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

Zhao, Angela; Dangerfield, Derek T.; Nunn, Amy; Patel, Rupa; Farley, Jason E.; Ugoji, Chinenye; Dean, Lorraine T.

doi:10.1007/s10461-021-03494-4

Cited by 37 publications

(21 citation statements)

References 82 publications

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“…As noted, there previously had been limited information describing implementation of pharmacist‐led PrEP management within primary care practices, especially academic institutions. Literature supporting PrEP services in community pharmacies pharmacist has mostly involved white, MSM, and Latinx populations 31,32 . Similarly, the patients referred to our PrEP service were predominately white, MSM.…”

Section: Future Directions and Opportunitiesmentioning

confidence: 97%

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Implementation of pharmacist‐led HIV pre‐exposure prophylaxis management to increase access to care at an academic internal medicine practice

Miller

Halza

Hovis

2022

J Am Coll Clin Pharm

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Introduction:The ongoing human immunodeficiency virus (HIV) epidemic continues to require attention to reduce the number of new infections. HIV pre-exposure prophylaxis (PrEP) has emerged as a highly effective strategy. Although its overall use in the United States has increased since initial approval, it is still underutilized, especially in populations disproportionately affected by HIV. One method for overcoming barriers to PrEP uptake includes utilizing pharmacists to increase access to care.Methods: For this initiative, a pharmacist-led PrEP service within a primary care practice was developed utilizing a collaborative practice agreement to enable ordering medications, lab tests, and immunizations. Following the sustainable initial implementation at the first site, expansion occurred to a second location. Data on referrals, patient demographics, and PrEP persistence were collected. Challenges, lessons learned, and future opportunities were also considered.Results: Since initiating services at both practice sites, a total of 76 patients were referred from August 2018 through March 2022. The majority of patients had their sex listed as male (96%) within the electronic health record and was white (69.7%).The mean age of patients was 33 years (range, 20-71). Of those who engaged with pharmacist-led PrEP management, 33.9% (20/59) were retained in care for at least 1 year. There were no occurrences of seroconversion during pharmacist management. Throughout the course of implementation, areas of improvement were identified and addressed for process improvement. Conclusion:Our experience supports that pharmacist-led PrEP management in an outpatient primary care practice is a sustainable option to address certain barriers to care. However, the ability for pharmacist-provided services may be limited by state pharmacy practice laws and/or lack of reimbursement opportunities for clinical services. Developing innovative practice models that integrate pharmacists in a variety of settings is imperative for further reducing HIV transmission.

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Section: Future Directions and Opportunitiesmentioning

confidence: 97%

“…Literature supporting PrEP services in community pharmacies pharmacist has mostly involved white, MSM, and Latinx populations. 31,32 Similarly, the patients referred to our PrEP service were predominately white, MSM. Various factors influence whether an individual utilizes PrEP therapy.…”

Section: Future Directions and Opportunitiesmentioning

confidence: 99%

Implementation of pharmacist‐led HIV pre‐exposure prophylaxis management to increase access to care at an academic internal medicine practice

Miller

Halza

Hovis

2022

J Am Coll Clin Pharm

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“…Following this, 188 Walgreens across the US have offered PrEP through their existing in-pharmacy clinics [ 29 , 30 ]. Existing pharmacy PrEP models, however, have not been tailored for BMSM and are critically needed to reduce HIV transmission and ultimately end the HIV epidemic [ 31 ]. Prior work indicates that offering HIV prevention services in pharmacies located in low-income, underserved neighborhoods is feasible [ 25 ] and can reduce stigma because pharmacies offer a host of less stigmatized health services (eg, vaccinations) [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

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

Crawford¹,

Harrington²,

Alohan³

et al. 2022

JMIR Res Protoc

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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

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“…On the wards, pharmacy teams can improve patient’s education and medication adherence. For the management of pharmacy teams, the record of interventions can inform on the service planning, training needs and clinical governance [ 1 , 3 , 4 , 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Using xPIRT to Record Pharmacy Interventions: An Observational, Cross-Sectional and Retrospective Study

2022

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Medication errors and omissions can potentially cause harm, prolong a hospital stay, lead to co-morbidities and even death. Pharmacy interventions (PI) ensure that these errors are identified and addressed, leading to improved patient safety and prescriber practice. Particularly in community hospitals, many only having general practitioners and not specialist doctors in their medical teams, PIs assume a strategic role. The PIs recorded throughout 8 months (between November 2021 and June 2022) in the community hospital wards in Powys, Wales, UK, using xPIRT (Pharmacy Intervention Recording Tool), a new pharmacy intervention record toolkit, were subjected to a retrospective analysis. The data were organised by location, drug, severity, acceptance, cost avoidance and intervention type. Significant prescribing errors were identified, which can potentially be different from those recorded in acute settings. Our results also informed on the need for integrated electronic prescribing systems paired with a PI recording tool to address effectively prescribing inaccuracies. Overall, this study was able to identify pharmacy teams as key to improve patient safety and care while contributing to significant cost-savings, through the recording of PI using xPIRT.

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

Cited by 37 publications

References 82 publications

Implementation of pharmacist‐led HIV pre‐exposure prophylaxis management to increase access to care at an academic internal medicine practice

Implementation of pharmacist‐led HIV pre‐exposure prophylaxis management to increase access to care at an academic internal medicine practice

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

Using xPIRT to Record Pharmacy Interventions: An Observational, Cross-Sectional and Retrospective Study

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