Abstract
This study evaluated the impact of peer patient navigation compared to standard care in promoting PrEP treatment among individuals at high risk for HIV in Alabama. The study was conducted at an LGBTQ+-focused primary care clinic dedicated to culturally competent, affirming care. Longitudinal data from January 2016 to June 2022, covering 4,194 visits by 764 patients, were analyzed. Three service periods were compared: Standard of Care (SOC) (01/2016-05/2018), PrEP-Up! (06/2018-06/2021), and Enhanced PrEP-Up! (07/2021-06/2022). Segmentation regression was employed to analyze (1) the effects of PrEP-Up! and Enhanced PrEP-Up! on appointment persistence (versus "standard of care"); and (2) the effect of COVID-19. Participants were 71.5% White, 19.2% Black, 3.5% Other race, and 5.8% Unknown race. Regarding ethnicity, 10.6% disclosed as Not Hispanic/Latino, 3.6% as Hispanic/Latino, 2% as Central American/Chicano, and 84.9% had ethnicity unavailable. 93.5% identified as male, with 56.9% identifying as LGBTQ+. Persistence rates under SOC averaged 88%. PrEP-Up! improved persistence to 95% initially but declined slightly over time. COVID-19 significantly disrupted persistence during early 2020, though rates gradually improved with the easing of restrictions. During the Enhanced PrEP-Up! period, persistence increased more slowly, possibly reflecting residual pandemic effects. Peer patient navigation effectively enhanced PrEP persistence in a region disproportionately impacted by HIV. Despite challenges posed by COVID-19, these findings emphasize the importance of community-centered interventions in addressing health disparities. Rebuilding trust in public health among marginalized populations is essential to improving equitable health outcomes.