Peer Navigation Research Articles

Increasing STI and HIV preventive behaviors and addressing community-prioritized social determinants of health among young GBQMSM and transgender women of color: Piloting a bilingual multilevel intervention

Abstract Background Sexually transmitted infections (STIs) and HIV disproportionately affect young people; gay, bisexual, queer, and other men who have sex with men (GBQMSM); transgender women; and persons of color. Our community-based participatory research partnership developed and implemented Impact Triad, a bilingual multilevel intervention harnessing peer navigation and mHealth to increase STI/HIV preventive behaviors and address four community-prioritized social determinants of health -- education, employment, social support, and discrimination -- among young African American/Black and Latine GBQMSM and transgender women. Methods Fifteen community-based peer navigators were trained to work within their social networks for 12 months. Each navigator engaged five social network members who completed baseline and immediate post-intervention assessments (retention rate = 97.3%). Regression modeling was used to assess changes in outcomes between baseline and follow-up. Results Among 74 enrolled social network members, the average age was 27.8; 61% identified as African American/Black, 31% as Latine, and 8% as multiracial/multiethnic. The majority self-identified as cisgender men and 8% as transgender women; 78% identified as gay. About half reported monthly income below $1,000. Compared to baseline, at follow-up, social network members increased: STI screening (P = .001), HIV testing (P = .001), condom use (P = .03), and PrEP use (P = .02). Knowledge of PrEP (P < .0001) and of community-based educational (P = .047), job-training (P = .002), and job-finding resources (P = .02) also increased. Social support increased (P < .0001) and perceived discrimination decreased (P < .01). Conclusions Pilot findings suggest that Impact Triad is promising in increasing STI/HIV protective behaviors and addressing social determinants of health among young GBQMSM and transgender women of color; further testing is warranted.

The role of community health workers in re-entry of people with HIV and substance use disorder released from jail: a mixed methods evaluation of a pilot study

BackgroundIncarcerated individuals face high rates of mental illness, substance use disorders and communicable diseases including HIV, with increased health complications and mortality in the early post-release period. Multiple re-entry interventions linking justice-involved individuals to community resources via peer navigation have emerged, though limited data exist on the mechanics and personal impact of these approaches. This paper quantifies and evaluates a pilot study of a combined Community Health Worker (CHW)-re-entry intervention for individuals released from jail who use substances and have HIV to inform future large-scale applications.MethodsA mixed-methods analysis of a CHW-re-entry intervention utilized in a pilot randomized controlled trial involving people with HIV who have a history of substance (stimulant, opioid or alcohol) use in Dallas, TX was conducted using an explanatory sequential design. Quantitative assessments of the intervention measured interaction types, time spent, and topics discussed and explored associations between the “dose” of intervention and patient outcomes. Qualitative analyses of CHW field notes and end-of-study participant interviews were triangulated with quantitative findings to elucidate the intervention’s impact.ResultsOf the 17/31 participants assigned to the intervention, 16 interacted with the CHW on at least one occasion, and 6 successfully completed a visit with the re-entry organization. Most CHW interactions occurred by phone (66%) or in person (28%). Frequently discussed topics included substance use, housing, and physical health. On average, participants spent 7.65 h (range 0-37.18, SD = 9.33) engaged with the intervention over 6 months. Intervention dose was associated with improved HIV control, decreased stimulant use, higher rates of recidivism, and improved clinical appointment show rate. Qualitative analyses revealed key intervention components, paralleling benefits of study participation alone: outreach, nonjudgmental approach, motivation and accountability.ConclusionsA CHW-re-entry intervention, while resource-intensive, shows preliminary promise in improving HIV and some substance use outcomes. Frequent telephone and in-person contact, with an empathetic yet goal-oriented approach, fostered participant support and motivation to address HIV and substance use. Participants reported that engagement in research provided accountability and a sense of purpose. Future studies should focus on optimizing implementation of CHW-based interventions to enhance impact on vulnerable populations.

