(1221) Community Pharmacy Sexually Transmitted Infections Test-to-treat Pilot Program

Objectives: The objective was to develop a community pharmacy-based sexually transmitted infection (STI) testing and treatment pilot program for chlamydia and gonorrhea. STI rates have been on the rise, however STI testing and treatment services are not widely accessible in all communities in the United States. Community pharmacies are highly accessible and are well-positioned to address the issue of rising STI rates by offering testing and treatment services in a convenient and non-stigmatizing way. Our implementation team included community pharmacists, clinicians and public health administrators from a local health department, and pharmacist researchers at a school of pharmacy. This pilot was funded by the National Association of City and County Health Officials and the Centers for Disease Control and Prevention.

Methods: Partners for this pilot program included an independent pharmacy, a local health department, and a university school of pharmacy. Policy and procedures, standing orders, patient education among other implementation enablers were co-developed by all partners. Stakeholders meetings occurred weekly or bi-weekly to facilitate implementation. Meeting minutes were taken to inform changes to the program, identify implementation strategies, and inform deliverables. Barriers and facilitators and our implementation outcomes (acceptability, adoption, feasibility, and fidelity) were assessed. Quantitative data analyzed were service utilization data to include the number of test kits distributed, positivity rates for chlamydia and gonorrhea, and number of patients who received treatment at the pharmacy. Qualitative data sources included patient satisfaction surveys after receiving treatment and stakeholder meeting minutes. Qualitative data was triangulated with quantitative data to evaluate implementation outcomes.

Results: The pilot program allows Allegheny county residents age 18 and older to order self-collection STI test kits to be delivered to their home or to the pharmacy. Individuals who test positive can choose to go to the local health department clinic or community pharmacy for treatment. Since program launch in November 2022, 1158 test kits were ordered and results were recorded for 418 of these kits. Four percent of the kits tested positive for chlamydia and 2% for gonorrhea. Two patients tested positive for both. Four patients chose to receive treatment at the pharmacy through the use of a standing order. Patient surveys found that the service provided by the pharmacist were “respectful and and made [them] comfortable”, more accessible [than other settings] because of extended hours. Restrictive collaborative practice regulation, difficulty granting pharmacy access to electronic health records were barriers, however regular and open communications between stakeholders help facilitate implementation. Uptake of testing kits and patient treatment at the pharmacy demonstrated program acceptability and adoption. On-going stakeholder meetings allow the implementation team to continue to triage this pilot program’s feasibility and fidelity in real time.

Conclusions: This novel STI test-to-treat program demonstrates that pharmacies can serve as accessible locations in the community. This pilot program opens the door for community pharmacies to make a public health impact to reduce or prevent the rising spread of STIs. Availability of STI test-to-treat programs may address certain social determinants of health, by improving health care access and reducing transportation barriers, and the stigma that patients with STIs may face. More pharmacies should consider partnering with local health departments and providers on test-to-treat services as an enhanced clinical service. Next steps for this pilot include expansion of testing to include additional STIs and adding additional pharmacy locations. Financial sustainability of these services will continue to be explored.