PrEP Navigator Perceptions of the Implementation of Injectable PrEP on HIV Prevention in Tennessee.

Tennessee is in the southern region of the United States and has not yet fully benefitted from HIV pre-exposure prophylaxis (PrEP). Relatively little research has focused on pivotal roles of PrEP navigators. This study examined PrEP navigator perceptions of implementing long-acting injectable (LAI) PrEP in Tennessee. Semi-structured interviews with state-funded navigators were audio-recorded, transcribed, and systematically coded using a hierarchical system. Coded transcripts were aggregated, sorted, and analyzed using an iterative inductive/deductive qualitative approach. Using the Consolidated Framework for Implementation Research (CFIR), institutional, individual, and modifying factors to initiating and transitioning to LAI PrEP were identified. Most navigators initially had limited training and experience with LAI PrEP. Navigators reported systemic barriers associated with accessibility to LAI PrEP such as health insurance, pharmaceutical policies, and cost policies. While navigators noted the continued support of the state health department, strategies for circumventing individual and structural barriers are needed for universally implementing injectable PrEP.