Intersectional stigma among Latino MSM and HIV prevention: barriers to HIV prevention and strategies to overcome the barriers

ABSTRACT Latino men, especially Latino men who have sex with men (LMSM), experience disparities in HIV prevention. Lack of attention to key barriers to care, such as stigma, result in inequitable access to HIV prevention and care for LMSM. This paper describes how intersectional stigma and related factors act as barriers to HIV prevention among Latino men and proposes strategies to overcome these barriers. Qualitative data were collected via in-depth interviews (n = 15) with Latino men about HIV prevention services, mobile outreach, peer navigation and care coordination, and analyzed using rapid qualitative methods. Three key themes emerged: (1) HIV stigma as a barrier to HIV testing, (2) sexual minority stigma as a barrier to accessing HIV prevention services and (3) strategies for stigma reduction, such as confidentiality, comprehensive education about HIV and prevention, and empathy and warmth from staff/care providers. Identified stigmas were intersectional. Addressing and reducing stigma is critical to engaging Latino men in HIV prevention and care, and requires strategies sensitive to the Latino cultural context and community.

Crisis prevention and response in Ryan white-funded HIV clinics

ABSTRACT The high prevalence of trauma among people with HIV (PWH) and its negative impact on HIV outcomes underscore the need for Ryan White-funded HIV clinics (RWCs) to implement trauma-informed care (TIC) inclusive of crisis prevention and response. As part of a mixed-methods study of TIC practices employed by RWCs, we conducted qualitative interviews with 36 administrators, providers, and staff from Southeastern RWCs exploring crisis prevention and response strategies. Interviews were guided by the Substance Abuse and Mental Health Services Administration TIC framework and analyzed using a framework-driven, qualitative thematic approach. Crisis prevention strategies included: using electronic medical records to identify patients at risk for experiencing crisis, peer navigators to help patients bypass clinic public spaces, protocols to ensure perpetrator-victim pairs were not concurrently scheduled, and social workers to help patients identify crisis triggers and develop safety plans, plus dedicating safe spaces for patients with extensive trauma histories. Crisis response included patient referral to onsite and community crisis intake, trauma support, and mental health services and having onsite security personnel and alarm systems. Several participants requested additional training in response protocols. Study findings highlight the need for RW network-wide TIC training and sharing of best practices in crisis prevention and response.

Navigating transitions into, through, and beyond peer worker roles: insider insights from the Supporting Harm Reduction through Peer Support (SHARPS) study

BackgroundPeer workers are individuals who draw on their personal experiences in a professional capacity to support clients. Existing research on the role of peer workers in mental health, homelessness, and substance use services has primarily focused on their impact on client outcomes. This paper describes the development of peer workers as they transition into, through, and beyond this role. Utilising data from the Supporting Harm Reduction through Peer Support (SHARPS) study, where Peer Navigators supported people experiencing homelessness and substance use challenges, this paper explores the sense-making involved in an intensive peer support worker role, adaptation to organisational culture, and engagement with opportunities for professional advancement.MethodsSemi-structured interviews with three Peer Navigators were conducted by two SHARPS study researchers at four time points in 2018 and 2019 corresponding with the beginning, middle, and end of the intervention. These data were analysed along with entries from the three Peer Navigators’ reflective diaries. Analysis followed a multi-stage approach to thematic analysis utilising both inductive and deductive processes. The Peer Navigators’ personal reflections have also been incorporated into the recommendations.ResultsThe foundational training provided to the Peer Navigators before taking up their role helped to ensure readiness and build confidence. This training illuminated the dynamics of supporting individuals with complex health and social challenges. Integrating into diverse organisational environments, the Peer Navigators adapted to new professional expectations and consistently advocated for harm reduction and psychologically informed approaches, sometimes encountering resistance from other professionals. Establishing effective relationships with participants and professionals was essential and involved dealing with challenges such as overcoming personal biases and navigating systemic obstacles. the Peer Navigators benefitted from the specially designed training to support career progress with personal and professional development opportunities which enabled successful transitions beyond the SHARPS study.ConclusionsPre-work training, coupled with support and adherence to key principles, enabled the Peer Navigators to integrate effectively into diverse organisations. Quality relationships were vital in achieving client outcomes and supporting the professional growth of the Peer Navigators. These findings are important for services employing peer workers and underscore the importance of a commitment to training and continuing professional development.

