- Need: To prevent new cases of HIV in rural Iowa.
- Intervention: TelePrEP provides preventive care via telehealth and prescription delivery.
- Results: Between February 2017 and August 2020, TelePrEP received 456 referrals, with 403 patients completing an initial visit.
136 Iowans were newly diagnosed with HIV, the largest
number reported in the state since 1998, likely due to
higher levels of testing. The rural county of Buena Vista
had the sixth highest prevalence in Iowa of people living
with HIV, with 112 per 100,000 people.
The risk of contracting HIV can be greatly reduced
Prophylaxis (PrEP), but the medication must be taken
every day and patients need follow-up appointments every
3 months. In addition, rural residents often don't have
access to it due to stigma, distance from the nearest
specialist, and a shortage of primary care providers
willing to prescribe and monitor PrEP.
is a public health-partnered, virtual pharmacist model
for PrEP delivery in rural and urban Iowa. TelePrEP
partners include the Iowa Department of Public Health and
University of Iowa Health Care. TelePrEP is funded by the
Iowa Department of Public Health through a
CDC Demonstration Project award.
Project coordinators reach out to vulnerable populations,
including people with sexually transmitted infections,
sexual partners of people living with HIV, and people who
Patients at high risk of contracting HIV can receive
video consultations in their own homes. TelePrEP uses a
HIPAA-compliant platform that works with smartphones,
tablets, or computers and can function in low-bandwidth
Patients complete lab work at an outpatient or public
health location and receive their medication at their
local pharmacy or through the mail. In addition, patients
can communicate with their pharmacist providers outside
of visits through phone, email, or texting.
Thanks to a Collaborative Practice Agreement (legal
agreement that expands the pharmacist's scope of
practice) with the medical director, University of Iowa
Health Care pharmacist providers can order labs and
prescribe and adjust medications based on lab results and
For more information about this program, please watch
TelePrEP has served more than 400 patients, of whom more
than 90% have started PrEP medication. TelePrEP services
are available throughout the state of Iowa. The Health
Resources & Services Administration (HRSA) listed the
project as a
Health Center Promising Practice.
Between February 2017 and October 2018, there were 127
initial video visits with pharmacists and 186 referrals.
For more information:
Hoth, A.B., Shafer, C., Dillon, D.B., Mayer, R., Walton,
G., & Ohl, M.E. (2019). Iowa TelePrEP: A
Public-Health-Partnered Telehealth Model for Human
Immunodeficiency Virus Preexposure Prophylaxis Delivery
in a Rural State. Sexually Transmitted Diseases,
46(8), 507-512. Article
Since initiation of TelePrEP in 2017, project
coordinators experienced the following challenges:
- Raising awareness of PrEP – especially in rural
counties and among people of color
- Addressing patients' privacy concerns
- Addressing stigma
- Complexity of navigating
insurance coverage for lab test and medication
Patients with high deductible healthcare plans and
uninsured patients face challenges with some of the lab
or out-of-pocket costs.
Create relationships with people and systems already in
place and build on successful work.
Understand the community you are trying to reach. Asking
patients about their needs and perceived barriers to care
keeps patients invested in your project and helps you
shape it to best fit their needs.
Be flexible and create a service that can change rapidly
when something doesn't work and strengthen the aspects
that are working.
HIV and AIDS
August 27, 2018
Date updated or reviewed
September 16, 2020
Suggested citation: Rural Health Information Hub,
TelePrEP [online]. Rural Health Information Hub. Available at:
[Accessed 19 May 2022]
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.