November 27, 2020

The PNP study

The Peer Navigators Project is a collaborative research project, that brings together researchers and community partners in Canada (Toronto, Montreal, and London) and Kenya (Eldoret and Kitale) to explore and evaluate the use of peer supports for SIY’s access to HIV and AIDS prevention, testing and treatment. Phase I of this study will evaluate and explore the acceptability and appropriateness of the Peer Navigator intervention from the perspectives of SIY, healthcare providers and community stakeholders. It will also characterize the adaptations needed in the intervention in and across the local contexts and describe community-informed enhancements needed to make the intervention work well in terms of linkage to HIV services in each of the 5 study sites.

Background

In Canada, about 1/3 of people diagnosed with HIV are youth. In Kenya, young people between the ages of 15 and 24 living with HIV constitute 15% of the total 1.5 million people living with HIV and AIDS in the country. Street-involved youth (SIY) and youth experiencing housing insecurity are at heightened risk of acquiring HIV as a result of injection drug use, polysubstance use, exchange and/or commercial sex, sexual violence, and being or having been trafficked. Despite recent advances in HIV and AIDS prevention and treatment, there is a dearth of knowledge about the services tailored towards populations of street-involved youth (SIY), especially if these youths are in smaller cities, identify as lesbian, gay, bisexual, transgender, queer,and/or Two-Spirited (LGBTQ2S), or live in low- and middle-income countries.

Importance of the study

In many ways, social and economic inequities lie at the heart of the HIV epidemic globally. Manifested through poverty, sex and gender disparities, race and other structural inequities, these inequities often result in addictions, homelessness, family violence, and violence against women and children more broadly. Often with nowhere else to go and seeking alternatives to what they are leaving, children and youth migrate to streets all over the world as a mechanism to survive. The primary pathways into homelessness for young people globally overlap to some extent with key determinants of HIV risk. HIV and hepatitis C epidemics have been intense and relatively well documented among SIY who inject drugs in Vancouver, Montreal, elsewhere in North America, Europe and Asia.

However, there is less known about and services tailored towards populations of SIY in smaller Canadian cities, marginalized inner-city SIY such as people who identify LGBTQ2S, and SIY in low- and middle-income countries. To date, these youths are not well engaged in HIV prevention or treatment. Tools to find, link, and effectively treat people living with HIV (PLHA) and prevent new infections now exist, but for many SIY these interventions may not be accessible and need to be specifically and carefully adapted and targeted.Reaching SIY and enabling them to make use of evidence-based HIV prevention and treatment interventions like anti retrovirals (ART) is critical to achieving the global goal declared by the United Nations of zero new infections and zero HIV deaths by 2030. Thoughtful and intentional work is needed to adapt and scale-up their delivery to effectively reach the most marginalized and high risk populations.

Methodology

The study is funded by the Canadian Institute for Health Research (CIHR). It started in 2018 and will run until 2023. The study seeks to engage Peer Navigators (PN) who are between the ages of 16 and 25 years. In Toronto and Montreal, PN will also identify as LGBTQ2S. Community stakeholders are working with SIY for at least 3 months. The project will also learn from health care providers and community stakeholders, including child protection officers,representatives of street involved youth community programs, and community leaders. Following a mixed method design, Phase I of the study will integrate quantitative survey, qualitative focus group, key informant semi-structured interviews and theatre testing to assess the acceptability and appropriateness of the PN intervention with the targeted populations in the different study sites.