Population characteristics in patients accepting versus declining HIV pre-exposure prophylaxis after targeted offer in large public hospital in the US south

Background Pre-exposure prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) is safe and effective, but its implementation is suboptimal with the US South having disproportionately high numbers of new HIV infections and low PrEP use. Methods Parkland Health in Dallas, Texas has implemented interventions to improve PrEP uptake. A retrospective review was conducted of targeted PrEP offers in 2022 to eligible patients aged >=16 years to compare differences between those who accepted versus declined PrEP. Results Of 2,219 patients offered PrEP, 287 were excluded. Of the remaining 1,932, 195 (10%) accepted a PrEP offer. Those who accepted were more likely to be from a younger age group (16–25 vs > 55 years, p -value <0.01), men who have sex with men ( p -value <0.01), and transgender females with male partners ( p -value <0.01). Other positive predictors of PrEP acceptance included being insured ( p -value 0.01), sero-discordant partner ( p -value <0.01), and pregnancy (p-value <0.01). Patients who accepted were more likely to have received multiple interventions (145/195 (74.36%) vs 580/1737 (33.39%), p -value <0.01). Conclusions A multipronged approach to increasing PrEP uptake in a health system in the South reached a variety of eligible patients. Future efforts should focus on improving PrEP engagement for Black, uninsured, heterosexual, and older individuals.