Rural North Carolinians face significant barriers to accessing comprehensive HIV prevention services, including pre-exposure prophylaxis (PrEP), due to limited infrastructure and persistent provider shortages. This policy proposal thoroughly analyzes multiple policy options including Status-Neutral Navigation Pilot Programs, Mobile HIV Prevention Pilot Programs, and expanding the scope of pharmacists to prescribe PrEP in rural North Carolina. Ultimately, to address these gaps in HIV care, we determined that expanding pharmacists’ scope of practice to include prescribing PrEP was the most optimal policy option to increase access to preventive HIV care across the state. This policy leverages North Carolina’s existing health care workforce to improve equitable access to services, particularly in underserved rural communities. We estimate that implementing a program of this scale would cost approximately 1. 19 million over three years.
Perry et al. (2026) studied this question.