Advancing Pre-hospital HIV Prevention in the United States: Embedding Rapid Testing and PrEP Screening within Emergency Medical Services

Emergency medical services (EMS) reach millions of Americans every year, yet seldom contribute to the nation’s HIV-prevention goals. This chapter argues that the mobility, public-trust capital, and round-the-clock availability of EMS can be leveraged to shorten the diagnostic window, accelerate linkage to antiretroviral therapy, and expand access to pre-exposure prophylaxis (PrEP). We synthesize epidemiological data illustrating persistent disparities in HIV incidence, outline how point-of-care fourth- and fifth-generation assays plus brief risk-screening tools can fit into a sub-30-minute low-acuity encounter, and show that existing CLIA waivers, community-paramedicine statutes, and interstate licensure compacts already permit paramedics to perform rapid testing and administer prophylactic injections. Evidence from pilot studies demonstrates high patient acceptability, favorable cost-effectiveness, and improved same-day linkage, while implementation-science frameworks (CFIR and RE-AIM) provide a roadmap for scale-up and evaluation. We examine barriers such as crew workload and data interoperability, highlight facilitators including bidirectional ePCR–EHR exchange and Medicaid reimbursement pathways, and propose a tiered evaluation plan encompassing process, outcome, and equity metrics. Future directions encompass multi-plex STI cartridges, mobile-integrated chronic-disease prevention, digital adherence tools, and adaptations for low-resource ambulance systems. Deploying HIV prevention in the pre-hospital arena transforms ambulances from mere transport vehicles into frontline public-health assets capable of advancing the ending the HIV epidemic initiative.