Understanding Patient Barriers and Facilitators Throughout the PrEP Care Continuum: an Analysis of Qualitative Interviews with PrEP Navigators in the United States

Pre-exposure prophylaxis (PrEP) is a medication that significantly reduces the risk of HIV infection when taken as prescribed, however, less than 36% of the 1.2 million eligible-for-PrEP Americans are currently prescribed it. PrEP navigators can help reduce barriers to PrEP uptake and increase access to care for those vulnerable to HIV. As part of formative work for designing an e-peer navigation tool, MyPEEPS Mobile Plus, twenty PrEP navigators were interviewed about barriers and facilitators to PrEP options, delivery, and peer navigation. We analyzed our findings using the nine-step PrEP care continuum as a framework. Participants described how medical mistrust, cultural competency, patient assistance programs, availability of PrEP options, prescriber knowledge and availability, housing insecurity, and rapport contribute to uptake and adherence of PrEP and retention in care. In summary, our study highlights the crucial role of PrEP navigators in facilitating access to HIV prevention services and demonstrates strategies to overcome individual and structural barriers in a clinical setting. These findings will improve the design of the MyPEEPS Mobile Plus intervention and may inform future e-peer navigation strategies.