Pre-exposure and post-exposure prophylaxis access in rural versus urban pharmacies in Georgia and Pennsylvania

Yasaswi Kislovskiy; Natalie Pino; Natalie D Crawford; Tierney Woitas; Shannon Cason; Anushka Konka; Tierra Kimble; Iris Olson; Dan Villarreal; Marian Jarlenski

doi:10.1016/j.japh.2024.102084

Pre-exposure and post-exposure prophylaxis access in rural versus urban pharmacies in Georgia and Pennsylvania

J Am Pharm Assoc (2003). 2024 Apr 2:102084. doi: 10.1016/j.japh.2024.102084. Online ahead of print.

Authors

Affiliations

¹ Drexel University, College of Medicine, Department of Obstetrics and Gynecology, Philadelphia, PA; Department of OB/GYN & Women's Institute, Allegheny Health Network, Pittsburgh, PA. Electronic address: dr.kislovskiy@gmail.com.
² University of Pittsburgh School of Medicine, Pittsburgh, PA.
³ Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA.
⁴ University of Pittsburgh, Department of Linguistics, Pittsburgh, PA.
⁵ The University of Georgia College of Pharmacy, Augusta, GA.
⁶ University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA.
⁷ Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, PA; Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA.

PMID: 38574992
DOI: 10.1016/j.japh.2024.102084

Abstract

Background: Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) prevent HIV among individuals at high risk for acquisition. Pre-existing structural barriers to PrEP/PEP access among rural patients may be exacerbated further if pharmacies do not keep PrEP/PEP in stock, constituting a significant barrier to mitigating the HIV epidemic.

Objectives: To compare PrEP/PEP availability for same-day pickup in rural vs urban Georgia and Pennsylvania pharmacies.

Methods: We conducted a cross-sectional simulated patient caller study, calling pharmacists in Georgia and Pennsylvania to see whether PrEP/PEP was available for same-day pickup. We identified retail pharmacies through state pharmacy boards and categorized rurality using state-based definitions. We used multivariable logistic regression to assess PrEP availability by rurality and Ending the HIV Epidemic (EHE) designation, accounting for chain pharmacy status and county-level racial composition.

Results: Among 481 pharmacies contacted (304 in Pennsylvania and 177 in Georgia), only 30.77% had PrEP for same-day pickup and only 10.55% had PEP for same-day pickup. PrEP availability did not differ significantly by state. Urban pharmacies had 2.02 (95% CI: 1.32-3.09) greater odds of PrEP same-day availability compared to rural pharmacies. Pharmacies in EHE counties had 3.45 (95% CI: 1.9-6.23) times higher odds of carrying PrEP compared to non-EHE counties.

Conclusions: Pharmacies were unlikely to carry PrEP or PEP. Pharmacies in rural compared to urban, and non-EHE compared to EHE locations were less likely to carry PrEP. Addressing pharmacy barriers to PrEP/PEP may enhance access to HIV prevention for those living at high risk of HIV.