Exploring peer navigation and support in the quality of HIV care experiences of female sex workers in the Dominican Republic

Abstract

Background Despite evidence on peer navigation’s association with positive HIV outcomes, such as engagement in HIV care and antiretroviral therapy (ART) initiation, the mechanisms through which peer navigation may influence these outcomes have been less explored. The purpose of this study is to describe the role of peer navigation and support on enhancing the quality of HIV treatment and care services experienced by female sex workers (FSWs). Methods Survey data was derived from a quantitative cohort (n = 211) of FSWs living with HIV in the Dominican Republic and complemented with data from two rounds of in-depth interviews (IDIs) from a qualitative subsample (n = 20 per round). Descriptive statistics and multivariable logistic regressions were used to explore the association between peer navigation and relational aspects of care and overall satisfaction of the quality of HIV treatment and care. Thematic analysis was employed to code and synthesize textual data from IDIs. Results 41.2% of the participants reported having had contact with a peer navigator in the last 6 months. Qualitative data revealed that peer navigation and support was instrumental in assisting FSWs linkage to HIV care after diagnosis, elevating FSWs’ ability to access more comprehensive clinical care facilities, and promoting agency by improving FSWs’ skills to more strategically and effectively engage with the clinic environment and health care providers. Peer navigation was positively associated with experiencing more respectful treatment by clinic staff (AOR: 6.65, 95% CI: 2.32–19.02), and greater satisfaction with overall HIV care services (AOR: 2.57, 95% CI: 1.77–3.74). Conclusion Promoting the full integration of peer navigation into healthcare structures is a strategic approach to enhance the quality of HIV care experienced by FSWs and improve their HIV-related outcomes.

Trajectories of HIV management among virally suppressed and unsuppressed female sex workers in the Dominican Republic: A comparative qualitative analysis

“…These findings also expand on quantitative associations previously found between patient-provider communication and increased odds of viral suppression and ART adherence (Karver, Donastorg, et al, 2022 ). Additionally, in line with previous research on peer healthcare navigators and social support interventions among FSW living with HIV in the DR (Karver, Barrington, et al, 2022 ; Kerrigan et al, 2020 ), peer social support and cohesion in our analysis helped participants to overcome stigma and structural barriers to HIV management while increasing their agency in accessing care and advocating for their health. These findings support confidence in the ability of peer navigator programs and other social support initiatives to improve the health of FSW living with HIV.…”

The effectiveness and sustainability of peer support interventions for persons living with HIV: a realist synthesis

“…Ensuring peer volunteers are appropriately qualified is an important aspect of effective peer support programmes. Qualified peer volunteers should: first, receive adequate training70 71; second, provide tailored service to meet PLHIV’s personal needs50 72–75; third, provide continuous support beyond the clinical setting52; fourth, act as a bridge between PLHIV and their social relationships, community and the health system52 76–78; and fifth, convey and translate critical information 52…”

Trauma, Mental Health Distress, and Infectious Disease Prevention Among Women Recently Released From Incarceration

“…Engagement with Transitions Clinic has been found to reduce acute care utilization, hospitalization for illnesses preventable with access to primary care, and criminal legal system contact (35,46). A growing body of literature has also demonstrated the effectiveness of peer CHWs in helping to increase access to needed HIV and other prevention and intervention services, while minimizing stigma (47,48). The use of peer community health agents has also been linked to a decrease in the level of stigma in typical healthcare-related interactions that can interfere with addressing HIV and other STIs, HCV and concomitant risks of substance use disorder and intimate partner violence (49).…”