From Self-Testing to HIV PrEP: A Mixed Methods Study on Navigation and PrEP Linkage Preferences Among Men Who Have Sex with Men in Philadelphia, Pennsylvania

Linkage to pre-exposure prophylaxis (PrEP) is critical to maximize the benefits of HIV self-testing (HIVST). However, PrEP uptake remains low after HIVST, particularly among men who have sex with men (MSM). Coupling HIVST with navigation may improve PrEP uptake. We conducted a mixed methods study of MSM who had completed an HIV self-test to explore how navigators could facilitate PrEP linkage and understand tester preferences. Participants completed a baseline survey and a 30-day follow-up survey. We purposively sampled MSM who had and had not seen a provider within 30 days after self-testing to conduct semi-structured interviews. A total of 84 MSM were enrolled in the quantitative survey. The median age was 28, 31% were Black, and 23% were Latine. In quantitative data, the most important characteristics of a navigator were having formal medical training, similar sexual orientation, and prior experience with PrEP. We interviewed a total of 21 MSM, 12 of whom had seen a provider within 30 days of self-testing. Three themes emerged in interviews: (1) Navigator knowledge: including health system knowledge and sexual health literacy while addressing PrEP misconceptions; (2) competence with MSM: understanding sexual minority identities and experiences, including through shared lived experiences; and (3) Communication skills: participants desired nonjudgmental, culturally sensitive navigators who were easily accessible. Together, these findings suggest that peer navigators with prior experience on PrEP and high sexual health literacy may be particularly effective in supporting linkage to care after self-testing. These insights can inform interventions to improve PrEP uptake after HIVST.