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PrEP program implementation and funding landscape in the United States: A Cross-sectional survey of state and local health jurisdictions, 2016-2025
ABSTRACT
Background:
HIV pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV infection when taken as prescribed, but individual and structural barriers persist and limit access to and uptake of this effective preventive medicine. Following the launch of the End the HIV Epidemic (EHE) initiative in the US in 2019, a variety of HIV prevention programs have been implemented, ranging from telemedicine PrEP prescribing to messaging campaigns to facilitate PrEP use. However, limited information exists regarding the types and characteristics of the programs implemented.
Objective:
Describe (1) HIV prevention efforts, with a focus on PrEP promotion programs, that were implemented by health departments between 2016-2025 in the US, (2) the distribution and characteristics of funding sources by program types, and (3) program-specific characteristics.
Methods:
We developed a survey to assess PrEP promotion programs. The survey was refined based on feedback from an advisory board comprising volunteers from 14 health jurisdictions. We identified eight PrEP promotion programs implemented between 2016-2025 - (1) PrEP Navigation, (2) PrEP Outreach and Education, (3) Messaging Campaigns, (4) Training for Clinicians and Clinical Staff, (5) Telemedicine PrEP, (6) PrEP Assistance Program, (7) Safety-Net Clinics, and (8) Optimization of Electronic Medical Record (EMR)/Electronic Health Record (EHR). Survey questions included whether a jurisdiction had such a program in place, program start and end periods, funding source, period of funding coverage, and program-specific contextual questions. The survey was sent to all state health departments, the District of Columbia, and seven local health jurisdictions (n=58) via email. The survey was launched on May 14, 2025, and data collection concluded on Apr 30, 2026.
Results:
47/58 (81%) health jurisdictions completed the survey. PrEP navigation (79%) was the most common program and EHR changes (19%) was the least common. Among the implemented programs, the proportion reported as ongoing at the time of the survey ranged between 58%-94%. The proportion of health jurisdictions that received federal funding to support each of the programs ranged from 53%-100%, state funding ranged from 32%-59%, and other funding ranged from 18%-32%. The characteristics identified were specific to each program. For example, PrEP navigation programs (n=37) included services such as linkage to a PrEP provider (100%), PrEP counseling (95%), insurance/benefit navigation (84%), and communication and engagement support (65%). The proportion of health jurisdictions implementing each program increased from 2%–23% in 2016 to 17%–70% in 2025.
Conclusions:
A variety of PrEP promotion programs were increasingly implemented from 2016-2025 across the nation, with the majority of programs active at the time of the survey. Programs were supported by a range of funding sources. Government grant opportunities played an important role in enabling program implementation. Future research should evaluate the effectiveness of these programs and their impact on PrEP uptake and retention in PrEP care. Clinical Trial: NA
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