Engage and adapt: peer-led implementation of HIV navigation in Australia

Background Alongside partnership, adaptation is one of the enduring themes of the Australian response to HIV, but the ability of peer insight and engagement to shape responses to change is often undervalued. In this article, we present a case study of a peer navigation for people living with HIV, run in partnership with clinical stakeholders, to examine its effectiveness and adaptability within a changing epidemiological landscape. Methods We draw on interviews and focus groups conducted in 2019 and 2020 with 30 peer workers, management and clinical stakeholders of a peer navigation program for people living with HIV operating in Victoria, Australia. Our interpretation uses a complex systems framework to evaluate peer programs, including their influence on health and service systems. Results We found that the peer navigation program's ability to adapt and remain effective in a changing epidemic and clinical service landscape was based partly on its engagement with its communities and partly on its efforts to align with the service and policy systems. There was evidence that the program influenced the policy sector based on the quality of its community engagement to reduce the vulnerabilities the sudden implementation of COVID-19-related restrictions created for people living with HIV. Conclusions Our findings demonstrate the wider value peer navigation programs deliver in the response to HIV and illustrate the partnership and investment strategies required to improve the implementation and impact of similar programs.