Problem: Pre-exposure prophylaxis (PrEP) is an effective strategy in the prevention of HIV acquisition. A substance use disorder (SUD) clinic in a metropolitan area serves a population with multiple risk factors for HIV acquisition. Despite offering PrEP, this clinic has determined PrEP uptake rate to be 16%. Purpose: The purpose of this quality improvement project was to increase PrEP uptake among HIV negative patients who have a high risk of HIV acquisition by implementing a same-day PrEP (SDP) protocol at a SUD clinic, an evidenced based, research supported practice change. Methods: This initiative was implemented over a 15-week period. Prior to implementation, the QI Project Lead mobilized and trained an interdisciplinary team of stakeholders including physicians, APRNs, RNs, and CHWs. Changes to structure and workflow included the establishment of a SDP protocol, integration of a SDP eligibility screening into the EHR, and the creation of a screening and prescribing workflow. Patients deemed eligible for SDP, were offered a prescription for PrEP on the same day as their appointment. Following PrEP initiation, patients were scheduled for a 1 week and 1 month follow up appointment where PrEP uptake was assessed. Results: All project team members completed SDP training. All patients (N=19) who presented for PrEP were screened for SDP eligibility (100%). Thirteen patients were eligible for SDP and 100% of these patients were offered SDP. Five patients (38%) initiated PrEP the same day as their appointment. Eight patients (62%) declined to start PrEP despite being offered SDP. Conclusions: Findings suggest that the SDP protocol has been successfully integrated into the clinic workflow demonstrating the feasibility and impact of SDP. PrEP uptake increased from 16% to 38%. Data highlight a need to further explore barriers to improve patient acceptance of PrEP.