"We're Not Gonna Aid You in Shooting Up": Stigma's Relationship to Harm Reduction in People Who Inject Drugs.

Harm reduction, when applied to drug use, prioritizes improving patient-centered health outcomes and reducing drug-related harm. In order for harm reduction strategies to be adopted by people who inject drugs (PWID), they need to be promoted, accessible, and accepted in that population and the community-at-large. While PWID face stigma at multiple levels, less is known about how stigma influences uptake and acceptance of harm reduction services and strategies among PWID. We aim to characterize the stigmatizing experiences PWID have had related to harm reduction and the role of stigma in influencing their acceptance and adoption of harm reduction services and strategies. A qualitative study using in-person, semi-structured interviews. We recruited hospitalized participants, age 18 and over, with a history of injection drug use. We developed an interview guide asking about various aspects of stigma and participants' experiences with naloxone, syringe service programs, fentanyl test strips, HIV and hepatitis C testing, and any other harm reduction strategies. Key themes were generated using a thematic analysis. We reached thematic saturation at 16 participants. PWID reported multi-level stigma related to harm reduction from themselves, the public, the healthcare system, and the legal and carceral systems. Themes were grouped into four main categories: internalized, interpersonal, intervention, and structural stigma. Stigma across all of these domains negatively impacted the ability of PWID to access harm reduction resources. Positive, non-stigmatizing experiences from others, such as syringe service programs and peer navigators, countered historically negative experiences and promoted greater education and comfort about using harm reduction resources among PWID. To expand the reach of harm reduction services, it is critical to develop interventions that can reduce the stigma against PWID and harm reduction.

Peer navigation intervention for individuals with serious mental illness reentering the community after jail incarceration: a qualitative case study

BackgroundCriminal legal system-involved individuals with serious mental illness (SMI) experience more challenges accessing mental health and other community services than those without a history of criminal legal system involvement. A formative qualitative study was conducted to explore feasibility and acceptability and inform the adaptation of a mental health peer navigation intervention for individuals with SMI reentering the community after jail incarceration.MethodsIn-depth qualitative interviews and focus-group discussions were conducted with mental health peer navigators (i.e., certified mental health peer support specialists, peer recovery coaches) and individuals with lived experience of SMI and criminal legal system involvement (N = 20 total). Data were analyzed using applied thematic analysis.ResultsFour major themes emerged: (1) Feasibility and acceptability of peer-provided services: all participants reported that peer navigation services would be feasible and acceptable for individuals with SMI reentering the community after jail incarceration; (2) roles of peer navigators in addressing barriers to care: peers can address barriers to care experienced during community reentry and contribute towards service linkage/engagement; (3) shared identity and combating stigma: having a shared identity with peer navigators may minimize the impact of stigma and make it easier for clients with multiple marginalized identities to seek support; and (4) peer navigator skills and recommendations for the planned program: essential peer navigation skills include authenticity, reliability, active listening, advocacy, trauma-informed care, motivational interviewing, and empathy. Recommendations for the planned program include initiating services while clients are in custody, emphasizing the voluntary nature of peer support, knowing the limits of a peer navigation intervention, and offering support for peer navigators while on the job.ConclusionParticipants saw peer navigation services for individuals with SMI with criminal legal system involvement as potentially feasible and acceptable. Such programs may enhance their impact by offering supportive supervision, emphasizing the voluntary nature of the service, and acknowledging recovery as a self-directed endeavor.

