Role of the pharmacist in pre-exposure chemoprophylaxis (PrEP) therapy for HIV prevention

Abstract

With a global estimate of 2.5 million new infections of HIV occurring yearly, discovering novel methods to help stem the spread of the virus is critical. The use of antiretroviral chemoprophylaxis for preventing HIV after accidental or occupational exposure and in maternal to fetal transmission has become a widely accepted method to combat HIV.Based on this success, pre-exposure chemoprophylaxis (PrEP) is being explored in at-risk patient populations such as injecting drug users, female sex workers and men who have sex with men. This off-label and unmonitored use has created a need for education and intervention by pharmacists and other healthcare professionals.Pharmacists should educate themselves on PrEP and be prepared to counsel patients about their means of obtaining it (e.g. borrowing or sharing medications and ordering from disreputable Internet pharmacies). They should also be proactive about medication therapy management in these patients due to clinically important drug interactions with PrEP medications. Only one trial exploring the safety and efficacy of tenofovir as PrEP has been completed thus far. However, five ongoing trials are in various stages and two additional studies are scheduled for the near future. Unfortunately, studies in this arena have met with many challenges that have threatened to derail progress. Ethical controversy surrounding post-trial care of participants who seroconvert during studies, as well as concerns over emerging viral resistance and logistical site problems, have already halted several PrEP trials. Information about these early trials has already filtered down to affected individuals who are experimenting with this unproven therapy as an “evening before pill”. The potential for PrEP is promising; however, more extensive trials are necessary to establish its safety and efficacy. Pharmacists are well-positioned to play a key role in helping patients make choices about PrEP, managing their therapy, and developing policy with an eye towards the future.

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

“…Such agreements would require the advocacy of policy changes that expand pharmacists’ scope of practice in certain states [ 35 ]. Another common theme was the need to train pharmacists to properly provide patients with PrEP adherence counseling, sexual health counseling, and adverse side effect screening [ 77 , 80 , 82 , 89 – 91 ].…”

“…Comprehensive training of pharmacists, particularly the more experienced, could heighten their willingness to participate in PrEP-related interventions, including screening and identification of eligible individuals. Moreover, adequate PrEP training among pharmacy staff could potentially increase patient comfortability with PrEP prescription and counseling by pharmacists [ 46 , 89 ]. Following proper training, pharmacists could be integrated into PrEP clinics within community pharmacies through which they may conduct PrEP consultations and prescribe PrEP to eligible patients through CPAs.…”

Psychosocial Factors and HIV Prevention for Gay, Bisexual, and Other Men Who Have Sex with Men

“…PEP's success, combined with the use of ARV prophylaxis to prevent HIV transmission from mother to child during pregnancy and childbirth, led to the development of pre‐exposure prophylaxis (PrEP), an ARV medication that has since been shown to reduce the risk of HIV infection in uninfected individuals when used prior to possible exposure (e.g., Clauson, Polen, Joseph, & Zapantis, ). A recent meta‐analysis of seven PrEP RCTs from around the world (Jiang et al, ) reported protection rates ranging from 6% to 65%, with all but one study reporting at least 39%.…”

The Role of the Pharmacist in Pre-Exposure Prophylaxis

“…Since truvada is included in the first line treatment of HIV [10], there is a possibility of sharing amongst those using it as treatment for HIV and those using it for PrEP. The possible dangers of sharing medications include development of drug resistance or even treatment failure for the one who lends [11]. Pharmacists can also discuss the dangers of sharing or borrowing medications amongst patients.…”

“…With the recent advances of technology, internet pharmacies are now widespread and medicines can be purchased even without a prescription [11]. Before patients can use PrEP, they should be assessed as being at very high risk for HIV acquisition [13].…”