EXPRESS-PrEP: Evaluating PrEP rapid engagement and same-day start for HIV prevention in gbMSM.

OBJECTIVES

Gay, bisexual, and other men who have sex with men (gbMSM) and transgender women (TGW) remain disproportionately affected by HIV in Canada, yet uptake of pre-exposure prophylaxis (PrEP) is suboptimal. Multi-step clinical pathways and laboratory delays contribute to initiation attrition. This study evaluated the impact of a same-day PrEP initiation model using tenofovir alafenamide/emtricitabine (TAF/FTC) in a Canadian clinic.

METHODS

We conducted a prospective, single-site observational cohort at HQ Health Hub in Toronto. Individuals ≥16 years presenting for sexually transmitted and blood-borne infections (STBBI) testing or treatment were screened for PrEP eligibility using a modified HIV Incidence Risk Index (HIRI) score (≥10) or PrEP request. Eligible participants were offered same-day initiation following testing and returned within 24 hours.

RESULTS

Of 1766 individuals offered PrEP, 1204 accepted (67.7%), 888 were screened, and 814 (91.7%) initiated within 24 hours. Median age of 31 years (26-34), 67% were non-white, and 94% cis-men. Retention from referred individuals was 66.7% at 6 months and 58.0% at 12 months. Compared to historical norms, more participants remained in care of those referred at 6 months (66.7% vs 31.5%, P <0.001). No serious renal adverse events occurred, and sexually transmitted infection (STI) prevalence did not differ significantly.

CONCLUSIONS

Same-day PrEP initiation is safe, feasible, and improves uptake and persistence. Adoption of this model may reduce barriers and accelerate HIV prevention.