OBJECTIVE: To examine the prevalence and settings of PrEP availability at opioid use treatment facilities in the United States.
METHODS: We examined PrEP trends from 2021 to 2024 using the National Substance Use and Mental Health Services Survey. Using multivariable logistic regression models, we calculated odds ratios (OR) and their 95% confidence intervals (CI) to examine associations between facility characteristics and PrEP prescribing in 2024.
RESULTS: A total of 13,755 substance use treatment facilities in 2021; 14,201 in 2022; 12,892 in 2023; and 13,875 in 2024 were included. The percentage of facilities offering PrEP increased from 6.03% in 2021 to 10.62% in 2024 (p < 0.01) nationwide. Despite comprising over 90% of facilities, outpatient (8.57%) and residential (14.26%) facilities had lower PrEP availability than inpatient facilities (23.19%). Facilities with methadone and buprenorphine had higher odds of PrEP availability (methadone OR = 7.52, 95% CI = 5.34, 10.59; buprenorphine only OR = 10.09, 95% CI = 7.53, 13.52) compared to those without these treatments. Facilities offering programs specific to people living with HIV (OR = 2.32, 95% CI = 1.83, 2.94) and those identifying as LGBTQ+ (OR = 1.75, 95% CI = 1.35, 2.27) were more likely to offer PrEP.
CONCLUSIONS: Despite the high number of people served in outpatient and residential facilities, PrEP access continues to remain low.
Trends in and program characteristics associated with pre-exposure prophylaxis availability among opioid treatment facilities in the United States
Preventive Medicine Reports, 17, 103671. doi: 10.1016/j.pmedr.2026.103671. PMCID: PMC13725471.