Optimal characteristics of peer navigators: adapting peer-based intervention with street-involved youth in Canada and Kenya with the aim of increasing HIV prevention, testing and treatment.
Edward Ou Jin Lee, Thai-Son Tang, Javi Fuentes-Bernal, Katie MacEntee, Juddy Wachira, Edith Apondi, Alex Abramovich, Abe Oudshoorn, David Ayuku, Reuben Kiptui, Amy Van Berkum, Sue-Ann MacDonald, Olli Saarela, Paula Braitstein
Author Information
Edward Ou Jin Lee: School of Social Work, Université de Montréal, C-7108, Pavillon Lionel-Groulx, 3150 Rue Jean-Brillant, Montréal, H3T1N8, Canada. edward.lee@umontreal.ca. ORCID
Thai-Son Tang: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Javi Fuentes-Bernal: School of Social Work, Université de Montréal, C-7108, Pavillon Lionel-Groulx, 3150 Rue Jean-Brillant, Montréal, H3T1N8, Canada.
Katie MacEntee: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Juddy Wachira: School of Medicine, Moi University, Eldoret, Kenya.
Edith Apondi: Moi Teaching and Referral Hospital, Eldoret, Kenya.
Alex Abramovich: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Abe Oudshoorn: Arthur Labatt Family School of Nursing, Western University, London, Canada.
David Ayuku: School of Medicine, Moi University, Eldoret, Kenya.
Reuben Kiptui: Academic Model Providing Access to Healthcare in Eldoret, Kenya, Eldoret, Kenya.
Amy Van Berkum: Arthur Labatt Family School of Nursing, Western University, London, Canada.
Sue-Ann MacDonald: School of Social Work, Université de Montréal, C-7108, Pavillon Lionel-Groulx, 3150 Rue Jean-Brillant, Montréal, H3T1N8, Canada.
Olli Saarela: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Paula Braitstein: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
BACKGROUND: We sought to adapt a peer navigator (PN) model to increase uptake of human immunodeficiency virus (HIV) prevention, testing and treatment of street-involved youth (SIY) in Canada and Kenya. This article presents key findings on the optimal characteristics of the PN model for SIY across and between sites, prior to intervention implementation. METHODS: Using an integrated mixed methods approach, eligible participants included SIY aged 16-29 years, healthcare providers and community stakeholders. Data collection tools drew from the CATIE (Canada) PN practice guidelines related to: PN role and responsibilities, training, supervision and integration into sites, among others. During interviews (n = 53) or focus groups (n = 11) with participants, a 39-item PN components checklist was administered (quantitative data), followed immediately by a semi-structured interview protocol with questions that allowed for deeper exploration into the acceptability and appropriateness of the PN intervention (qualitative data). The checklist enabled participants to identify PN characteristics and/or activities as core (essential) or peripheral (adaptable and less important). Spearman's rank correlations (ρ) were used to quantify agreement across sites and participant groups. Qualitative data were inductively coded and analysed using a single codebook. RESULTS: Quantitative data analysis revealed that out of 39 checklist items, 31 (79%) were considered core. These primarily pertained to host organization, PN characteristics and PN activities. For example, it was agreed that core PN activities included outreach to out-of-care SIY and providing health and social service referrals. There were mixed opinions about asking the PN to declare previous experience with drug use and HIV status, but there was agreement that the PN should have previous experience of street-involvement. Qualitative data analysis suggested that although all participant groups across sites agreed that the PN intervention was acceptable and appropriate, the participants from each site also identified specific adaptations related to their host organization and target SIY. CONCLUSIONS: Our findings indicate high agreement among participant groups across all sites on some optimal PN intervention characteristics, particularly host organization characteristics, the PN themselves and their activities. However, context-specific adaptations are necessary to successfully scale-up the PN intervention. This model is applicable in diverse regions and organizational contexts.
