The Effect of Senate Bill-159 on the Provision of Hiv Pre- and Post-Exposure Prophylaxis in Sacramento, California

ABSTRACT

Purpose of Study The passing of Senate Bill (SB)-159 in May, 2019 allows California pharmacies to provide HIV pre-exposure (PrEP) & post-exposure prophylaxis (PEP) to patients without a physician's prescription. The goal of this study is to investigate whether Sacramento pharmacies are familiar with SB-159 and carry PrEP/PEP, evaluate SB-159's progress over the past three years, and elucidate possible avenues for further improvement in implementation. Methods Used This study reports findings from surveys of state-licensed pharmacies in Sacramento conducted in 2020-2021 (Year 1) and 2022-2023 (Year 2) using an IRB-approved script. The script assessed the pharmacy's stock, promotion of PrEP/PEP, and familiarity with SB-159. Surveys for Year 2 are still ongoing. Respondent pharmacies were identified as carriers or non-carriers based on whether they carried prophylaxis. Respondents that scored a familiarity >= 3 for SB-159 were assigned as "familiar." The survey also investigated reasons for not furnishing Prophylaxis, advertising of Prophylaxis without prescription, comfort with dispensing protocol, and future plans for staff training to dispense Prophylaxis. Summary of Results: We first examined if pharmacies in Sacramento, California carried stock of PEP/PrEP. In Year 1 (2020-21), 14% of surveyed pharmacies reported carrying PEP/PrEP (7 out of 50). In Year 3 (2022-2023), this increased to 62% (24 out of 39 surveyed pharmacies). Next, we examined the familiarity of pharmacies and pharmacists with SB-159. In Year 1, 43% of carriers (3/7) and 16% of non-carriers (7/43) were familiar with SB-159. By Year 3, pharmacies were more familiar with the law, with 67% of carriers (16/24) and 54% of non-carriers (7/13) reporting to be familiar with SB-159. Finally, we examined whether the pharmacies advertised the ability to obtain PEP/PrEP prophylaxis without a prescription. In Year 1, 28.6% of carriers and 6.98% of non-carriers stated they advertise the ability to obtain PEP/PrEP prophylaxis without a prescription. In Year 3, the values decreased to 4.2% and 0%, respectively. Conclusion(s) Compared to Year 1, there was an increase in the percent of Year 3 pharmacies surveyed that stock PrEP/PEP. However, data from the past 2 years show that carriers and non-carriers showed similar responses to questions related to familiarity with SB-159 and advertising. Taken together, this would suggest that the passing of SB-159 has increased access to HIV PrEP/PEP, yet has not significantly improved pharmacy advertising and awareness. Possible explanations include the focus that pharmacies have put into vaccination efforts against the COVID 19 pandemic instead of fulfilling SB-159. Future studies should include survey questions that objectively assess a pharmacy's familiarity with SB-159, and follow up with pharmacies that plan to implement training for their staff to dispense PrEP/PEP.