Trust and task-sharing: the acceptability of nurses and peer educators in PrEP delivery among sexually and gender-diverse adolescents in Brazil

Objectives : To examine the acceptability of oral and long-acting injectable PrEP (LAI-PREP) delivery by nurses and peer educators among sexual and gender diverse adolescents in Brazil. Design : A qualitative study using semi-structured interviews and reflexive thematic analysis. Setting : Community-based PrEP services in São Paulo and Salvador, Brazil, conducted within the PrEP15-19 demonstration study. Participants : Twenty PrEP clients aged 15–23 years (16 Black, 4 White; 14 cisgender men, 5 transgender or gender-diverse individuals) and nine healthcare staff (5 nurses, 2 peer educators, 2 physicians). Results : Trust emerged as the foundational element of PrEP engagement. Clients perceived nurses and physicians as having equivalent competence for prescribing PrEP though nurses were described as providing more comprehensive information. Support for peer-led prescription was mixed; most participants preferred peer involvement to remain focused on education and care navigation rather than clinical procedures. While LAI-PrEP was viewed positively, its technical requirements reinforced a preference for nurse-led delivery over peer involvement. Conclusions : Nurses are widely accepted as PrEP prescribers, while peer educators are valued primarily for their complementary, supportive roles. The introduction of LAI-PrEP may reinforce medicalized care models. To successfully implement differentiated PrEP delivery, programs must address professional hierarchies and prioritize the development of interdisciplinary teams.