Project Title: Telemedicine for PrEP throughout Mississippi (Tele-Prep-MS) Uptake of PrEP in the southern United States has been slow, especially in areas distant from academic medical centers that provide PrEP care. Despite underserved populations in the South having alarmingly high rates of HIV, a large percentage of at-risk individuals are not engaged in PrEP care due to limited access to academic medical centers. Mississippi (MS), the site of this proposed project, has the seventh highest incidence of HIV of any state and CBOs that provide HIV/STI testing outside of urban areas report that very few of their at-risk individuals use PrEP. Unfortunately, physicians outside of academic centers are often reluctant to prescribe PrEP because they lack the expertise, training, and the support necessary to provide comprehensive HIV prevention care. Those who are at-risk do not seek PrEP from academic centers because of stigma, travel burdens, and financial concerns. To overcome these barriers, this project will develop and pilot test a program to deliver PrEP care in underserved remote communities in MS through telemedicine clinical care delivered in local CBOs. Telemedicine will allow specialists to provide care at a distance and while simultaneously enhancing the capacity of local CBOs to provide quality HIV testing and counseling, PrEP treatment, and linkage to HIV care if needed. It will allow patients to receive the highest level of medical care from trusted CBOs within their local communities. It will also enhance the CBO's mission by allowing it to provide a new, high-quality medical service. The specific aims of this project are to: 1. Develop a PrEP telemedicine program for CBOs that provide HIV/STI testing. The program, to be called Tele-PrEP-MS, will be developed through a collaborative development approach with University of Mississippi Medical Center specialists and local stakeholders (CBO agency staff, administrators and patients). 2. Implement Tele-PrEP-MS in two CBOs that conduct HIV testing for underserved areas in MS. 3. Determine the acceptability and feasibility of Tele-PrEP-MS, and examine the individual, organizational and structural factors associated with its acceptability and feasibility. This aim uses a mixed methods approach that includes in-depth interviews of stakeholders (patients, staff, and administrators) and an online survey of 300 patients. 4. Examine PrEP-related outcomes (proportions screened for PrEP eligibility, attending a PrEP medical evaluation, accepting a PrEP prescription, beginning and adhering to PrEP) to compare the academic medical center and the CBOs, and also to examine any factors related to these outcomes.

Project Narrative This study will develop and test a program to deliver PrEP care in underserved communities in Mississippi (MS) through telemedicine, distance-based, clinical care delivered in local community based organizations (CBOs). The intervention will be developed in collaboration with medical specialists at the University of Mississippi Medical Center (UMMC) and local CBO stakeholders (providers, administrators and patients). A total of 240 individuals will be recruited from CBOs in MS. Participants will be able to receive PrEP counseling in the CBO and PrEP care via telemedicine from a PrEP specialist at UMMC. Our study will provide a wealth of information about PrEP-related outcomes and HIV testing among MS residents living in underserved communities. If successful, this program will be able to be disseminated to other CBOs in the South.