Addressing Structural Vulnerability through mHealth: Integrating Peer Navigation In Mypeeps Plus to Improve PrEP Engagement Among YMSM

Background and Purpose:
Young men who have sex with men (YMSM)—particularly Black and Latino youth—bear a disproportionate burden of HIV, driven by structural vulnerability including housing instability, stigma, medical mistrust, and inequitable access to affirming care. Despite high awareness, PrEP uptake remains low, with studies showing fewer than one-third of MSM reporting current use and as little as 3% uptake among adolescents . Existing digital interventions improve knowledge but often fail to address structural and relational barriers to engagement. MyPEEPS Plus responds to this gap by integrating an evidence-based mHealth intervention with virtual peer navigation, combining digital education with relational support to facilitate PrEP initiation and persistence. This study is grounded in structural vulnerability and implementation science frameworks to enhance reach, equity, and scalability in Ending the HIV Epidemic (EHE) jurisdictions.

Methods:
Guided by a multi-level, structurally informed framework and user-centered design, we conducted iterative intervention refinement integrating expert review, youth advisory board input, and qualitative interviews with 20 PrEP navigators across diverse U.S. settings . Findings informed development of a combined mHealth and e-peer navigation intervention incorporating evidence-based strategies, including the HIV Incidence Risk Index for MSM (HIRI-MSM), motivational interviewing, and OARS communication techniques to support client-centered engagement. The intervention is being evaluated in an NIH-funded randomized controlled trial (NCT06741618) enrolling ~500 YMSM (ages 16–25 years) nationwide. Participants are randomized to receive (1) MyPEEPS Plus app alone or (2) app plus virtual peer navigation. Primary outcomes include PrEP initiation, adherence, and persistence over 12 months, with secondary outcomes assessing acceptability, feasibility, and engagement.

Results:
Formative findings highlight how structural vulnerability—particularly housing instability, provider bias, and fragmented access to care—shapes PrEP engagement. Peer navigation emerged as a critical mechanism to mitigate these barriers by fostering trust, addressing medical mistrust, and supporting navigation of complex care systems. The integration of remote navigation expands access beyond clinic-based models, addressing geographic inequities in PrEP availability . Usability testing demonstrated high acceptability and informed refinements including personalization and streamlined navigation. Prior MyPEEPS Mobile data showed reductions in sexual risk behavior but limited PrEP uptake, underscoring the need for integrated structural and relational components.

Conclusions and Implications:
MyPEEPS Plus advances a structurally grounded, technology-enabled intervention that integrates mHealth with peer navigation to address multi-level determinants of PrEP engagement. For social work research, this study demonstrates how structural vulnerability frameworks can be operationalized within digital intervention design to promote health equity. From an implementation science perspective, the intervention emphasizes scalability, remote delivery, and real-world feasibility. This work contributes to the development of equitable, youth-centered HIV prevention strategies that extend the reach of PrEP services and strengthen engagement across the continuum among marginalized YMSM.