COVID-19 vaccine implementation at a syringe services program: experiences of frontline staff

BackgroundWhile people with substance use disorders, including people who inject drugs (PWID), experience increased risk for COVID-19 infection and adverse outcomes, COVID-19 vaccination rates among PWID are consistently lower than those observed in the general population. Offering COVID-19 vaccines at syringe services programs (SSPs) has been proposed as a critical strategy to increase vaccine uptake among this population. We explored the experiences of frontline staff at an SSP in Miami, Florida implementing onsite COVID-19 vaccines.MethodsBetween June and July 2022, we conducted in-depth semi-structured interviews with 17 staff members of an SSP in Miami, Florida. Data collection and codebook thematic analysis of transcribed interviews were guided by the Consolidated Framework for Implementation Research (CFIR).ResultsFacilitators and barriers of COVID-19 vaccine implementation at the SSP aligned with all major CFIR domains. Key facilitators included the SSP’s established partnership with the local health department for vaccine distribution, its existing funding sources which could be leveraged for vaccine-related expenses, consensus among staff about the need for new strategies to increase vaccine uptake among PWID, and PWID’s trust in the SSP. Major—but largely modifiable—barriers included lack of participant compensation, limited internal collaboration and communication regarding the vaccine initiative beyond implementation leads and innovation deliverers due to competing priorities and segmented roles and responsibilities, and insufficient involvement of the most participant-facing staff (i.e., the SSP’s peer navigators and outreach workers).ConclusionsImplementing onsite COVID-19 vaccines was perceived as feasible and acceptable by frontline staff at the SSP, however contextual factors impeded optimal implementation. Multilevel strategies, such as participant compensation for vaccine completion and internal educational meetings with staff to improve vaccine implementation and reach, are required. As a trusted source of preventative services for PWID, SSPs are an underutilized venue for increasing vaccine uptake among this population, and findings from this study could inform the expansion of low-barrier vaccine services at SSPs nationwide.

A Stepped-Wedge, Cluster-Randomized, Multisite Study of Text Messaging Plus Peer Navigation to Improve Adherence and Viral Suppression Among Youth on Antiretroviral Therapy.

To address the need for improved virologic suppression among youth living with HIV (YLH) on antiretroviral treatment (ART), we evaluated peer navigation plus TXTXT daily text message ART reminders. YLH aged 15-24 on ART for at least 3 months at six research sites in four Nigerian cities. Using a stepped-wedge design, Cluster 1 was non-randomized, while Clusters 2 and 3 were randomized to sequences of routine care (control period) and 48 weeks of the combination intervention (intervention period). The primary endpoint was viral suppression (HIV-1 RNA <200 copies/mL) at week 48 of the intervention. Secondary endpoints included adherence measured by self-report (90% considered adherent). Post-hoc analysis assessed virologic control at <50 copies/mL and <1000 copies/mL. Generalized estimating equations determined the difference between intervention and control periods in the intention-to-treat population. We enrolled 558 YLH and followed 541 over time, mean age 18 years, 53.8% female, 71.7% perinatally infected, and 38.6% virologically non-suppressed at enrollment. For the primary endpoint, the intervention periods displayed a small, non-significant increase in viral suppression < 200 copies/mL (OR = 1.16 [0.88, 1.54], p = 0.297). There was a significant effect of the combination intervention on virologic control <1000 copies/mL (OR = 1.42 [1.03, 1.94], p = 0.030). Self-reported adherence also improved (OR = 2.07 [1.46, 2.95], p < 0.001). Peer navigation plus daily text message ART reminders demonstrated limited benefit among ART-experienced, predominantly perinatally-infected YLH, with no significant effect on viral suppression below 200 copies/mL despite improvement in self-reported adherence.

