Want to receive publications straight to your inbox?

United States

This program used patient navigation to improve pre-exposure prophylaxis (PrEP) initiation and persistence (ability to continue to use PrEP medications for as long as needed) among Black/African American gay, bisexual and other men who have sex with men (gbMSM) in Mississippi. Patient navigation sought to support clients to identify and address barriers to PrEP through education, regular check-ins and support. Black/African American gbMSM who received patient navigation services were significantly more likely than those who did not to attend a PrEP clinical appointment at three months and to have picked up more than one PrEP prescription within six months of their first appointment.

Program description

This program took place at a community health centre (CHC) in Jackson, Mississippi. The CHC provides primary care services to underserved populations and emphasizes care for lesbian, gay, bisexual and transgender people. The program’s patient navigation approach built on the CHC’s current approach to PrEP initiation and care (standard of care model) and aimed to improve PrEP initiation and persistence in Black/African American gbMSM. Program participants were newly prescribed PrEP and then randomly assigned to either a patient navigation care model or a standard of care model.

The standard of care model included:

  • education on PrEP from a health care provider during the first PrEP appointment
  • two reminders for each subsequent PrEP clinical care appointment through phone calls (one seven days in advance and the other one day in advance of the appointment)
  • limited transportation assistance to get to PrEP appointments at the CHC
  • financial assistance for PrEP (in cases where there was a change in or loss of insurance status)

The patient navigation model built on the standard of care model; it included all the above services plus a single session with a PrEP navigator that was held right after the first PrEP appointment (or within seven days if clients couldn’t stay after their first appointment), as well as regular check-ins between clients and PrEP navigators. During the first session the PrEP navigator had a discussion with the client to:

  • identify or address ways to overcome potential barriers or concerns related to initiating and accessing PrEP
  • build trust in the healthcare system and with providers
  • provide help to navigate health insurance and paying for PrEP care
  • identify strategies for maintaining adherence to PrEP

At the end of the first session, PrEP navigators made plans to check in with clients on a regular basis and together they established ways to communicate with each other. They could stay in contact via phone calls, text messages or social media platforms, according to the client’s preference. For the first month, check-ins were done weekly and concentrated on issues related to PrEP initiation. After this period, check-ins were done every two weeks for up to six months and addressed access barriers, referrals to resources and services, appointment reminders, and potential changes to care.

Additionally, program staff could follow up with a client’s pharmacy to determine whether prescriptions had been picked up and communicate this information to PrEP navigators. PrEP navigators could then follow up with clients who were not picking up prescriptions and help to address any barriers they were facing to PrEP care.


Between September 2018 and July 2020, 60 participants were enrolled in the program; participants were randomly assigned one-to-one to the standard of care arm or the patient navigation arm of the study. All participants were cisgender, Black/African American gbMSM from 18 to 35 years old. Most participants identified their sexual orientation as gay (56.7%) or bisexual (35.0%). When clients were enrolled in the study, 46.7% reported having health insurance and 40.0% reported having a primary healthcare provider.

Overall (in both arms):

  • 66.7% of people attended at least one follow-up clinical appointment after being prescribed PrEP
  • 78.3% of people picked up at least one prescription for PrEP within the six months after their first clinical appointment
  • 55.0% of people picked up more than one prescription for PrEP within the six months after their first clinical appointment
  • 46.7% of people had greater than 80% of all days covered with pill supply after their first prescription

Compared with the standard of care arm, clients in the patient navigation arm were:

  • 1.62 times more likely to attend a clinical PrEP appointment at three months (70.0% vs. 43.3%)
  • 1.47 times more likely to have picked up at least one PrEP prescription in the six months after their first clinical appointment (93.3% vs. 63.3%)
  • 2.67 times more likely to have picked up more than one PrEP prescription in the six months after their first clinical appointment (80.0% vs. 30.0%)
  • 3.00 times more likely to have greater than 80% of all days covered by a PrEP prescription after the pickup of their first prescription (70.0% vs. 23.3%)

These were all statistically significant outcomes. Participants in the patient navigation arm were more likely to attend a clinical appointment at six months than those in the standard of care arm (36.7% vs. 26.7%), although this result was not statistically significant.

Clients in the patient navigation arm also had a shorter length of time from their first clinical appointment to picking up their first prescription (median of one day vs. median of 41 days).

Implications for service providers

On the basis of data relating to prescription pickup and clinical PrEP follow-up visit attendance from this pilot study, patient navigation appears to improve PrEP initiation and persistence over the standard of care approach. The flexible nature of the first patient navigation meeting allowed the PrEP navigator to tailor support to the individual client (e.g., accompaniment to appointments, transportation needs). Furthermore, the ability of program staff to access prescription pickup data to determine which clients were not engaging in PrEP usage meant that the program’s limited navigation resources could be allocated to where they were most needed (i.e., clients who did not pick up a prescription).

The flexibility of the patient navigation approach enabled PrEP navigators to provide support to different degrees depending on the client's needs, which created a personalized approach and built trust between the PrEP navigator and client.

It should be noted that this study took place in a context where PrEP medication is not publicly funded and less than 50% of clients reported having health insurance, which may be a major barrier to PrEP persistence in this context. Patient navigation in this context was shown to play a major role in ensuring continual access to PrEP medication over the course of the study.

Related resources

A nurse-led HIV PrEP program integrated within a safer opioid supply program - evidence brief

Black PRAISE: An intervention to strengthen how Black congregations understand HIV affecting Black communities - evidence brief

The Maple Leaf PrEP Clinic - case study


Goedel WC, Sutten Coats C, Chan PA et al. A pilot study of a patient navigation intervention to improve HIV pre-exposure prophylaxis persistence among Black/African American men who have sex with men. Journal of Acquired Immune Deficiency Syndromes. 2022;90(3):276-82.