Eligibility and Acceptability of Same-Day HIV Pre-Exposure Prophylaxis Initiation During Emergency Care Encounters in Nairobi, Kenya: A Cross-Sectional Study

BACKGROUND: Emergency departments (EDs) provide care to higher-risk and underserved populations for HIV services. This study evaluated eligibility and acceptability of same-day HIV pre-exposure prophylaxis (PrEP) initiation among persons seeking emergency care in Nairobi, Kenya. DESIGN: Cross-sectional study. METHODS: ED patients were continuously screened at Kenyatta National Hospital (5 July to 18 August 2024). Non-pregnant and non-incarcerated persons aged >18 years were enrolled. Data were collected on socio-demographics, health characteristics and PrEP aspects. PrEP eligibility was based on national guidelines. Acceptability was defined as participants reporting willingness to initiate same-day PrEP, if indicated. Multivariable regression assessed factors associated with acceptability of ED-PrEP initiation, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: Among 325 enrolled participants (median age: 31 years), 56.3% were male and 15.3% were from key populations (KPs). PrEP-eligibility was 16.0%, and 74.6% of participants reported willingness to initiate same-day PrEP. For persons from KPs, PrEP eligibility was 28.6%, and acceptability was 73.5%. Correlates of same-day PrEP initiation included having a primary/regular sex partner (aOR=2.26, 95% CI: 1.20-4.24, p=0.01) and multiple sex partners in the past three months (aOR=2.36, 95% CI: 1.29-4.33, p=0.01). Injection was the preferred PrEP formulation (62.5%), with 70.0% preferring a six-month dispensing interval. CONCLUSION: High PrEP eligibility and acceptability suggest that emergency care settings in Kenya are strategic PrEP programming venues, with potential to expand access to underserved populations. Further research is warranted to inform strategies to implement PrEP in ED settings in Kenya and other similar settings.