Feasibility of reaching populations at high risk for HIV in community pharmacies.

BACKGROUND: Growing evidence has shown feasibility for HIV prevention service integration in pharmacies, including HIV testing and screening for pre-exposure prophylaxis (PrEP). Yet, further work is needed to determine whether pharmacies can effectively reach those at increased risk of HIV transmission. OBJECTIVES: We aimed to describe the HIV risk profiles and willingness to obtain HIV prevention services of a sample of pharmacy clients. METHODS: This was a cross-sectional pilot study aimed to develop a culturally appropriate pharmacy-based PrEP delivery model among Black men who have sex with men (MSM). Two pharmacies were recruited from low-income, underserved communities and participants were recruited within pharmacies for screener and social and behavioral surveys. Individuals were grouped by PrEP eligibility due to sexual risk, injection drug use risk, or both, and demographic and willingness measures were compared. RESULTS: Among 460 pharmacy clients, 81 (17.6%) would have been eligible for PrEP due to sex or injection drug use risk. Most were eligible due to sexual risk (58.0%), while a substantial proportion were eligible due to injection drug use (27.2%) or a combination of sexual and injection drug use risk behaviors (42.0%). Of these eligible, median age was 31 years (IQR=28,32) and most had ≥1 female (75.3%) or male (96.3%) partner in the past 6 months. There was high willingness to receive a free HIV test in a pharmacy (90.1%). Most were willing to screen for PrEP in a pharmacy (95.1%) despite these services not being available in the state where this study was performed. There were no differences in willingness to obtain pharmacy-based HIV prevention services across risk groups. CONCLUSION: This study shows that pharmacies in disadvantaged areas can serve a key role in preventing and decreasing the transmission of HIV by reaching populations with high HIV burden and providing HIV prevention services.

Using the andersen healthcare utilization model to assess willingness to screen for prep in pharmacy-based settings among cisgender sexually minoritized men: results from the 2020 american men's internet survey.

BACKGROUND: Pre-exposure prophylaxis (PrEP) to prevent HIV is severely underutilized among sexually minoritized men (SMM). Inequitable access to PrEP-prescribing facilities and providers is a critical barrier to PrEP uptake among SMM. Integrating HIV prevention services, such as PrEP screening, into pharmacy-based settings is a viable solution to addressing HIV inequities in the US. We aimed to examine willingness to obtain PrEP screening in a pharmacy and its associated correlates, leveraging Andersen's Healthcare Utilization Model (AHUM), among a national sample of SMM in the U.S. METHODS: Data from the 2020 American Men's Internet Survey, an annual online survey among SMM, were analyzed. Drawing on AHUM-related constructs, we used a modified stepwise Poisson regression with robust variance estimates to examine differences in willingness to screen for PrEP in a pharmacy. Estimated prevalence ratios (PR) were calculated with 95% confidence intervals (CI95%). RESULTS: Out of 10,816 men, most (76%) were willing to screen for PrEP in a pharmacy. Participants were more willing to screen for PrEP in a pharmacy if they (1) had a general willingness to use PrEP (PR = 1.52; CI95% =1.45, 1.59); (2) felt comfortable speaking with pharmacy staff about PrEP (PR = 2.71; CI95% =2.47, 2.98); and (3) had HIV-related concerns (PR = 1.04; CI95% =1.02, 1.06). There were no observed differences in men's willingness to screen for PrEP in a pharmacy by race/ethnicity, education level, annual household income, nor insurance status. CONCLUSIONS: Strategically offering PrEP screening in pharmacies could mitigate access-related barriers to HIV prevention services among SMM, particularly across various sociodemographic domains. Importantly, this approach has vitally important implications for addressing broader inequities in HIV prevention. Future studies should examine strategies to successfully integrate PrEP screenings in pharmacies among diverse populations, especially among those at elevated risk for HIV.

Implementation Science of Integrating Pre-Exposure Prophylaxis in Pharmacist-Led Services in the United States.

