Abstract:
Background We sought to adapt a peer navigator (PN) model to increase uptake of human immunodeficiency
virus (HIV) prevention, testing and treatment of street‑involved youth (SIY) in Canada and Kenya. This article presents
key findings on the optimal characteristics of the PN model for SIY across and between sites, prior to intervention
implementation.
Methods Using an integrated mixed methods approach, eligible participants included SIY aged 16–29 years,
healthcare providers and community stakeholders. Data collection tools drew from the CATIE (Canada) PN practice
guidelines related to: PN role and responsibilities, training, supervision and integration into sites, among others.
During interviews (n = 53) or focus groups (n = 11) with participants, a 39‑item PN components checklist was admin‑
istered (quantitative data), followed immediately by a semi‑structured interview protocol with questions that allowed
for deeper exploration into the acceptability and appropriateness of the PN intervention (qualitative data). The check‑
list enabled participants to identify PN characteristics and/or activities as core (essential) or peripheral (adaptable
and less important). Spearman’s rank correlations (ρ) were used to quantify agreement across sites and participant
groups. Qualitative data were inductively coded and analysed using a single codebook.
Results Quantitative data analysis revealed that out of 39 checklist items, 31 (79%) were considered core. These
primarily pertained to host organization, PN characteristics and PN activities. For example, it was agreed that core
PN activities included outreach to out‑of‑care SIY and providing health and social service referrals. There were mixed
opinions about asking the PN to declare previous experience with drug use and HIV status, but there was agree‑
ment that the PN should have previous experience of street‑involvement. Qualitative data analysis suggested
that although all participant groups across sites agreed that the PN intervention was acceptable and appropriate,
the participants from each site also identified specific adaptations related to their host organization and target SIY.Conclusions Our findings indicate high agreement among participant groups across all sites on some optimal PN
intervention characteristics, particularly host organization characteristics, the PN themselves and their activities. How‑
ever, context‑specific adaptations are necessary to successfully scale‑up the PN intervention. This model is applicable
in diverse regions and organizational contexts.
