Modified Project Summary/Abstract Section Improved linkage to and uptake of pre-exposure prophylaxis (PrEP) is critical to end the HIV epidemic in the United States (US). Despite PrEP’s high efficacy, less than 20% of PrEP-eligible people have received a prescription and gaps in uptake expose regional and racial disparities. In 2018, the US South accounted for more than half of all new HIV diagnoses but only one-third of PrEP users. PrEP use in North Carolina (NC) similarly lags, with uptake lowest among young sexual and gender minority populations (YSGM) who account for nearly two-thirds of the state’s incident infections. The PrEP-to-Need ratio, which is a metric of PrEP equity that measures PrEP uptake relative to new HIV diagnoses highlights disparities in PrEP uptake among specific demographic groups such as Black, Hispanic, Southern people, and women, indicating these groups are underserved relative to their epidemic need. For newly diagnosed adolescents and adults in North Carolina in 2022, the most likely route of HIV transmission reported was male-male sex (reported by 57.8%), followed by heterosexual sex (18.7%). Among NC counties with the highest rate of HIV diagnoses, four have rural designation and nine are small or medium metropolitan areas. NC’s HIV epidemic thrives alongside rising sexually transmitted infections (STI), which are also frequently concentrated in rural areas. Despite behavioral risk overlap of incident STIs and HIV, in NC, PrEP is only offered at a few, primarily urban health department (HD) affiliated STI clinics. The lack of robust healthcare infrastructure in these areas presents challenges for HIV prevention services. Leveraging STI clinics as an on-ramp to PrEP is an ideal opportunity to capitalize on STI service encounters and address disparities in PrEP access. A pathway to PrEP that utilizes existing clinic infrastructure to identify potential PrEP users, adapts services to ameliorate clinic constraints, and tailors PrEP engagement tools to specific client needs is a compelling strategy to improve PrEP access, uptake, and persistence in rural NC. This multilevel intervention to link PrEP and STI services, addresses barriers at policy, clinic, provider, and user levels. The strategy builds capacity and confidence via clinic training; facilitates patient handoff to navigators for linkage to financial support; and uses an evidence-based digital health platform, connecting users to peer educators, PrEP resources, and telehealth providers. The overarching objective is to parlay YSGM’s and cisgender women’s episodic STI service encounters into linkage to convenient, continuous PrEP care in NC.