Examining engagement in and initial efficacy of a structured peer health navigator intervention to improve HIV and related outcomes among YBMSM living with HIV


BACKGROUND: HIV health disparities among young black men who have sex with men (YBMSM) are often the result of a complex intersection of trauma, psychosocial cofactors, and low access to socioeconomic resources. To address these disparities and needs, the WITH U intervention employed peer health navigation that attended to behavioral health needs, linkage to services, and psychosocial support. This study reports on engagement and efficacy of the intervention.
METHODS: This was a longitudinal mixed-methods single-arm study. Data were collected from enrollment and 6-month self-administered quantitative surveys with all participants and semi-structured qualitative interviews with a sub-sample of 22 participants. Quantitative analyses included frequencies, means, and bivariate correlations. Deductive and inductive content analysis was used to analyze qualitative data.
RESULTS: WITH U participants were 65 YBMSM, average age of 25-26 years (M=25.55,SD=2.51). Approximately one quarter of participants scored at or above the clinical cutoff for depression or anxiety symptoms, and over 40% reported being bothered by past traumatic stressors in the last month. More than half of participants reported food insecurity in the last three months, over a third were concerned about housing, and a quarter were unable to pay their utilities when needed.
Overall, participants reported high satisfaction with WITH U and attended an average of 5-6 of 12 possible sessions with health navigators (M=5.69, SD=3.05). Attending a greater number of sessions was significantly associated with being virally suppressed at enrollment (rs(50)=.36, p<.05) and six month-follow-up (rs(38)=.34, p<.05), as well as greater concern about housing (rs(54)=.29, p<.05) and experiencing unemployment for at least three months in the last year (rs(54)=.29, p<.05). This aligned with qualitative findings that navigator support around basic needs was critical to participants. Although participants identified mental health support from navigators as important, experiencing more depressive symptoms was significantly associated with attending fewer sessions (rs(54)= -.32, p<.05). A switch to virtual sessions due to the COVID19 pandemic was a barrier to engagement for some participants.
CONCLUSIONS: Engagement in WITH U was associated with improved health outcomes and social determinant health assistance needs. Novel methods for better engaging YBMSM virtually, especially those with depression, are needed.