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Background The introduction of PrEP reimbursement in Italy by the National Health System (SSN) increased national uptake, although structural and regional barriers endure. TelePrEP is an exclusively online PrEP service launched in April 2023 through a collaboration between community health workers and infectious disease specialists. This study aims to analyze PrEP user’s territoriality and motivations to understand how TelePrEP might address systemic shortcomings and support individuals who cannot access the Italian SSN.Material and Methods TelePrEP is an ongoing fully remote service which provides PrEP prescription and care through an integrated ePlatform for consultations, prescriptions, and test result exchanges. Counseling is delivered via Zoom calls, fostering user–provider trust. Clients’ demographic/behavioral data are collected in a dedicated database for monitoring and evaluation purposes. Beyond clinical management, the service supports enrollment at territorial centers, by facilitating referrals and bridging prolonged waiting lists until access is secured. PrEP users enrolled between April 2023 and December 2025 were considered; geographical distribution of users is described considering the number of existing territorial PrEP centers.Results A total of 562 people contacted TelePrEP, with 121 referred directly to existing territorial centers ( figures 1-2). Data analysis reveals significant regional trends and barriers:Regional Disparities: high demand was observed in Northern Italy (Lombardy, Veneto) despite a higher density of PrEP centers (figure 3), likely reflecting community-driven awareness in the absence of public PrEP campaigns. In 2025, requests notably increased in Central Italy and the Islands (figure 4).Systemic Shortcomings: 50% of users accessed TelePrEP due to institutional barriers, with 25.1% reporting long waiting lists (36.8% in Lombardy, figure 5) and 25.1% geographical distance (17.5% in Piedmont, 10.5% in Calabria, figure 6).Negative experiences and lack of access to the SSN: 4% of users felt uncomfortable within the public health system, 5.3% lacked an Italian health card, making TelePrEP their primary or only access point, and 8,4% preferred TelePrEP to protect their privacy (figure 7).Referrals: 42% of discontinuations occurred after accessing a local public PrEP center.Conclusions While PrEP reimbursement is a landmark achievement, universal access remains hindered by geographical disparities, administrative barriers, and avoidance of the SSN among users seeking clinical privacy or reporting negative experiences with institutional care. Our data show that TelePrEP complements the public sector by supporting individuals who might otherwise fall through the cracks of the SSN. By providing a low-threshold entry point and facilitating referrals and access, TelePrEP highlights the value of community-led digital health models in advancing health equity and national HIV prevention goals.Abstract P187 Figure 1–7