level 3 epidemic alert, the Taiwan Centers for Disease Control (Taiwan CDC) launched four strategies to contain this outbreak among PLHIV in this prevaccine era, including improving the quality of contact tracing, delivering health information via peer navigators, expanding SARS-CoV-2 screening and encouraging vaccination, and addressing hesitancy. The outbreak of COVID-19 related to Alpha strain among PLHIV in 2021 ceased four weeks after peaking and lasted eight weeks.

Influence of Female Genital Mutilation/Cutting on Health Morbidity, Health Service Utilization and Satisfaction with Care among Somali Women and Teenage Girls in the United States

IntroductionThere is scant evidence on the health morbidities experienced by Somali women and girls affected by female genital mutilation/cutting (FGM/C) and their resultant health-seeking behavior in the USA as compared to those who have not undergone the procedure. To fill this gap, we conducted a comprehensive examination of health morbidity among women and teenage girls with and without FGM/C in a Somali migrant community.MethodsUsing a comprehensive community-based participatory research approach, a cross-sectional survey was administered to 879 Somali women and teenage girls in Phoenix and Tucson, Arizona. We employed Chi-square and analysis of variance to disentangle health and healthcare use among those with and without FGM/C.ResultsThe majority of respondents had undergone FGM/C (79%). Respondents with FGM/C experienced significantly more health concerns compared to uncut women and girls, with those possessing Type III FGM/C experiencing significantly more obstetric, gynecologic, sexual, and mental health morbidity than those with Type I or Type II. Rates of service use, while varied, were low overall, particularly for mental health services, even with health insurance. The majority of respondents who sought care indicated that their concerns were resolved, and they were satisfied with the healthcare received.ConclusionsCommunity-engaged strategies that build upon satisfaction with care of women who seek care to enhance trust, nurture community embeddedness and facilitate peer navigation, while equipping health and social service providers with the competency and tools to provide respectful, trauma-informed care, will be critical to advance health equity for FGM/C-affected communities.

Isisekelo Sempilo study protocol for the effectiveness of HIV prevention embedded in sexual health with or without peer navigator support (Thetha Nami) to reduce prevalence of transmissible HIV amongst adolescents and young adults in rural KwaZulu-Natal: a 2\u2009\xd7\u20092 factorial randomised controlled trial

BackgroundAntiretroviral therapy (ART) through universal test and treat (UTT) and HIV pre-exposure prophylaxis (PrEP) substantially reduces HIV-related mortality, morbidity and incidence. Effective individual-level prevention modalities have not translated into population-level impact in southern Africa due to sub-optimal coverage among adolescents and youth who are hard to engage. We aim to investigate the feasibility, acceptability, and preliminary population level effectiveness of HIV prevention services with or without peer support to reduce prevalence of transmissible HIV amongst adolescents and young adults in KwaZulu-Natal.MethodsWe are conducting a 2 × 2 factorial trial among young men and women aged 16–29 years, randomly selected from the Africa Health Research Institute demographic surveillance area. Participants are randomly allocated to one of four intervention combinations: 1) Standard of Care (SOC): nurse-led services for HIV testing plus ART if positive or PrEP for those eligible and negative; 2) Sexual and Reproductive Health (SRH): Baseline self-collected vaginal and urine samples with study-organized clinic appointments for results, treatment and delivery of HIV testing, ART and PrEP integrated with SRH services; 3) Peer-support: Study referral of participants to a peer navigator to assess their health, social and educational needs and provide risk-informed HIV prevention, including facilitating clinic attendance; or 4) SRH + peer-support.The primary outcomes for effectiveness are: (1) the proportion of individuals with infectious HIV at 12 months and (2) uptake of risk-informed comprehensive HIV prevention services within 60 days of enrolment. At 12 months, all participants will be contacted at home and the study team will collect a dried blood spot for HIV ELISA and HIV viral load testing.DiscussionThis trial will enable us to understand the relative importance of SRH and peer support in creating demand for effective and risk informed biomedical HIV prevention and preliminary data on their effectiveness on reducing the prevalence of transmissible HIV amongst all adolescents and youth.Trial registrationTrial Registry: clincialtrials.gov. ClinicalTrials.gov Identifier NCT04532307. Registered: March 2020.