Nurse-Led Rapid Initiation of HIV Pre-Exposure Prophylaxis Care Among Incarcerated Individuals with Continuation of Care Services Post-Incarceration

Incarcerated individuals are at heightened risk for HIV acquisition. HIV pre-exposure prophylaxis (PrEP) is a highly effective preventive measure that is significantly underutilized by this group. The period of incarceration presents a structured environment to identify those at higher risk of HIV exposure, initiate PrEP, and provide continuity of care following release. Recognizing the limited duration and unpredictable nature of incarceration, as well as the constrained availability of prescribing providers, we propose a nurse-led, same-day PrEP initiation model. This approach is aligned with current CDC guidelines and aims to increase PrEP uptake during incarceration. Post-release, participants will be offered a structured follow-up system to support continuation of care. The long-term goal is to develop a scalable PrEP initiation and follow-up intervention. The present proposal seeks to finalize intervention materials, clinical protocols, and an implementation plan for a nurse-led, same-day PrEP initiation intervention with continuation of care after incarceration. The intervention will be tested through a preliminary randomized controlled trial (RCT) in which participants will receive the nurse-led PrEP uptake intervention and access to same-day PrEP initiation and a 30-day supply of PrEP upon release from incarceration. Then, participants will be randomized to receive continuation of care services upon release (NAV) or to a control condition that approximates standard-of-care (SOC) in a 2:1 (NAV:SOC) ratio. Baseline and follow-up interviews will be conducted at 1, 3, and 6 months. The primary outcome is linkage to follow-up care, defined as obtaining a PrEP prescription within six months of release, verified through medical records. The findings will inform the feasibility, acceptability, and preliminary efficacy of this approach, which may serve as a guide for other carceral settings seeking to implement evidence-based, HIV prevention programs. The Rhode Island Department of Corrections (RIDOC) is a site well-suited to conduct this study due to its existing infrastructure and provision of PrEP as part of routine standard of care.