Table 5.

Facilitators to PrEP initiation and persistence

Broad factors	Themes	Participant quotes
Stigma reduction	Normalize/Rebrand PrEP to be for everyone	“PrEP is for everyone not just MSM. But, whenever it's advertised on TV or anywhere else, I see MSM associated with PrEP, so if I talk to anyone who identifies as heterosexual, they think that PrEP is for homosexual activity, and I'm like that's not necessarily the case.”—[PrEP Navigator] “You know, PrEP is not a negative or a positive person's medicine or a gay man's medicine, PrEP is for everybody. Those are some of the stigmas.”—[PrEP Navigator]
	Provide Peer Driven PrEP education	“The guy that helped me to make the decision to get PrEP, that’s one of the things he was really harping on. It’s protecting yourself from HIV if I was to come in contact with someone that did have HIV. Not just protecting me, but protecting the person I’m in a relationship with.”—[34-year-old, currently taking PrEP] “I think it should be a peer, someone they can relate to. Sometimes children seem to learn better from a peer. I believe even in adulthood, it takes a peer to really push someone or encourage them to do something. Like even in my case, it took a peer to get me to get PrEP. Someone who’s experienced it. Someone who knows the ins and out of it.”—[34-year-old, currently taking PrEP] “Friends can be a big influence, especially in a community of MSM. If you have friends that is taking it, they can provide positive feedback. And if you have friends who are not, then, it’s the opposite.”—[Nurse]
	Provide PrEP Education to Younger People	“I feel like if we can build some type of proper organization or some type of speaker who could come down here to talk to these certain schools where you have young black men and women are being sexually active. Like, what are the risks? And how could this affect you long term?—[26-year-old, currently not taking PrEP] “Once they get older, you get set in your ways and it’s hard to break that barrier, but educatin’ them while they’re young and just lettin’ them know about the medicine. And also, educatin’ them about other STDs as well. Educate them while they’re young before they get too old and set in their ways.”—[Nurse] “I would even say, high school if you can, targetin' college freshmen just because we see so many young people comin' in shock that didn't know that they could possibly get HIV. I think as early as possible.”—[Nurse Practitioner]
	Have MSM / Members of the Community as Clinic Staff	“I do believe that they should be men who have sex with men and also on PrEP since that’s what we’re advocating for.”—[23-year-old, currently taking PrEP] “I think it makes it easier to where having people to actually introduce it to them if they don’t know about it and someone who may look like them or who may be MSM. I believe you don’t really see too many MSM nurses or physicians who are willing to express that, but I think it’ll make them comfortable.”—[Nurse] “Like the patient I had this morning, was askin' me if I knew of any providers who were LGBT in that community or were LGBT friendly. I think that would make a difference as to who's givin' you this information. Someone who has walked a mile in their shoes.”—[Nurse Practitioner]
Patient/provider alliance	Don’t Act Surprised by Anything Patients Say	“I think being open with these patients and not acting shocked or surprised at anything that they say really does play a part in making them feel comfortable enough to tell you the truth.”—[Nurse Practitioner]
	Inform Patients of the Different Medications for PrEP	“We have Descovy which is another option. Just let them know about that. To have an honest dialogue. Not just to mention the medicine but tell them what it does and what it doesn't.”—[Licensed Master Social Worker]
	Be Available for Questions	“I guess, being available. We use our cell phones a lot to get ahold of people, and just letting them know that we're here. We have lots of services for people, so they know that they can call us, come in, and just talk, and just be available. If we can't answer, we guide them to what they need.”—[Patient Care Coordinator]
Structural factors	Offer Same Day PrEP Appointments	“Definitely the rapid PrEP; the same-day PrEP. They’re served at the medical college, so able to get everything they need right then and there.”—[Nurse]
	Offer the Option to Ship PrEP	“I mean, just last week I had a client tell me, "I just don't know why I'm still taking this?" Because we had an issue with his pharmacy and getting the medicine delivered to him. And, he just absolutely did not want to pick that medicine up, so I had to work some magic and get it shipped to him.”—[PrEP Navigator]
	Inform Patients of Payment Assistance Programs	“For some, it may be not taking PrEP, being able to pay for it. Because PrEP is pretty expensive.”—[34-year-old, currently taking PrEP] “I think people are worried about the price because I was kinda shocked to find out how much it woulda costed if I didn’t have insurance and assistance plan.”—[23-year-old, currently taking PrEP]
	Offer Variety of Forms of PrEP	“The best way for me to take PrEP is to give me an injection. I would prefer it, as a person that takes PrEP. I would prefer an injection over pills.”—[PrEP Navigator] “Probably, the longer-term one. If the implant is gonna last three years, I would say that route. That's probably gonna be the most preferred because of the time and minimal pain associated with gettin' it placed versus comin' ever so often to get a shot.”—[Nurse Practitioner] “I'm gonna stick with the old-fashioned everyday pill because they don't want to forget and don't want to take that chance.”—[Clinical Research Coordinator]