Koss CA, Charlebois ED, Ayieko J, et al. - Researchers examined preexposure prophylaxis (PrEP) uptake and engagement after population-level HIV testing and universal PrEP access in order to inscribe gaps in the PrEP cascade in rural Kenya and Uganda. From the ongoing SEARCH (Sustainable East Africa Research in Community Health) study, observational data was analyzed in this 72-week interim analysis. HIV testing and PrEP were offered at health fairs and facilities following community sensitisation and PrEP education in 16 rural communities in western Kenya, eastern Uganda, and western Uganda. Enhanced PrEP counselling was provided to individuals 15 years and older who were identified to be at an increased HIV risk on the basis of serodifferent partnership or empirical risk score, or who otherwise self-identified as being at high risk but were not in serodifferent partnerships or identified by the risk score. They tested 70,379 community residents 15 years or older who had not previously been diagnosed with HIV during population-level HIV testing from June 6, 2016, to June 23, 2017. Among these individuals, HIV-negative tests were reported in 69,121; of these, 12,935 had elevated HIV risk (1,353 [10%] serodifferent partnership, 6,938 [54%] risk score, 4,644 [36%] otherwise self-identified risk). Observations suggest that inclusive risk assessment (combining serodifferent partnership, an empirical risk score, and self-identification of HIV risk) was feasible and was capable of recognizing individuals who could benefit from PrEP during population-level HIV testing. In the PrEP cascade, they noted the biggest gap in PrEP uptake, especially for young and mobile individuals. PrEP intake was reported among participants who began PrEP and had perceived HIV risk during follow-up, but drug concentrations consistent with poor adherence was reported in one-third, highlighting the requirement for novel approaches and long-acting formulations as PrEP roll-out expands.