Attitudes about community pharmacy access to HIV prevention medications in California

Abstract

Increasing access to human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) is a high priority for the Ending the HIV Epidemic Initiative. Expanding access to PrEP and PEP through a variety of health care settings, including community pharmacies, may increase access in communities most in need. California is the first state to allow community pharmacists to furnish PrEP and PEP directly to consumers. Our objective was to assess attitudes among key stakeholders about a California policy to allow community pharmacists to furnish HIV PrEP and PEP. Methods: We conducted a qualitative case study with key pharmacy stakeholders. Semistructured phone interviews were audio-recorded and transcribed verbatim. We generated analytical memos for each interview and working with these analytical memos, we conducted a constant comparison across cases to identify commonalities and differences. Results: We launched the study in October 2018 and interviewed pharmacists (n ¼ 7) working in a variety of settings, including retail-, clinic-, and community-based pharmacies. We also interviewed medical providers (n ¼ 2) working in high-volume PrEP clinics and sought input from representatives of large retail chain pharmacies (n ¼ 2). Overall, pharmacists and medical provider informants shared similar opinions about the central benefits as well as the key challenges related to pharmacist-delivered PrEP and PEP services. Benefits included: community pharmacists are widely accessible, PrEP and PEP protocols are similar to other preventative medications, policy may lead to efficiencies in the health care workforce, and community pharmacists are authorities on medication adherence. Challenges included: implementation issues may limit pharmacist involvement, and missed opportunities to diagnose and treat other health conditions. Conclusion: This study characterizes the types of benefits and challenges that can be expected when PrEP and PEP prescribing privileges are extended to community pharmacists. This information may be useful to policymakers and other stakeholders considering legislation to permit direct prescription of PrEP and PEP by pharmacists.

Pharmacy-Based Interventions to Increase Use of HIV Pre-exposure Prophylaxis in the United States: A Scoping Review

“…Twenty-four empirical studies concerning pharmacist and patient perceptions of PrEP were identified (Table 1 ). The sample size of such studies ranged from 9 [ 44 ] to 7148 [ 45 ]. Fourteen studies contained primary observational data concerning practicing pharmacists’ and Doctor of Pharmacy (PharmD) students’ knowledge, perceptions, and attitudes of pharmacy-based PrEP interventions [ 44 , 46 – 55 ].…”

“…The sample size of such studies ranged from 9 [ 44 ] to 7148 [ 45 ]. Fourteen studies contained primary observational data concerning practicing pharmacists’ and Doctor of Pharmacy (PharmD) students’ knowledge, perceptions, and attitudes of pharmacy-based PrEP interventions [ 44 , 46 – 55 ]. Pharmacists and/or pharmacy students from all four of the U.S. Census Bureau regions were represented.…”

“…Pharmacists and/or pharmacy students from all four of the U.S. Census Bureau regions were represented. Eight studies measured practicing pharmacist knowledge of PrEP, and pharmacist familiarity with PrEP and CDC guidelines for PrEP eligibility varied across different regions of the U.S [ 44 , 47 – 50 , 56 – 58 ]. Five studies measured proportions of pharmacists with familiarity on PrEP and/or the CDC guidelines for PrEP; familiarity ranged from 42% in Nebraska and Iowa to 91% in New York [ 47 , 56 ].…”

An observational survey assessing the extent of PrEP and PEP furnishing in San Francisco Bay Area pharmacies

“…14 In a qualitative case study assessing the attitudes of key pharmacy stakeholders toward PrEP and PEP furnishing, most agreed that community pharmacists are widely accessible providers, that PrEP and PEP furnishing protocols are similar to those for other preventive medications, and that policies that allow pharmacists to furnish could increase access. 15 Similarly, in a study assessing patient perspectives of PrEP furnishing, 100% of patients agreed or strongly agreed that having pharmacistprescribed PrEP would benefit their community, and 93.3% of patients agreed or strongly agreed they would feel comfortable seeking PrEP information or HIV testing from a pharmacist. 16 Previous research has found that pharmacist furnishing can increase access to other therapies, including hormonal contraception, naloxone, smoking cessation medications, vaccines, and syringes.…”

“…[17][18][19][20][21] Before 2019, pharmacists in California could furnish PrEP and PEP under a formal collaborative practice agreement (CPA) in which a medical provider and a pharmacist form a partnership. 15 Although this method is difficult to implement, it led community pharmacies to provide and expand access to PrEP/PEP. 22 As of 2020, PrEP and PEP services had been implemented in some community pharmacies and ambulatory care clinics.…”