ArticleFrontiers in health services2026
Patient pathways to PrEP persistence: a qualitative resilience-focused journey mapping study with cisgender Black and Latino men who have sex with men and clinical PrEP staff at a federally qualified health center.
Article in Frontiers in health services, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Persistence in pre-exposure prophylaxis (PrEP) use remains inequitably implemented among cisgender Black and Latino men who have sex with men (BLMSM) who could benefit from PrEP. Despite multilevel social barriers across the PrEP care continuum, many BLMSM mitigate or overcome these barriers to sustain their PrEP use, suggesting underlying resiliencies that can strengthen PrEP programs and policies. Methods: We conducted qualitative journey mapping interviews with 16 PrEP-sustained BLMSM and 7 clinical PrEP staff (medical and social/outreach services) at a federally-qualified health center (FQHC) in Philadelphia, Pennsylvania (United States). Interviews explored BLMSM's PrEP trajectories, elucidating which processes and resources supported BLMSM's ability to overcome barriers (e.g., job transitions, health insurance coverage). Results: PrEP trajectories included cyclical knowledge-building and contemplation, immediate linkage upon learning about PrEP when accessing health services, brand and modality transitions, and periods of disengagement followed by re-linkage. Structural barriers related to cost, insurance coverage, pharmacy access, clinic hours, housing and employment instability, and medical burnout and fatigue were identified. BLMSM and PrEP staff identified key facilitators supporting barrier reduction, such as affirming provider communication, co-located phlebotomy, transportation assistance, and problem-solving adherence challenges. Participants emphasized PrEP coordinators as being central to support PrEP service navigation, outreach for PrEP discontinuers, problem-solving financial challenges, and liaising between insurance companies and pharmacies. Discussion: Our findings illuminate how resilience processes (i.e., overcoming barriers) and patient-centered, team-based support within an FQHC can transform common disruptions into opportunities for sustained or renewed PrEP engagement, advancing resilience-informed PrEP engagement models that advocate for practice-oriented solutions and future implementation research.
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