Examining use of telehealth in jails: linking women to community OUD services

BackgroundOpioid use disorder (OUD) remains a significant health care need for women, particularly those involved in the criminal legal system (CLS). There are no studies to date that focus on the utilization of telehealth as a platform for assessment and linkage to medications to treat opioid use disorder (MOUD) at community re-entry for women, despite the fact that women have unique risk factors that may contribute to opioid relapse in the community. The purpose of this mixed-methods study is to provide an overview of the innovative use of telehealth for linking incarcerated women to community MOUD treatment in the Kentucky-hub of the Justice Community Opioid Innovation Network (JCOIN).MethodsThis study incorporates qualitative and quantitative data collection with MOUD providers, recovery staff involved in peer navigation services, and women who are incarcerated to understand perceptions of the use of telehealth prior to jail release as a linkage to community services.ResultsFindings from this study suggest overall support for the use of telehealth between community MOUD treatment providers and women who are incarcerated using videoconferencing technology. On average, there was very little variation in provider favorable feedback related to clinical engagement or in face-to-face comparability, as well as how telehealth allowed the participant to discuss personal and sensitive issues during the clinical assessment.ConclusionsStudy findings suggest benefits associated with the use of telehealth in increasing access to treatment for women with OUD. Jails are critical venues for telehealth interventions because they provide the opportunity to reach women who have been actively using illicit substances, often have advanced-stage substance use disorders which have compromised their health and mental health, and often have not been previously identified as needing treatment.Trial registration: This study was originally registered on 8/23/19, ClinicalTrials.gov, #NCT04069624.

Oral Health Recovery: Randomized Evaluation of an Oral-Behavioral Health Integration Approach.

This study implemented a single-session oral health education and referral program in behavioral health settings serving people with psychiatric disabilities. The program was led by peer specialists ("peers")-lay community behavioral health workers with personal experience of mental health challenges who are trained and certified to support others. Investigators collaborated with peers, state government, and clinical leadership to design and implement the program. Randomized parallel assignment was used to compare 2 arms: (1) group viewing of an oral health educational video (VC) and (2) a peer-led 1-time class providing education and motivation to access dental care (the Oral Health Recovery Group; OHRG). In both arms, peers followed up with participants to encourage accessing dental care and reinforce at-home care goals. Oral health knowledge, at-home care, motivation, appointment scheduling, and utilization were assessed at baseline, postintervention, and 2 mo. Qualitative interviews assessed barriers and facilitators. More than half of participants reported oral pain in the previous year. Pre-/postintervention survey results did not significantly improve in either arm or differ between arms. At follow-up, 25 (68%) in OHRG and 14 (56%) in VC reported meeting a dental at-home care goal because of the program. Ten (27%) in OHRG and 9 (36%) in VC reported making a dental appointment because of the program. Most were satisfied with the program. Interviewed participants were comfortable with peers in this role, yet access barriers remained. Single-session oral health interventions were implemented in behavioral health settings. The fact that surveys did not significantly improve suggests that more intensive interventions may be needed. Nevertheless, peers successfully scheduled dental appointments for vulnerable patients. Given that dental appointments were scheduled after only a 1-time class and light-touch peer navigation, oral health integration in behavioral health settings shows promise as a financially sustainable approach that merits further research. The results of this study can be used by staff in behavioral health settings who wish to consider peer-led financially sustainable approaches to providing oral health education and linkages to dental care for their clients.

Increasing Transplant Access with a Novel Care Model Employing Transplant Peer Navigators (TPNs)

Increasing Transplant Access with a Novel Care Model Employing Transplant Peer Navigators (TPNs)

Are operations backed by best practices in American problem-solving courts?

ABSTRACT Background Problem-solving courts (PSCs) are specialized courts offering evidence-based interventions for rehabilitating and diverting individuals from carceral institutions. PSCs allow participants to address problems influencing their behavior, such as mental health and/or substance use disorders, while remaining in the community under court supervision. PSCs are designed to serve as linkage sites to support services and research supports PSCs’ efficacy in doing so. Objective Less is known about how PSC operations align with national best practices specified by All Rise (professional association of PSCs) in serving court participants. Methods This study explores whether American PSCs adopt All Rise’s 10 best practice principles based on surveys from a larger study of PSC operations reported by local (n = 849) and state (n = 42) PSC coordinators. Results Of the All Rise principles captured in our study, only 4% of courts adopted eight EBPs whereas 56% of the courts adopted four to six EBPs. PSCs using EBPs employed diversified staff positions, collaborated with multiple treatment providers, participated in treatment trainings, offered peer navigators, used validated screening tools, used varied treatment modals, and had eligibility criteria for participants to enter PSC programs. Conclusions PSCs’ operations were generally backed by some of All Rise’s best practices.

