A Scoping Review of Emergency Department HIV Preexposure Prophylaxis: Feasibility, Attitudes, and Implementation Barriers

HIV remains a major public health challenge in the United States, and pre-exposure prophylaxis (PrEP) is a highly effective prevention strategy for individuals with sexual and injection drug use exposures. Despite its effectiveness, uptake remains low among populations frequently seeking care in the emergency department (ED), including people who are unhoused and people who use drugs. The ED represents a critical but underutilized setting for HIV prevention. This review examines feasibility, patient and provider attitudes, and implementation barriers related to ED-based PrEP delivery.

We conducted a scoping review of English-language, peer-reviewed studies published between 2017 and 2024 using PubMed. Search terms included emergency department or ED or emergency room or ER combined with HIV prevention, pre-exposure prophylaxis, initiation, linkage to care, patient perspectives, acceptance, and people who use drugs. Articles were screened for relevance to ED-based PrEP delivery and implementation outcomes. Data were extracted and synthesized using thematic analysis.

Eighteen studies met inclusion criteria. Four dominant domains influencing ED PrEP delivery emerged: stigma and risk perception; awareness and education; initiation and retention barriers; and implementation facilitators. Stigma and low perceived HIV risk limited willingness to initiate PrEP, particularly among people who use drugs. Awareness improved following brief education. Provider barriers included limited time, lack of standardized workflows, and uncertainty regarding follow-up. Structural barriers such as housing instability, transportation challenges, and lack of insurance further impeded initiation and retention. Higher initiation and linkage rates were observed when EDs used navigation services, warm handoffs, or same-day prescribing.

ED-based PrEP delivery is feasible and acceptable when paired with patient-centered education, navigation, and care coordination. Strategies that reduce structural barriers and streamline outpatient linkage appear most effective. These findings support the ED as a critical venue for HIV prevention and highlight the need for prospective implementation studies evaluating ED-initiated PrEP outcomes.