HIV Pre-exposure Prophylaxis Use Among Men Experiencing Incarceration in the United States: A Prospective Cohort Study

Background:Pre-exposure prophylaxis (PrEP) is an effective approach to preventing HIV acquisition and recommended for populations over-represented in carceral systems, given the overlap with populations disproportionately impacted by HIV. However, few studies have focused on PrEP initiation outcomes in a carceral setting to maximize public health impact.Setting:This study was conducted in a unified jail/prison system within the state of Rhode Island located in the United States.Methods:A prospective observational cohort of men initiating PrEP within a jail setting was enrolled in this trial. Men were referred by providers, staff, or after self-presenting for HIV preventive care, these individuals were offered enrollment in the study that involved evaluation for clinical PrEP eligibility, PrEP initiation while incarcerated, continuation upon community re-entry, and linkage to a community PrEP provider after release.Results:A total of 100 men in the jail facility (eg, "intake") were enrolled in the cohort. Of the 100 men enrolled, 83% were determined to be PrEP eligible through standard clinical evaluation, 37% were prescribed PrEP, and 26% initiated PrEP while incarcerated. In total, 5% of enrolled individuals were linked successfully to PrEP care in the community.Conclusion:Our findings suggest preliminary feasibility and acceptability of initiating PrEP within a jail setting. There were significant challenges across the PrEP care continuum that can be used to inform future studies and practice.