Lessons Learned From a Trial of a Bilingual Community-Based Peer Navigation And mHealth Intervention to Address HIV, STI, HCV, and Mpox Inequities Among GBQMSM and Transgender and Nonbinary Persons in Appalachia

Our community-based participatory research partnership developed and tested the bilingual Appalachian Access Project, a peer navigation and mHealth intervention designed to promote HIV, sexually transmitted infection, hepatitis C virus, and mpox prevention and care among gay, bisexual, queer, and other men who have sex with men and transgender and nonbinary persons in Appalachia and to support medically supervised gender-affirming hormone therapy (GAHT) access among those desiring it. Although the intervention did not achieve its intended behavioral outcomes (e.g., increased use of HIV testing, preexposure prophylaxis [PrEP], HIV care, and GAHT), we identified ten critical lessons for future intervention research, including needs for: increased contact between study team members and peer navigators, more streamlined health outcome priorities, minimum intervention dose requirements for peer navigators, formal group activities, smaller catchment areas, and provider and organizational capacity-building interventions. Deeper understanding of intervention implementation can strengthen future efforts to reduce health disparities in Appalachia.