Pharmacist-led HIV PrEP Programs Could Help Boost Access

Pharmacist-led HIV pre-exposure prophylaxis (PrEP) programs may help improve access to the treatment, especially in underserved areas, a new study suggests.

The study, published in Open Forum Infectious Diseases, enrolled 60 patients. The participants joined a pharmacist-led PrEP program in 2017 and completed 139 visits with pharmacists, who followed recommended guidelines in authorizing emtricitabine-tenofovir disoproxil fumarate prescriptions. The program was conducted at a university-based HIV clinic, a community pharmacy and 2 community-based clinics.

“Pharmacists are easily accessible at most community pharmacies and now are increasingly more present in the ambulatory clinic setting,” lead author Josh Havens, PharmD, BCPS, assistant professor in the University of Nebraska Medical Center’s College of Pharmacy and pharmacy director at Nebraska AIDS Drug Assistance Program, told Contagion^®. “Through the right training and professional relationships with medical providers with collaborative practice agreements, pharmacists can help to close the PrEP provider gaps and reinforce the recent shifts by the Trump administration to end the HIV epidemic. In the clinic setting, the implementation of PrEP services from an ambulatory care pharmacist could be easily done. Conversely, a pharmacist-led PrEP service from the community pharmacy setting could work but would pose challenges that would need to be abated in order to properly deliver PrEP care.”

Retention in the program at 3 months was 73%, followed by 58% at 6 months, 43% at 9 months, and 28% at 12 months. The authors called the drop-off in retention “disappointing” but noted that it was similar to retention rates found in studies of other PrEP programs. All of those who completed a patient satisfaction survey indicated that they would recommend the pharmacist-led PrEP program. Pharmacists also reported satisfaction with the program and rarely reported feeling uncomfortable (2.2%) or experiencing workflow disruptions (0.7%).

Challenges to these programs include pharmacist compensation for the services—as not all states allow pharmacists to bill for these services—and concerns about workflow disruptions and acceptance of the program. The community pharmacy also faced challenges with collecting and processing specimens to test for sexually transmitted infections (STI), and the study suggested such settings may be better suited for follow-up visits after initial prescriptions are issued.

“We had anticipated more participant involvement in our pharmacist-led PrEP program at the primary care clinic setting given the holistic care that would be offered,” Havens told Contagion^®. “However, participants have very little interest and ever worse retention. Additionally, we had mitigated the logistical challenges of STI collection and processing and the lack of point-of-care testing for HBV [hepatitis B virus] serology and RPR [rapid plasma regain] at the community pharmacy site prior to starting the study but did not recognize how hard it would be to coordinate these issues after the study.”

The idea warrants further study.

“Larger scale research studies exploring ways to alleviate the logistical challenges noted in our study would help to strengthen its applicability,” Havens told Contagion^®. “Additionally, studies evaluating PrEP persistence and sustainability within the pharmacist-led PrEP model are needed.”

Efforts to increase awareness and uptake of PrEP have been ongoing. Investigators have noted that only about 70,000 Americans have active PrEP prescriptions although 1.2 million individuals are believed to be at sufficient risk to warrant the treatment. New strategies to improve PrEP use have included alternative dosing, injectable drugs, implants, gels, vaginal films, and vaginal rings.

Increasing education about PrEP also has been a goal. A recent study suggested that pharmacy students need more education about PrEP to better understand the treatment. The study found that, while most students were aware of PrEP, they lacked knowledge about such things as dosing frequency, approved medication, and HIV testing requirements.