Building bridges to care: the experience of peer navigation in enabling linkage to PrEP for adolescent men who have sex with men and transgender women

Abstract

Vulnerable populations are at increased risk for HIV/AIDS, especially adolescent men who have sex with men (AMSM) and adolescent travestis and transgender women (ATGW). Pre-exposure prophylaxis (PrEP) is one component of combination HIV prevention and is already available for these populations in Brazil. However, ensuring its uptake entails certain challenges since inequality and barriers have traditionally marked access and linkage to the related public health services. Peer navigation could be a way of mediating the linkage process because it involves peers keeping track of others’ care schedules, dynamically fostering linkage to care according to the needs of users and the actors involved in their everyday care contexts. Therefore, this study proposes analyzing peer-navigator-mediated linkage to PrEP care for 15- to 19-year-old MSM and transgender women from the PrEP1519 project in Salvador, Bahia State, Brazil. In total, 15 field notebooks/diaries, written in April-July 2019, by four peer navigators were analyzed, as were the transcripts of one focal group and 20 semi-structured interviews with adolescents (17 MSM and three trans women) between June and December 2019. Linkage via peer navigator and participant is influenced by emotional dynamics and shared personal characteristics. It is fluid and unstable and calls for care practices to be shaped to meet each participant’s needs. For peer navigation to be adopted as a care strategy for sexually transmitted infection prevention and treatment, it should envisage not only increased linkage to care but also sensitivity to service users’ specific characteristics and lived experiences.

Do Peer Navigators Improve Initiation and Retention in HIV/VH/STI Treatment Programs for People From Key Populations? A Systematic Review of Effectiveness, Values and Preferences, and Cost

“…However, our overall conclusions in support of peer navigation programs are strengthened by the positive experiences and perspectives on peer navigation programs for key populations that have focused on pre-exposure prophylaxis or HIV testing, instead of treatment support. 22–24…”

Prevención combinada del VIH para hombres adolescentes que tienen relaciones sexuales con otros hombres y con mujeres adolescentes transgénero en Brasil: vulnerabilidades, acceso a la atención en salud y expansión de la PrEP

“…Los retos para vincularse a los servicios y las experiencias de uso de la PrEP en la vida cotidiana de los adolescentes, temas centrales para aumentar la eficacia de la PrEP, se debaten en dos artículos. En el primero, Oliveira et al 37 analizaron la vinculación de HSH adolescentes y mujeres transgénero adolescentes a la clínica de PrEP en Salvador, a través de la mediación de navegadores pares y mostraron que navegadores y adolescentes trabajaban juntos, se afectaban mutuamente y se necesitaban para "hacer" o producir un vínculo con la atención. Santos et al 38 exploraron las percepciones y experiencias de jóvenes gays, bisexuales y otros HSH de los sitios de São Paulo y Salvador, en relación a la búsqueda, uso y adherencia a la PrEP utilizando el abordaje interseccional, es decir, discutiendo aspectos personales/relacionales y dimensiones estructurales y simbólicas como facilitadores y barreras para el continuo de cuidados en PrEP.…”