(1120) Prep up Pharmacies: Preliminary Evidence of a Feasibility Study for Pharmacist-led Same-day Pre-exposure Prophylaxis Screening and Dispensing

Objectives: nly 30% of the 1.2 million people indicated for pre-exposure prophylaxis (PrEP) to prevent HIV are prescribed. Poor access to PrEP, particularly for racially minoritized populations, are a major driver of low PrEP uptake and racial inequities in PrEP uptake and HIV. Pharmacies could drastically expand access to PrEP given their ubiquitous locations and flexible hours. Community pharmacists also show strong promise for being able to screen, prescribe and dispense PrEP. However, in the United States Southeast where HIV is disproportionately impacted, state legislation prevents pharmacists from doing so. We tested a same-day PrEP pharmacy model for the US Southeast at a community pharmacy in Atlanta, Georgia that fits within legislative limitations where pharmacy clients self-test for HIV and are prescribed PrEP via a telehealth prescription.

Methods: We recruited one community pharmacy in Atlanta, Georgia with the highest prevalence of HIV. Recruitment is ongoing for another pharmacy from a similar neighborhood. Pharmacy staff were trained on recruiting pharmacy clients into the research study (phase 1), HIV fundamentals including screening for PrEP (phase 2), and post-HIV testing counseling (phase 3). Pharmacy staff informed pharmacy clients about a short screener survey to determine study eligibility. Eligible pharmacy clients were age 18 and older and either reported 1) having sex in the past 6 months unprotected or with a HIV positive partner or 2) injecting drugs in the past 6 months. Eligible pharmacy clients were offered a 20-minute socio-behavioral survey, self-administered HIV test, and if HIV-negative, a 30-day telehealth prescription of PrEP with referral to a clinic for PrEP care or referral to HIV treatment services based on the outcome of the HIV test. Descriptive characteristics of the pharmacy clients were calculated for entry into each step of the pharmacy model.

Results: Overall, 247 pharmacy clients were approached about the study, and of those, about 26% (n=64) were willing to be screened for study eligibility. Most individuals (71.9%; 46/64) who screened for the survey were eligible indicating high HIV risk in the pharmacy client population. Of 46 pharmacy clients who agreed to participate, more than half (58.7%) were behaviorally eligible for PrEP and were recommended for HIV testing. However, HIV testing uptake was low (17.4%). Of those who performed self-HIV testing in the pharmacy (n=8), most were eligible for PrEP (88%) but declined to onboard because of low HIV risk perceptions. PrEP was initiated among one pharmacy client and one pharmacy client tested positive for HIV.

Conclusions: Preliminary evidence shows high feasibility of this model for pharmacy clients and pharmacy staff. While it is highly feasible to screen for and dispense same-day PrEP in a pharmacy, barriers to PrEP uptake among pharmacy clients who are at high HIV risk may persist because of low-risk perceptions. Future studies can test a strong pharmacist recommendation that educates pharmacy clients about PrEP and indications for individuals with specific risk behaviors to determine whether PrEP uptake is increased. Given that low risk perceptions are barriers to PrEP in other clinical settings, more work is needed educate the general population about PrEP and normalize PrEP and HIV risk. Pharmacies are a disease neutral site that could help normalize HIV with non-stigmatized chronic diseases. Thus, continued exploration of pharmacies as a site for HIV prevention resources is needed.