The University of Kentucky Research Foundation received a $194,380 Project Grant from the National Institute on Drug Abuse (CFDA 93.279 - Drug Use and Addiction Research Programs) to develop and test a low-threshold peer-facilitated telehealth intervention to increase pre-exposure prophylaxis (PrEP) uptake and retention among people who inject drugs (PWID) in Appalachian Kentucky. The 3-year project aims to: 1) collaborate with local harm reduction partners to design the peer-facilitated teleprep intervention, 2) conduct a pilot randomized trial to evaluate the intervention's preliminary efficacy on PrEP initiation and persistence compared to standard peer-delivered PrEP education and referral, and 3) assess implementation outcomes including feasibility, acceptability, and fidelity. This innovative project leverages Kentucky's existing harm reduction infrastructure to increase PrEP access for a high-risk population in a rural "PrEP desert" and generate evidence for an integrated low-threshold approach to improving PrEP engagement among PWID.