Opportunities to Increase Access to HIV Prevention: Evaluating the Implementation of Pharmacist-Initiated Pre-exposure Prophylaxis in California

Lauren A Hunter; Laura J Packel; Pooja Chitle; Raiza M Beltran; Sally Rafie; Loriann De Martini; Betty Dong; Orlando Harris; Ian W Holloway; Ayako Miyashita Ochoa; Sandra I McCoy

doi:10.1093/ofid/ofad549

Opportunities to Increase Access to HIV Prevention: Evaluating the Implementation of Pharmacist-Initiated Pre-exposure Prophylaxis in California

Open Forum Infect Dis. 2023 Nov 3;10(11):ofad549. doi: 10.1093/ofid/ofad549. eCollection 2023 Nov.

Authors

Affiliations

¹ School of Public Health, Division of Epidemiology, University of California, Berkeley, Berkeley, California, USA.
² Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA.
³ Birth Control Pharmacist, San Diego, California, USA.
⁴ University of California, San Diego Health, San Diego, California, USA.
⁵ California Society of Health-System Pharmacists, Sacramento, California, USA.
⁶ School of Pharmacy, University of California, San Francisco, San Francisco, California, USA.
⁷ School of Nursing, University of California, San Francisco, San Francisco, California, USA.

Abstract

Background: Pharmacies are a promising setting through which to expand access to human immunodeficiency virus (HIV) prevention, including pre-exposure and post-exposure prophylaxis (PrEP and PEP, respectively). We aimed to evaluate and inform the implementation of California's Senate Bill 159 (2019), allowing pharmacists to independently prescribe PrEP and PEP.

Methods: From October through December 2022, we conducted a cross-sectional study of 919 California pharmacists and pharmacy students, primarily recruited via the email listservs of professional organizations. Participants completed an online survey assessing the implementation of pharmacist-initiated PrEP/PEP, including knowledge, attitudes, practices, perceived barriers, and implementation preferences elicited through a discrete choice experiment.

Results: Among 919 participants (84% practicing pharmacists, 43% in community pharmacies), 11% and 13% reported that pharmacists at their pharmacy initiate PrEP and PEP, respectively. Most believed that pharmacist-initiated PrEP/PEP is important (96%) and were willing to provide PrEP (81%); fewer (27%) had PrEP/PEP training. Common implementation barriers were lack of staff/time and payment for pharmacist services. Participants preferred PrEP implementation models with in-pharmacy rapid oral HIV testing and pharmacists specifically hired to provide PrEP services.

Conclusions: Despite pharmacists' supportive attitudes, Senate Bill 159 implementation in California pharmacies remains limited, in part due to policy-level and organizational-level barriers. Ensuring PrEP/PEP-related payment for services and sufficient workforce capacity is key to leveraging pharmacists' role in HIV prevention.

Keywords: California; HIV prevention; pharmacies; post-exposure prophylaxis; pre-exposure prophylaxis.

Abstract

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