Research Summary

Study: Prescribing PrEP Via Telemedicine a Major Component of HIV Prevention in the United States

Edited by:
Ashton L. Stahl

Key Highlights:

  • Nearly 1 in 5 US preexposure prophylaxis (PrEP) users received prescriptions through a single national telemedicine provider in 2024.
  • More than three-quarters of telePrEP users were new to PrEP, and over one-third were uninsured.
  • Retention in telePrEP care was consistent across cohorts but declined over time, similar to clinic-based PrEP patterns.

A national cohort study published in JAMA Network Open reports that telemedicine-based prescribing of HIV preexposure prophylaxis (telePrEP) has become a substantial component of HIV prevention in the United States. Analyzing data from the largest US telePrEP provider, researchers found that telePrEP accounted for approximately 19% of all PrEP use nationally in 2024, reflecting rapid growth over 5 years.

The investigators conducted a retrospective, single-arm cohort study using electronic health record data from MISTR LLC, a for-profit telehealth company providing PrEP nationwide. The study included patients who received at least 1 day of prescribed PrEP between November 27, 2018, and March 5, 2025. National PrEP utilization data from AIDSVu were used to contextualize telePrEP prescribing as a proportion of all US PrEP use. Researchers assessed retention in care for cohorts initiating PrEP in 2020, 2021, and 2022.

Study Findings

Between 2018 and early 2025, physicians prescribed telePrEP to 162,422 unique patients through the platform. The patients were predominantly young (mean age, 33.3 years) and male (96%), with racial and ethnic representation including 12% African American or Black individuals and 25% Hispanic or Latino individuals. Notably, 77% of users had never taken PrEP prior to enrollment, and 36% were uninsured.

TelePrEP use expanded markedly over time, increasing from 6,443 users in 2020 to 110,068 users in 2024. As a share of all US PrEP use, telePrEP rose from 2% in 2020 to 9% in 2022 and reached 19% in 2024. Most users (81%) opted for home-based laboratory specimen collection rather than in-person testing.

Retention analyses showed similar patterns across initiation cohorts. In the year following PrEP initiation, 67% to 73% of patients remained in care. Retention declined from 42% to 43% in the second year and then from 32% to 33% by the third year. Annual reinitiation rates after discontinuation ranged from 2% to 5%.

Clinical Implications

According to the study authors, these findings suggest that telePrEP has become a critical component of the US HIV prevention infrastructure, particularly for individuals who are new to PrEP or lack health insurance. The authors noted that policies such as the Affordable Care Act, which provides coverage for preventive services, and the 340B Drug Pricing Program were central to enabling broad access to telePrEP, including for uninsured populations.

Expert Commentary

“This cohort study found that nearly 1 in 5 PrEP users in the US received their PrEP prescriptions from a single national telemedicine company in 2024…The rapid growth and overall magnitude of telePrEP provision suggests that it is a critical part of HIV prevention infrastructure in the US that merits continued regulatory support,” the researchers concluded.

Reference:
Siegler AJ, Koh SHE, Schukraft T, et al. Telemedicine preexposure prophylaxis prescribing from a large online US company. JAMA Network Open. 2025;8(12):e2546792. doi:10.1001/jamanetworkopen.2025.46792