PROJECT SUMMARY. HIV pre-exposure prophylaxis (PrEP) is a highly effective method to decrease HIV transmission that remains underutilized. This submission is a planning project to engage a Community Collaborative of providers and users of ED services, community-based organization (CBO) staff, and policymakers to develop a set of strategies to incorporate PrEP services in Emergency Departments (EDs) in the four most highly burdened counties in New York State. We will address the “Prevent Pillar” of the Ending the HIV Epidemic by using an intersectional lens to address key social and structural determinants of HIV. Specifically, offering PrEP in the ED will broaden access to this prevention tool to populations experiencing intersecting vulnerabilities affecting access to health care (e.g., racism, homophobia/transphobia, unstable housing), as these individuals frequently present in EDs for non-emergent care. The proposed work is framed by the Consolidated Framework for Implementation Research (CFIR) and addresses early steps in the PrEP cascade (screening/identification, education/offer of PrEP, PrEP uptake, linkage to primary care). The Specific Aims are to form and work together with a Community Collaborative to: 1) Use data from 40 interviews we will conduct with a wide network of stakeholders (ED staff/clinicians and patients, CBO program staff, and ED administrators that have successfully integrated PrEP in other US hospitals) to identify implementation strategies to address challenges to offering PrEP in urban EDs in high HIV prevalence settings serving sizable populations of vulnerable individuals, and 2) Develop a Toolkit of PrEP service delivery implementation strategies for EDs informed by the Collaborative’s deliberations and review of the stakeholder data. Aims are informed by pilot interviews with ED leaders in our target counties, who described EDs as appropriate sites to identify individuals who could benefit from PrEP but do not have access to it. Yet, despite the potential of EDs to integrate PrEP and promote its uptake, multiple institutional, provider and patient-level challenges need to be addressed. The Collaborative will work with the investigators to iteratively identify what is known and not known (in order to guide the stakeholder interviews), draw on data being collected through these interviews, apply their own knowledge, experience, and expertise, and then formulate a set of strategies to address the challenges associated with providing PrEP in the ED and linking users to ongoing primary care. The primary product(s) of the collaborative are a set of ED-based PrEP implementation strategies, tailored to the needs of individuals with intersecting vulnerabilities. As no single approach will work in all EDs, we will “package” each strategy, describing its implementation elements (core components, critical resources, staffing, institutional commitments, protocols/workflows) to create a comprehensive Toolkit from which faciliti...