Table 3.
Summary of Barriers to Obtaining PrEP, by Category.
| Barrier | Patient Navigator Solution | Number of Participants Experiencing Barrier, n = 30 | Participants Who Encountered Barrier and Started PrEP | ||
|---|---|---|---|---|---|
| Logistical barriers | Total for those experiencing at least 1 logistical barrier | 21 | 70.0% | 9/21 | 42.9% |
| Transportation difficulties | Offered resources for transportation | 14 | 46.6% | 5/14 | 35.7% |
| Unstable housing | Provided flexibility in communication and/or relayed messages from providers’ offices if needed, arranged for alternative medication delivery strategies | 10 | 33.3% | 4/10 | 40.0% |
| Difficulty navigating insurance coverage | Assisted with communication with insurance company and/or suggested alternative PrEP provider/clinic | 7 | 23.3% | 4/7 | 57% |
| Unable to complete forms without assistance | Assisted with completion of forms | 5 | 16.6% | 3/5 | 60.0% |
| Could not take time off from work | Provided participant with options for health centers with extended operating hours | 5 | 16.6% | 3/5 | 60% |
| Financial barriers | Total for those experiencing at least one financial barrier | 20 | 67.7% | 8/20 | 40% |
| Lack of medical insurance | Referred to federally qualified health centers and other centers providing PrEP care for patients regardless of ability to pay; provided information regarding patient assistance programs | 11 | 36.6% | 3/11 | 27.2% |
| Could not afford co-pay | Informed participants of available co-pay assistance programs and provided appropriate forms for enrollment | 7 | 23.3% | 5/7 | 71.4% |
| Could not afford administrative costs (eg, notary services) related to attaining PrEP | Provided participant with options regarding community resources that provided administrative services at no cost | 4 | 13.3% | 3/4 | 75% |
| Provider-related barriers | Total for those experiencing at least one provider-related barrier | 15 | 50.0% | 8/15 | 53.3% |
| Difficulty obtaining appointment for PrEP provider visit | Assisted with scheduling appointment | 9 | 30% | 7/9 | 77.7% |
| Provider not comfortable prescribing PrEP | Options for alternative PrEP provider offered | 6 | 16.7% | 4/6 | 66.6% |
| Uncomfortable speaking with a provider about PrEP | Options for alternative PrEP provider offered and/or coached participant on how to start conversation with provider about PrEP | 6 | 20% | 4/6 | 66.6% |
| Social barriers | Total for those experiencing at least one social barrier | 5 | 16.7% | 1/5 | 20.0% |
| Insured through parents or spouse—reluctant to use insurance to access PrEP due to concern about parental or spousal notification | Informed participants of low-cost health resources that offered PrEP, where insurance was unnecessary if the individual could pay out-of-pocket for services | 4 | 13.3% | 1/4 | 25.0% |
| Spouse unwilling to provide documents needed to access patient programs | Coached participant on effective communication strategies that could be used to encourage their partner’s co-operation and support for PrEP seeking | 1 | 3.3% | 0/1 | 0% |
Abbreviations: PrEP, pre-exposure prophylaxis.