Study | Location | Results |
End users | ||
Begnel et al24 | Kenya | When asked whether someone would be most likely to obtain PrEP at a clinic, pharmacy, kiosk or other location, 44% chose clinics, 37% chose pharmacies, 17% chose kiosks and 1% chose other. |
Crawford et al25 | USA | Most participants (69%) were willing to discuss PrEP with pharmacy staff and 61.35% were willing to be screened for PrEP in pharmacy. There were no differences by race, after accounting for PrEP interest. |
Crawford et al26 | USA | Most MSM supported in-pharmacy STI, HIV and PrEP screenings and dissemination. Benefits included convenience and accessibility. Participants wanted to ensure privacy, confidentiality and welcoming staff for MSM. |
Havens et al21 | USA | At 6-month follow-up, all of the survey respondents stated they would definitely recommend the P-PrEP programme. |
Lutz et al27 | USA | 93.9% were comfortable seeing a pharmacist to discuss PrEP, and 93.9% were comfortable having a pharmacist test for HIV before starting PrEP; 83.7% were comfortable having a pharmacist prescribe PrEP, although only four participants (8.2%) strongly agreed. |
Minnis et al28 | South Africa | In this discrete choice experiment about hypothetical long-acting PrEP options, ‘where PrEP is available’ was relatively less important than other attributes such as dosing frequency, pain or injection site. Females preferred using a product that was offered at a health clinic over accessing it at a pharmacy (p<0.001). Among males, men who have sex with women only had somewhat more preference for availability at a community location compared with a pharmacy and health clinic, whereas MSM held opposite views with pharmacy or health clinic preferred over a community location (p=0.01). |
Zhu et al29 | USA | Most participants supported pharmacists prescribing PrEP (mean 4.0 (SD=1.0), range 3.9–4.1 on a scale of 1–5 with 5 strongly agree). Most (58.1%) had no concerns; the most common concerns were ‘prefer to obtain a prescription from my doctor’ (16.2%) and ‘privacy concerns’ (15.4%). Participants were more likely to support pharmacy PrEP if they had previous interactions with pharmacists or if they had previously used PrEP (vs non-users). |
Pharmacists and other professional stakeholders | ||
Broekhuis et al30 | USA | Respondents were ‘moderately concerned’ or ‘very concerned’ about the following issues: time burden (61%), inadequate compensation for services (55%), outside skill set (39%), patient adherence to therapy (63%), loss to follow-up (56%) and promotion of antiretroviral drug resistance (51%). |
Crawford et al26 | USA | Although STI, HIV and PrEP services were not currently available, all pharmacists expressed considerable support for providing these services within their pharmacies. |
Havens et al21 | USA | The P-PrEP pharmacists felt comfortable performing point-of-care testing at all visits except on one occasion (0.7%, 1 of 139). One pharmacist at the community pharmacy site reported three occasions (2.2%) in which they felt uncomfortable conducting sexual histories during P-PrEP follow-up visits. Workflow disruption at the community pharmacy site was reported only once (0.7%) throughout the study. |
Hopkins et al31 | USA | Pharmacists and pharmacy technicians expressed strong willingness and support for screening and dispensing PrEP in pharmacies. Both groups expressed concerns about the time and the resources needed to perform PrEP screening and dispensing. Technicians also reported concerns about privacy for patients as well as the need for community support and awareness of pharmacy-based PrEP screening, and they recommended scheduling of PrEP screening activities during a limited part of the day to facilitate screening. Pharmacists reported fewer barriers but a need for more training of pharmacy staff to assist with PrEP screening and dispensing implementation. |
Koester et al32 | USA | Participants felt benefits included accessibility (longer pharmacy hours and accessible staff and locations), access to refill data to council on adherence and alignment with other medications already given by pharmacists. Barriers included questions about who would cover costs and potential lack of privacy and training. Medical providers were not entirely supportive of expanding the pharmacists’ scope of practice to include PrEP due to concerns about training to handle potential complications or other health issues that might present. |
Ortblad et al33 | Kenya | Stakeholders were enthusiastic about a model for pharmacy-based PrEP delivery. Potential challenges identified included insufficient pharmacy provider knowledge and skills, regulatory hurdles to providing affordable HIV testing at pharmacies and undefined pathways for PrEP procurement. Potential solutions included having pharmacy providers complete the Kenya Ministry of Health-approved PrEP training, use of a PrEP prescribing checklist with remote clinician oversight and provider-assisted HIV self-testing and having the government provide PrEP and HIV self-testing kits to pharmacies during a pilot test. |
MSM, men who have sex with men; P-PrEP, pharmacist-led PrEP; PrEP, pre-exposure prophylaxis; STI, sexually transmitted infection.