Abstract B063: A community-based organization, health equity uplift and growth alliance for triple negative breast cancer and metastatic breast cancer in young women

Abstract Background: Triple Negative Breast Cancer (TNBC) and Metastatic Breast Cancer (MBC) disproportionately affect the Black, indigenous, and people of color (BIPOC) community as well as younger women. Breast cancer (BC) is the leading cause of cancer-related deaths in women less than 40 years old, and survival rates for young women with BC remain lower than for their older counterparts. While more effective treatments and progress in genomic and genetic testing have improved survival of those affected by BC, not everyone has benefited from these advances. Methods: In early 2023, Tigerlily Foundation issued a request for proposal for community-driven initiatives to educate and support young BIPOC women at risk or living with TNBC or MBC in under resourced communities. Fifteen applications were received by Tigerlily over a 6-week period, and 5 community-based organizations (CBOs) in under-resourced metropolitan areas were recommended for $20,000 each in funding by an independent review panel. Tigerlily met with CBO leaders 3 times between May 2023-April 2024 to share experiences, lessons learned and successes. Results: The community- based organization health equity uplift and growth (CBO HUG) alliance resulted in patients and caregivers with increased awareness regarding BC stage, type, and equitable care standards. Approximately, 620 CBO led programs were held over 12 months, where 15,419 BIPOC community members were reached, and 340 community members were referred for screening or health services in partnership with CBOs, Tigerlily’s ANGEL Advocates (Peer Navigators) and NCI Cancer Center Leadership. Programs generally fell into 19 program types, e.g., game nights, radio podcasts, and programs in connection with mobile mammogram units. Twelve Tigerlily ANGEL advocates participated by sharing Tigerlily resources and their stories, providing educational material, facilitating discussion groups, and co-designing content and evaluation instruments. Evaluation reports identified over 40 actionable and notable practices. These practices are categorized by those that worked well and those that need improvement, as noted by CBO leadership and/or ANGEL advocates. Conclusions: The CBO HUG Alliance education and capacity building initiative fostered solutions and bolstered community-based organizations in under-resourced communities. This program leveraged peer navigation and culturally sensitive programming to help young BIPOC persons optimize their health. CBO leaders provided local expertise and community-driven solutions which are at the core of Tigerlily’s commitment to uplift others by listening, learning, leveraging what we learned, and letting the community lead. Next steps include sustained co-curation of tailored content to support empowerment of priority populations. Citation Format: Jeanne M. Regnante, Mandi L. Pratt-Chapman, Belinda Paulicin, Amy Leader, Virginia Leach, LaToya A. Cooper, Sue Steele, Maimah Karmo. A community-based organization, health equity uplift and growth alliance for triple negative breast cancer and metastatic breast cancer in young women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B063.

Peer navigation for smoking cessation in people with HIV who smoke: a pilot randomized controlled trial.

People with HIV (PWH) cite smoking within their social networks as a barrier to quitting. We examined the feasibility, acceptability, and preliminary efficacy of a tailored intervention, Peer Navigation Social Support for Smoking cessation (PNSS-S), designed specifically for PWH who smoke. We randomized 64 PWH who smoked (mean age 54.5 years; 41% female) to PNSS-S or standard care (SC). After meeting with a clinic nurse to discuss quitting strategies and pharmacotherapy, the PNSS-S group received 12 weekly phone calls from a trained HIV peer navigator (PN), who provided smoking cessation counseling and social support for quitting. Outcomes were assessed at 12- and 24-weeks. Sixty-two percent of participants indicated interest in quitting at baseline. PN utilization was high with a mean number of weekly calls completed of 8.9 (SD 3.1), demonstrating excellent feasibility. Higher treatment satisfaction scores (29.1 [SD 3.0]) were reported in PNSS-S, compared to control (25.8 [SD 4.1], t = -3.39, d = 0.89, p = .001). Notably, positive social support for quitting increased significantly from baseline to week 12 in PNSS-S (17.4 [SD 11.4] to 25.1 [SD 12.2], p = .01), whereas SC showed no significant change (t = 1.11, df 29, p = .24). At week 24, 5 (16.6%) participants in PNSS-S and 3 (8.8%) in SC endorsed 7-day point prevalence smoking abstinence: OR=2.05 95% CI=[0.45-10.88]. Peer-based smoking cessation counseling increased the odds of abstinence and significantly increased social support for quitting. Further study is warranted. Cross training HIV peer navigators to address smoking cessation may be a cost-effective approach, as it utilizes existing HIV clinic-based resources. By strengthening social support and providing a peer-based approach, this intervention may help reduce the burden of tobacco-related health issues in this population, ultimately contributing to better overall health and longevity for PWH. Further research is needed to refine and expand upon these findings.

