The Leaky Preexposure Prophylaxis Cascade-Barriers and Facilitators to Preexposure Prophylaxis Uptake and Adherence Among Youth Experiencing Homelessness in the US South: A Mixed Methods Study.

This was a small substudy of 44 youth, all from the parent intervention arm and already interested in PrEP, so it does not represent all youth experiencing homelessness or all PrEP-eligible youth. The parent study randomized participants to nurse case management or usual care, but this substudy only followed intervention participants, so it cannot test whether the nurse-led intervention caused PrEP uptake or adherence. The study took place during the pandemic, which affected recruitment, retention, appointments, and whether the PrEP navigator could attend visits. Qualitative interviews produced themes about barriers and facilitators, not evidence that any intervention worked. Starter counts differ across sections: 22 reported PrEP uptake or obtained a prescription, but 18 starters were interviewed. Urine tenofovir testing was research-only and will no longer be manufactured, and no injectable PrEP was available. Interviewer bias may have occurred because participants knew their goal was PrEP and may have spoken more positively. Eligibility required independent reading and excluded acute mental health crisis or suspected substance influence, so higher-need youth may be missing.

The authors reported no real or perceived vested interests related to this article. No funding source is stated in the supplied text.

Do not conclude that a PrEP navigator alone can solve PrEP uptake or adherence. Participants also received nurse case management, shared decision-making, motivational interviewing, PrEP screening, education, and urine-test follow-up, so the contribution of any single component cannot be separated.