HIV testing in community pharmacies and retail clinics: A model to expand access to screening for HIV infection

Abstract

Objective To test the feasibility of offering rapid, point-of-care human immunodeficiency virus (HIV) testing at community pharmacies and retail clinics. Design Pilot program to determine how to implement confidential HIV testing services in community pharmacies and retail clinics. Setting 21 community pharmacies and retail clinics serving urban and rural patients in the United States, from August 2011 to July 2013. Participants 106 community pharmacy and retail clinic staff members. Intervention A model was developed to implement confidential HIV counseling and testing services using community pharmacy and retail clinic staff as certified testing providers, or through collaborations with organizations that provide HIV testing. Training materials were developed and sites selected that serve patients from urban and rural areas to pilot test the model. Each site established a relationship with its local health department for HIV testing policies, developed referral lists for confirmatory HIV testing/care, secured a CLIA Certificate of Waiver, and advertised the service. Staff were trained to perform a rapid point-of-care HIV test on oral fluid, and provide patients with confidential test results and information on HIV. Patients with a preliminary positive result were referred to a physician or health department for confirmatory testing and, if needed, HIV clinical care. Main outcome measures Number of HIV tests completed and amount of time required to conduct testing. Results The 21 participating sites administered 1,540 HIV tests, with 1,087 conducted onsite by staff during regular working hours and 453 conducted at 37 different HIV testing events (e.g., local health fairs). The median amount of time required for pretest counseling/consent, waiting for test results, and posttest counseling was 4, 23, and 3 minutes, respectively. A majority of the sites (17) said they planned to continue HIV testing after the project period ended and would seek assistance or support from the local health department, a community-based organization, or an AIDS service organization. Conclusion This pilot project established HIV testing in several community pharmacies and retail clinics to be a feasible model for offering rapid, point-of-care HIV testing. It also demonstrated the willingness and ability of staff at community pharmacies and retail clinics to provide confidential HIV testing to patients. Expanding this model to additional sites and evaluating its feasibility and effectiveness may serve unmet needs in urban and rural settings.

Provision of Clinical Preventive Services by Community Pharmacists

“…Early diagnosis may lead to early treatment and reduced disease spread. Testing can be conducted at community pharmacies to increase access to care (22–24). …”

Exploring pharmacy and home-based sexually transmissible infection testing

“…Much can be learned from the HIV community’s experience, as well as other experienced countries, on how to fund laboratory support, connect testers with their results and link those testing positive with treatment and care. 17 US programs that have been successful with the distribution of home collection kits, such as IWTK and California’s ‘I Know’ campaign, should be considered as models for adaptation or expansion on a national level. 47 In the meantime, greater availability of rapid point-of-care tests, and collaborations such as practice agreements between physicians and pharmacists (as well as between local health departments, providers and pharmacies) could maximise connection to treatment.…”

“…As more pharmacies have expanded their business models to include public health services, there has been a call to ‘embrace the intersectoral nature of public health and work to achieve our public health mission through the dynamic arena of pharmacy practice (p. 142).’ 16 Retail clinics have the potential to offer greater access and anonymity in a much less stigmatised setting to those seeking STI testing. Some demonstration work has already been performed exploring the feasibility and acceptability of HIV testing in pharmacies, 17–21 but published literature exploring US-based introduction of STI testing into the pharmacy-setting is nearly non-existent.…”

ASHP Guidelines on Pharmacist Involvement in HIV Care

“…Community pharmacies are addressing this issue and improving patient access to HIV testing by offering onsite rapid HIV testing and counseling services. 21,22 Pharmacists in community and outpatient settings perform point-ofcare HIV tests, provide pretest and posttest patient counseling, counsel patients with a positive result about confirmatory testing, and facilitate a linkage to care. 23 CDC is developing a toolkit for HIV testing in community pharmacies and retail clinics, and the Michigan Pharmacists Association offers an accredited certificate course for pharmacists focused on point-of-care testing in community pharmacies.…”