Preexposure Prophylaxis for HIV Prevention in a Rural Southern Clinic

Little is known about implementing preexposure prophylaxis (PrEP) for human immunodeficiency virus in the rural US South, where most human immunodeficiency virus infections occur. This article describes at-risk populations participating in PrEP in a rural eastern North Carolina community. This study also identified the reasons for PrEP discontinuation and documented outcomes of patients undergoing PrEP therapy. Abstract Objectives Little is known about implementing preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) in the rural US South, where most HIV infections occur. To investigate how to better reach the at-risk population in rural eastern North Carolina (ENC), the characteristics and clinical courses of those receiving PrEP from our clinic were reviewed and analyzed. Methods A retrospective study was used to describe the characteristics and outcomes of PrEP participants in rural ENC. Results Thirty-five patients were included whose median age was 37 years (range 22–69). The majority of patients tolerated PrEP well and continued the medication, with only 6 (17%) discontinuations; the reasons for discontinuing included partner mistrust, intolerance to medication, and pregnancy. Patients who initiated PrEP in ENC were more likely to be insured (89%), White (66%), and male (69%). Average travel time to the clinic was 34 minutes (range 2–123 minutes) and the average travel distance was 23 mi (range 1–93 mi). Conclusions The study results were noteworthy given that in North Carolina, young Black men have the highest estimated rates of HIV infection. The reasons behind this discrepancy are likely multifactorial, and this study highlights the need for future programs and research to make PrEP more widely accessible to the at-risk population in this rural ENC community.