Making long-acting HIV PrEP routine in college health: durable systems, not dedicated heroes

For many U.S. students, college health is the practical home of primary care and their most direct point of access to HIV prevention. In this commentary I argue that HIV pre-exposure prophylaxis (PrEP), including long-acting cabotegravir and lenacapavir, should be offered as routine preventive care in college health rather than as a specialty service. Nearly all responding student health services in national benchmarking data offer STI and HIV testing and contraception, while far fewer offer PrEP or prompt clinicians to educate patients on PrEP. That gap, the June 2025 approval of lenacapavir, and a quality improvement initiative that raised PrEP counseling from 3.0% to 97% point to a capacity-based framework of on-site, hybrid, and closed-loop referral models. The minimum standard is not identical infrastructure but a reliable pathway from routine offer to receipt of the chosen regimen. Clinics need durable systems rather than dedicated heroes.