BACKGROUND: Racial inequities in HIV in the United States (US) are pervasive. Pre-exposure prophylaxis (PrEP) is one of the most effective yet underutilized HIV prevention strategies, and stark inequities in PrEP uptake exist. Lack of access to PrEP clinics is a major barrier to access that could be overcome by integrating pharmacists into the provision of PrEP services including prescribing and dispensing. METHODS: A number of reviews have shown promise in folding pharmacies into the expansion of PrEP services, but this review extends those by examining the implementation science evidence of pharmacist-led PrEP services in the US. We reviewed literature over the past five years of the implementation science of pharmacist PrEP services (2018-2023) and present seminal findings in this area. RESULTS: Only two studies are anchored within an implementation science framework despite all studies assessing common implementation science constructs. Overwhelming evidence supports feasibility and adoption of PrEP services in pharmacies yet gaps in workflow integration, scalability and sustainability exist. CONCLUSION: Continuing to build the implementation science evidence of pharmacy-based PrEP services is critical to standardize our measures across varying contexts and inform policy efforts that support pharmacy-based PrEP services.

Examination of HIV Preexposure Prophylaxis Need, Availability, and Potential Pharmacy Integration in the Southeastern US.

Importance: Daily preexposure prophylaxis (PrEP) use can prevent up to 99% of HIV infections; however, PrEP uptake is low due to poor access to PrEP-prescribing locations for populations at increased risk for HIV, especially in the southeastern US. Pharmacies are a feasible option to increase PrEP access, but little is known about how they could complement current PrEP-prescribing locations. Objective: To examine geographic distributions of current PrEP-prescribing locations compared with pharmacies and the facility to need ratios (PFNRs) according to HIV risk in the Southeast and describe the potential reach of pharmacies to expand PrEP access. Design, Setting, and Participants: Data for this cross-sectional study of PrEP-prescribing locations and pharmacies were compiled from January 1 to December 31, 2021. States or specific counties in the Southeast included in this study were jurisdictions identified as high-priority areas for the Ending the HIV Epidemic in the US (EHE) initiative. Exposure: Expansion of HIV prevention services to pharmacies. Main Outcomes and Measures: Choropleth maps of 5-year HIV risk per 100 000 persons were developed for EHE jurisdictions in the southeastern US. PrEP-prescribing locations (obtained from a national database of PrEP prescribers) and pharmacies (obtained from state pharmacy boards) were overlayed on HIV risk maps. The PFNRs by state were calculated as number of facilities (PrEP-prescribing locations or pharmacies) divided by 5-year HIV risk per 100 000 persons. Lower PFNRs indicated lower geographic availability of locations to meet the needs of the population at risk for HIV. The PFNRs for current PrEP-prescribing locations vs pharmacies were compared. Results: Among the 2 southeastern states and 13 counties in 4 southeastern states included, PrEP-prescribing locations were unequally distributed across EHE areas, with substantially fewer in areas at high risk for HIV. Pharmacies were evenly dispersed across areas regardless of HIV risk. The mean PFNR across all states for current PrEP-prescribing locations was 0.008 (median, 0.000 [IQR, 0.000-0.003]); for pharmacies, it was 0.7 (median, 0.3 [IQR, 0.01-0.1]). The PFNRs were at least 20.3 times higher for pharmacies compared with PrEP-prescribing locations. States with the greatest potential increase in PFNRs with expansion to pharmacies included Kentucky, South Carolina, and Tennessee. Conclusions and Relevance: The findings of this cross-sectional study suggest that expanding HIV prevention services to pharmacies in EHE areas in the Southeast could significantly increase capacity to reach individuals at increased risk of HIV transmission. Legislation aimed at allowing pharmacists to prescribe PrEP and provide HIV prevention services may be an important next step in ending the HIV epidemic.

Comparing open-ended question methods to vignette methods to explore willingness to obtain pre-exposure prophylaxis access in pharmacies among black men who have sex with men.

Black men who have sex with men (BMSM) are at higher risk of HIV transmission than any other group; however, their uptake of the highly effective HIV prevention medication, pre-exposure prophylaxis (PrEP), is low. In collaboration with a communitybased organization in Atlanta, Georgia, we explored ten HIV-negative BMSM's willingness to obtain PrEP in pharmacies using standard open-ended and vignette qualitative methods. Three overarching themes were identified: privacy, patient-pharmacist interactions, and HIV/STI screening. While open-ended questions allowed participants to provide broad answers on their willingness to receive prevention services at a pharmacy, the vignette drew out specific responses to facilitate in-pharmacy PrEP delivery. Using both openended questions and vignette data collection strategies, BMSM reported high willingness to screen for and uptake PrEP in pharmacies. However, the vignette method allowed for greater depth. Open-ended questions elicited responses that highlighted general barriers and facilitators of PrEP dispensing in pharmacies. However, the vignette allowed participants to customize a plan of action that would best fit their needs. Vignette methods are underutilized in HIV research and may be helpful in supplementing standard open-ended interview questions to uncovering unknown challenges about health behaviors and obtain more robust data on highly sensitive research topics in HIV research.

