HIV Pre-exposure Prophylaxis at a Local Public Health Department in the Southern United States: Reducing Barriers, Increasing Access, and Lessons Learned.

Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is a key component of a comprehensive approach to ending the HIV pandemic. Still, uptake is low for individuals most likely to derive the greatest benefit, including underrepresented populations in the Southern United States (U.S). We initiated a rapid PrEP initiation program to increase PrEP uptake. We performed a retrospective study analyzing demographic, clinical characteristics, and rates of PrEP follow-up for individuals started on rapid PrEP at the Durham County Department of Public Health in Durham, North Carolina, U.S. We also evaluated what factors were associated with continuation of PrEP and subsequent PrEP follow-up. Overall, rates of PrEP continuation were low at 42% at 3 months. PrEP continuation was positively associated with follow-up at one of the academic medical centers in our area. Almost half of the individuals who failed to make their 3-month PrEP appointment were subsequently seen back in our Sexual Health Clinic, and these individuals were more likely to identify as female and lack health insurance. Overall, PrEP discontinuation rates were high at 3 months, likely in part due to high rates of individuals lacking health insurance in our setting. Half of the individuals who discontinued PrEP returned to our health department for sexual health services, suggesting that while offering PrEP at local health departments in the U.S. may be an important entry point for PrEP care, providing the full spectrum of PrEP care at local public health departments may improve retention on PrEP.