Ask AI
Back Back
Same Day HIV PrEP
The “Golden Hour” in HIV Prevention: Why It’s Time for Same-Day HIV PrEP 

Released: May 18, 2026

Jeffrey Kwong
Jeffrey Kwong, DNP, MPH, AGPCNP-BC, FAANP, FAAN, AAHIVS, ACRN
Activity Information

Activity

Progress
1
Course Completed
Continue
Key Takeaways
  • Delays between identifying PrEP eligibility or patient interest and PrEP initiation create opportunities for disengagement from care.
  • Same-day PrEP improves initiation rates and short-term retention, removes structural barriers to access, and normalizes PrEP as routine care by reducing the time between clinical readiness and access to prevention.

Fourteen years after the first oral option for HIV pre-exposure prophylaxis (PrEP) was approved by the FDA, we now have 2 oral formulations and 2 long-acting injectables available for PrEP. However, despite these advances in biomedical prevention, too many individuals who could benefit from PrEP are not receiving it.

In the United States, up to 2 million people could benefit from PrEP, but fewer than one quarter are currently prescribed it. This gap is even more pronounced among populations disproportionately affected by HIV, including Black and Latino/a communities, transgender individuals, and cisgender women.

Challenging barriers contribute to this underutilization, such as stigma, limited familiarity with PrEP, and more.

But there is a barrier that is simpler to overcome: time, and specifically, the delay between identifying PrEP eligibility and initiation of the first dose of PrEP.

The Golden Hour
In emergency medicine, the concept of the “golden hour” refers to how timely intervention dramatically improves outcomes in acute conditions, such as myocardial infarction or stroke.

A similar principle applies across the HIV care continuum. Rapid antiretroviral therapy initiation on or near the same day as diagnosis has transformed HIV treatment by improving rates of viral suppression, reducing transmission, and increasing retention in care. A key reason why it helps is reduced loss to follow-up during the critical period between diagnosis and treatment initiation.

A comparable gap exists in the HIV prevention continuum. Any delay between identifying patient interest or PrEP eligibility and receipt of the first dose of PrEP is an opportunity for that patient to disengage. Each additional step in the HIV PrEP workflow, including making patients return for lab results prior to prescribing and pharmacy coordination, increases the likelihood of loss to follow-up, leaving them vulnerable to HIV.

In some reports, the time between identification of an eligible PrEP candidate and first dose of PrEP was as high as 30-90 days. For that patient, that can be months without protection.

The Silver Bullet
Same-day PrEP addresses this gap by reducing the time between clinical readiness and providing immediate access to prevention. This strategy is supported in the CDC HIV PrEP Guidelines and has been demonstrated to be both safe and effective in multiple clinical settings. Evidence from same-day PrEP programs demonstrates higher initiation rates and improved short-term retention compared with standard models. In addition, same-day PrEP normalizes it as routine preventive care, helping reduce stigma and structural barriers to access.

What Can You Do?
Successful implementation of same-day PrEP does require system-level support, including healthcare professional and administrative buy-in, streamlined workflows, access to rapid and standard laboratory testing, availability of medication, and appropriate patient education. Furthermore, appropriate systems need to be in place to make sure retention, or persistence, in preventive care is maintained.

Although changing your practices to normalize and streamline PrEP may seem daunting, there are well-defined steps that you can take to facilitate it:

  • Implement protocols allowing for rapid, same-day PrEP prescribing
  • Streamline laboratory workflows so baseline testing occurs without delaying initiation
  • Identify ways to offer on-site dispensing or starter packs to eliminate pharmacy-related delays
  • Integrate patient navigation systems to support follow-up, adherence, and refill completion
  • Address financial barriers during the initial visit through insurance screening and assistance programs
  • Expand interdisciplinary roles for nurses, pharmacists, social workers, advanced practice providers, and navigators to support protocol-driven initiation

From both a clinical and public health perspective, integrating same-day PrEP into routine care is a necessary step toward closing persistent gaps in PrEP uptake and advancing efforts to end the HIV epidemic.

This principle of offering and receiving an intervention on the same day has been successfully used to improve uptake, access, and coverage of other preventive health measures such as immunizations. Why should HIV PrEP be any different? We should take advantage of this “golden hour” in the HIV prevention cascade and capitalize on patient readiness, motivation, and desire to prevent HIV.

Your Thoughts
What are some challenges you face with timely initiation of PrEP in your practice? How can the strategies presented here address those challenges? Leave a comment to join the discussion!

Continue