Examining pharmacies' ability to increase pre-exposure prophylaxis access for black men who have sex with men in the United States.

BACKGROUND: Pre-exposure prophylaxis (PrEP) has not effectively reached black men who have sex with men (BMSM). Using innovative, nontraditional health care settings-such as community pharmacies-may improve PrEP uptake among BMSM. OBJECTIVE: To examine correlates of patient willingness to be screened for PrEP (via human immunodeficiency virus [HIV] testing and risk assessment) in pharmacies among BMSM in the United States. METHODS: Data from the 2020 American Men's Internet Survey were analyzed. Using a modified Poisson regression method with robust variance estimates, we examined differences in willingness to screen for PrEP in pharmacies among BMSM. A 95% confidence interval (95% CI) was calculated for each estimated prevalence ratio (PR). RESULTS: Of 826 respondents, 637 (77%) were willing to be screened for PrEP in pharmacies. Having a high school degree (PR 0.76 [95% CI 0.62-0.95]), willingness to use PrEP (1.70 [1.41-2.05]), and comfort speaking with pharmacy staff about PrEP (2.5 [1.86-3.51]) were significantly associated with willingness to screen for PrEP in a pharmacy setting. Importantly, there were no observed differences in willingness by age, employment status, annual household income, or insurance status. CONCLUSION: Pharmacy-based PrEP access may be an effective strategy to end inequities in HIV, given that our results indicate that most BMSM are willing to be screened for PrEP in pharmacies. Future studies should examine whether willingness to use pharmacy-based HIV prevention services is associated with subsequent uptake of these services among BMSM.

Integrating and Disseminating Pre-Exposure Prophylaxis (PrEP) Screening and Dispensing for Black Men Who Have Sex With Men in Atlanta, Georgia: Protocol for Community Pharmacies.

BACKGROUND: Black men who have sex with men (BMSM) suffer from alarmingly high rates of HIV in the United States. Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV infection by 99% among men who have sex with men, yet profound racial disparities in the uptake of PrEP persist. Low PrEP uptake in BMSM is driven by poor access to PrEP, including inconvenient locations of PrEP-prescribing physicians, distrust of physicians, and stigma, which limit communication about PrEP and its side effects. Previous work indicates that offering HIV prevention services in pharmacies located in low-income, underserved neighborhoods is feasible and can reduce stigma because pharmacies offer a host of less stigmatized health services (eg, vaccinations). We present a protocol for a pharmacy PrEP model that seeks to address challenges and barriers to pharmacy-based PrEP specifically for BMSM. OBJECTIVE: We aim to develop a sustainable pharmacy PrEP delivery model for BMSM that can be implemented to increase PrEP access in low-income, underserved neighborhoods. METHODS: This study design is a pilot intervention to test a pharmacy PrEP delivery model among pharmacy staff and BMSM. We will examine the PrEP delivery model's feasibility, acceptability, and safety and gather early evidence of its impact and cost with respect to PrEP uptake. A mixed-methods approach will be performed, including three study phases: (1) a completed formative phase with qualitative interviews from key stakeholders; (2) a completed transitional pilot phase to assess customer eligibility and willingness to receive PrEP in pharmacies during COVID-19; and (3) a planned pilot intervention phase which will test the delivery model in 2 Atlanta pharmacies in low-income, underserved neighborhoods. RESULTS: Data from the formative phase showed strong support of pharmacy-based PrEP delivery among BMSM, pharmacists, and pharmacy staff. Important factors were identified to facilitate the implementation of PrEP screening and dissemination in pharmacies. During the transitional pilot phase, we identified 81 individuals who would have been eligible for the pilot phase. CONCLUSIONS: Pharmacies have proven to be a feasible source for offering PrEP for White men who have sex with men but have failed to reach the most at-risk, vulnerable population (ie, BMSM). Increasing PrEP access and uptake will reduce HIV incidence and racial inequities in HIV. Translational studies are required to build further evidence and scale pharmacy-based PrEP services specifically for populations that are disconnected from HIV prevention resources. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35590.