Effect of Same-Day, Direct HIV PrEP Dispensation on PrEP Initiation and Early Retention in a Sexual Health Clinic

BACKGROUND: Daily oral pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV but remains underutilized in the United States. Various factors, including limited access, contribute to drop-offs across the PrEP care continuum. In 2021, Seattle-King County's sexual health clinic (SHC) introduced same-day, in-clinic dispensing of an initial bottle of oral emtricitabine/tenofovir disoproxil fumarate at no out-of-pocket cost as an alternative to electronic prescribing to external community pharmacies (e-prescribing). METHODS: We conducted a retrospective observational study using routinely collected SHC data to identify patients who completed ≥1 initial PrEP visit from November 1, 2020, to May 30, 2023. Successful early PrEP retention was defined as an initial visit, a PrEP prescription within 14 days, and a follow-up visit within 6 months. We compared the proportion achieving early retention across three phases: Phase 1 (e-prescribing only), Phase 2 (transition period), and Phase 3 (same-day dispensing with some e-prescribing), using two-sample tests of proportions. RESULTS: Of 917 eligible patients, 649 (70.8%) were successfully retained on PrEP; 25.0% were uninsured. Early retention was similar across phases: 71.9% (210/292) in Phase 1, 70.0% (194/277) in Phase 2, and 70.4% (245/348) in Phase 3. Compared with Phase 1, retention did not differ significantly in Phase 2 (P=0.62) or Phase 3 (P=0.67), nor by dispensing modality within Phases 2 and 3. CONCLUSIONS: In this urban SHC, early PrEP retention remained stable at approximately 70%. Same-day, in-clinic dispensing was not associated with improved early retention but may reduce barriers and delays, representing a feasible low-barrier delivery model in resourced SHCs.