"They treat us equally, they guide us": peer navigation for HIV care linkage in men who have sex with men and transgender women in Lima, Peru.

To analyze the elements of a navigation program in Lima that facilitated the linkage of men who have sex with men (MSM) and transgender women (TW) with HIV care. We conducted interviews with 20 users receiving navigation services and 4 peer navigators living with HIV. The work of the navigators contributed to filling a gap in HIV services, providing personalized accompaniment to navigate the health care system and facilitating the process of engaging with care. Patient navigation based on the development of users' strengths can be a useful and feasible strategy to improve linkage to medical care for MSM and TW in Peru, incorporating peer navigators to health teams, horizontality in treatment and public health strategies with greater community participation.

Randomized Controlled Trial of 60 minutes for Health With Rapid Antiretroviral Therapy to Reengage Persons With HIV Who Are Out of Care.

Many persons with HIV remain out of care (PWH-OOC). We evaluated InstaCare, a complex intervention integrating the brief behavioral intervention 60 minutes for Health with the rapid restart of antiretroviral therapy (rapid ART). Prospective open-label randomized controlled trial among PWH-OOC in San Diego, USA. PWH-OOC were randomized 1:1 to InstaCare or a time-and-attention control integrating a diet-and-nutrition behavioral intervention also with rapid ART initiation (restart ≤7 days from enrollment). All participants had access to support services (free transport, HIV peer navigation, adherence counseling, and linkage to care) and primary care services (mental health, case management, social work, medication-assisted treatment, and specialist pharmacy). The primary outcomes were viral suppression (<50 copies/mL) and re-engagement with care (≥2 HIV care visits >90 days apart) by 24 weeks. Outcomes were reported on an intention-to-treat basis. Between November 2020 and August 2022, 52 PWH-OOC were enrolled. Baseline substance use in the preceding month (49%), unstable housing (51%), moderate/severe depression (49%), and moderate/severe anxiety (41.7%) were prevalent. Rapid ART was provided for all participants. At week 24, the proportion with HIV viral load <50 copies/mL was 37.3% (19/51) (InstaCare 28.0%, control 46.2%, P = 0.25). Fourteen (27.5%) were engaged with care (InstaCare 7/25 [28.0%], control 7/26 [26.9%], P = 1.00). Most participants (94%) reported low or very low emotional distress associated with rapid ART. Study lost to follow-up by week 24 was high (23/51, 45%). The InstaCare complex intervention did not improve viral suppression or reengagement with care among PWH-OOC. Investigation of high-intensity, individually adapted interventions is needed among PWH-OOC.

Subspecialty physicians’ perspectives on barriers and facilitators of hepatitis C treatment: a qualitative study

