OBJECTIVES
To assess HIV pre-exposure prophylaxis (PrEP) provision in U.S. health centers (HCs).
DESIGN
The U.S. Ending the HIV Epidemic (EHE) initiative designated HCs as the main health care system through which PrEP scale-up occurs. HCs offer primary care to over 30 million disproportionately uninsured, racially or ethnically minoritized, and low-income patients. This study is the first to assess PrEP provision across HCs, including characteristics of clinics, patient populations, and policies associated with PrEP prescribing.
METHODS
The Health Resources and Services Administration's Uniform Data System contained aggregate data on PrEP prescriptions and patient sociodemographics at HCs from January 1 through December 31, 2021, in 50 U.S. states, the District of Columbia, and 8 U.S. territories. We compared patient demographics and availability of Medicaid expansion and PrEP assistance programs at HCs that prescribed versus those that did not prescribe PrEP.
RESULTS
Across 1,375 HCs serving 30,193,278 patients, 79,163 patients were prescribed PrEP. HCs that prescribed any PrEP had higher proportions of sexual, gender, racial, and ethnic minority patient populations compared with HCs that prescribed no PrEP. Compared with HCs that prescribed no PrEP, a higher proportion of HCs that prescribed PrEP were located in designated high-priority jurisdictions of the EHE initiative or states with Medicaid expansion or public PrEP assistance programs.
CONCLUSIONS
HCs are critical for scaling up PrEP in minoritized populations disproportionately affected by HIV, facilitated through federal and state-level policies. These findings highlight service gaps and inform future interventions to optimize PrEP implementation and support EHE initiative goals.