A Pharmacist-Led, Same-Day, HIV Pre-Exposure Prophylaxis Initiation Program to Increase PrEP Uptake and Decrease Time to PrEP Initiation

Abstract

Mississippi has one of the highest rates of HIV in the United States, but has low pre-exposure prophylaxis (PrEP) uptake, particularly among black men who have sex with men (MSM) and women. From November 2018 to May 2019, patients at high risk of HIV who tested negative for HIV at a nonclinical testing center in Jackson, Mississippi, were referred to an on-site clinical pharmacist for same-day PrEP initiation. The pharmacist evaluated patients for medical contraindications to PrEP, but no baseline labs were obtained. The pharmacist provided a PrEP prescription and scheduled a clinical appointment for patients within 6 weeks, at which time they were evaluated by a clinician and completed baseline labs. The pharmacist evaluated 69 patients for PrEP; 57% were MSM, 77% were black, and 65% were uninsured. All patients received a PrEP prescription; 83% received the prescription the same day and 97% received it within 5 days. Fifty-three (77%) of 69 clients filled the prescription; 87% of whom filled it within 1 week. Only 23 (43%) of 53 clients who filled their prescription attended their initial clinical appointment within 6 weeks of obtaining PrEP. There were no differences in PrEP initiation or retention by patient sex/gender. This pilot program suggests that an on-site pharmacist working in a nonclinical testing center in the southern United States can successfully initiate PrEP among predominately low-income black MSM. Future efforts should seek to better integrate laboratory testing into this demedicalized model of PrEP and to improve retention in care.

Acceptability and Feasibility of Pharmacy-Based Delivery of Pre-Exposure Prophylaxis in Kenya: A Qualitative Study of Client and Provider Perspectives

“…In recent years, standalone pharmacy-based PrEP delivery programs have been successfully implemented in select parts of the U.S. (e.g., Seattle, San Francisco, Miami, Denver, St. Louis, Jackson, and Omaha) [5,[19][20][21][22][23][24].…”

<p>Pre-Exposure Prophylaxis (PrEP) in the Prevention of HIV: Strategies, Target Populations and Upcoming Treatments</p>

“…Of those who received a prescription, 77% filled the prescription and 43% of them attended their first appointment within 6 weeks. 19 Similar pharmacist-led PrEP initiatives with positive results can be seen in other trials. [20][21][22] While expanding the role of a pharmacist does not remove all barriers to PrEP, it certainly can ease access.…”

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

“…Only three of such interventions included a control group [ 68 ]; the remaining studies evaluated newly implemented programs without comparison data. The most common intervention activity was pharmacist prescription of PrEP [ 69 – 74 ], which was well-received by patients [ 70 ]. Other activities included pharmacist facilitation of PrEP initiation via remote or telephone consultations with patients interested in PrEP [ 69 , 71 ].…”

“…Other activities included pharmacist facilitation of PrEP initiation via remote or telephone consultations with patients interested in PrEP [ 69 , 71 ]. Four studies were designed to initiate PrEP among eligible participants, achieving successful PrEP initiation among a range of 54%-100% of participants [ 69 – 72 , 74 ]. A separate study, which focused on retention, employed a PrEP Navigation (PN) tool to minimize the number of days between PrEP prescription and pickup, ultimately shortening this interval by 1.42 days [ 68 ].…”