IntroductionThe hepatitis C virus (HCV) causes chronic and curable disease with a substantial burden of morbidity and mortality across the globe. In the United States (US) and other developed countries, incidence of HCV is increasing and people who inject drugs are disproportionately affected. However, HCV treatment rates amongst patients with substance use disorders (SUD) are suboptimal. In this study, we aimed to understand the perspectives of subspecialist physicians who care for substantial numbers of patients with HCV, including addiction medicine, infectious diseases, and hepatology physicians, to better understand barriers and facilitators of HCV treatment.MethodsWe recruited subspecialty physicians via purposive and snowball sampling and conducted semi-structured interviews with 20 physicians at 12 institutions across the US. We used a mixed deductive and inductive approach to perform qualitative content analysis with a rapid matrix technique.ResultsThree major themes emerged: (1) Perceptions of patient complexity; (2) Systemic barriers to care, and (3) Importance of multidisciplinary teams. Within these themes, we elicited subthemes on the effects of patient-level factors, provider-level factors, and insurance-based requirements.ConclusionOur results suggest that additional strategies are needed to reach the “last mile” untreated patients for HCV care, including decentralization and leverage of telehealth-based interventions to integrate treatment within primary care clinics, SUD treatment facilities, and community harm reduction sites. Such programs are likely to be more successful when multidisciplinary teams including pharmacists and/or peer navigators are involved. However, burdensome regulatory requirements continue to hinder this expansion in care and should be eliminated.

Correlates of viral suppression among sexual minority men and transgender women living with HIV in Mpumalanga, South Africa.

Sexual minority men (SMM) and transgender women in South Africa engage in HIV care at lower rates than other persons living with HIV and may experience population-specific barriers to HIV treatment and viral suppression (VS). As part of a pilot trial of an SMM-tailored peer navigation (PN) intervention in Ehlanzeni district, South Africa, we assessed factors associated with ART use and VS among SMM at trial enrolment. A total of 103 HIV-positive SMM and transgender women enrolled in the pilot trial. Data on clinical visits and ART adherence were self-reported. VS status was verified through laboratory analysis (<1000 copies/ml). We assessed correlates of VS at baseline using Poisson generalized linear model (GLM) with a log link function, including demographic, psychosocial, clinical, and behavioral indicators. Among participants, 52.4% reported ART use and only 42.2% of all participants had evidence of VS. Of the 49.5% who reported optimal engagement in HIV care (consistent clinic visits with pills never missed for ≥ 4 consecutive days) in the past 3-months, 56.0% were virally suppressed. In multivariable analysis, SMM were significantly more likely to be virally suppressed when they were ≥ 25 years of age (Adjusted prevalence ratio [APR] = 2.0, CI 95%:1.0-3.8); in a relationship but not living with partner, as compared to married, living together, or single (APR = 1.7, CI 95%:1.0-2.7), and optimally engaged in care (APR = 2.1, 95% CI:1.3-3.3). Findings indicate a need for targeted treatment and care support programming, especially for SMM and transgender women who are young and married/living with their partners to improve treatment outcomes among this population.

Challenges recruiting and retaining people at risk for HIV who use methamphetamine in a randomized PrEP adherence trial in Seattle, WA.

Methamphetamine is associated with increased HIV risk and suboptimal adherence to pre-exposure prophylaxis (PrEP). Interventions to support PrEP adherence for people who use methamphetamine are needed. We evaluated peer navigation to support adherence among people initiating PrEP who use methamphetamine. The HIV Prevention in Methamphetamine Users (HMU!) study enrolled participants from May 2018-January 2022 in Seattle, WA, and followed them for 6 months. Surveys collected sociodemographic, drug use, and sexual behavior data at enrollment, month 3, and month 6. Dried blood spots (DBS) were collected at months 1, 3, and 6 to measure PrEP adherence. We enrolled 21 participants of a target sample of 40, of whom 20 were prescribed PrEP. Nine participants (43%) received peer navigation and 12 (57%) received standard of care or text messaging. At baseline, most participants reported at least weekly methamphetamine use (17, 81%) and condomless receptive anal intercourse (CRAI) (16, 76%). One-third reported CRAI with a partner with HIV. Among those who provided a DBS, 78% and 50% had results commensurate with ≥4 pills/week at the month 3 and 6 visit, respectively. More than half of those prescribed PrEP completed a month 6 visit (11, 55%). Retention was not associated with peer support compared to standard of care or text messaging (p = .20). We enrolled half our target sample size despite extensive recruitment efforts. As expected, participants had challenges with PrEP adherence and persistence. While peer navigation interventions should be studied further, additional interventions are likely needed to support PrEP uptake, adherence, and persistence among people who use methamphetamine.