Background: In the United States, young men who have sex with men (YMSM) of color represent a high number of new human immunodeficiency virus (HIV) diagnoses annually. HIV pre-exposure prophylaxis (PrEP) is effective and acceptable to YMSM of color, yet PrEP uptake is low in those communities due to barriers including stigma, cost, adherence concerns, and medical distrust. A telehealth-based approach to PrEP initiation may be a solution to those barriers. This pilot study investigates one such intervention called PrEPTECH. Methods: We enrolled 25 HIV-uninfected YMSM, aged 18–25 years, from the San Francisco Bay Area into a 180-day longitudinal study between November 2016 and May 2017. Participants received cost-free PrEP services via telehealth (e.g., telemedicine visits, home delivery of Truvada® and sexually transmitted infection [STI] testing kits), except for two laboratory visits. Online survey assessments querying PrEPTECH features and experiences were administered to participants at 90- and 180-days. Results: Eighty-four percent of participants were YMSM of color. Among the 21 who completed the study, 11 of the 16 who wanted to continue PrEP were transitioned to sustainable PrEP providers. At least 75% felt that PrEPTECH was confidential, fast, convenient, and easy to use. Less than 15% personally experienced PrEP stigma during the study. The median time to PrEP initiation was 46 days. STI positivity was 20% and 19% at baseline and 90-days respectively. No HIV infections were detected. Conclusions: Telehealth programs like PrEPTECH increase PrEP access for YMSM of color by eliminating barriers inherent in traditional clinic-based models.