EXPRESS-PrEP: Evaluating PrEP Rapid Engagement and Same-Day Start for HIV Prevention in gbMSM

Abstract

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.

Keywords: HIV prevention; PrEP.