California HIV/AIDS Research Program

Objective: Increasing access to human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) is a high priority for the Ending the HIV Epidemic Initiative. Expanding access to PrEP and PEP through a variety of health care settings, including community pharmacies, may increase access in communities most in need. California is the first state to allow community pharmacists to furnish PrEP and PEP directly to consumers. Our objective was to assess attitudes among key stakeholders about a California policy to allow community pharmacists to furnish HIV PrEP and PEP.

Methods: We conducted a qualitative case study with key pharmacy stakeholders. Semi- structured phone interviews were audio-recorded and transcribed verbatim. We generated analytical memos for each interview and working with these analytical memos, we conducted a constant comparison across cases to identify commonalities and differences.

Results: We launched the study in October 2018 and interviewed pharmacists (n 1⁄4 7) working in a variety of settings, including retail-, clinic-, and community-based pharmacies. We also interviewed medical providers (n 1⁄4 2) working in high-volume PrEP clinics and sought input from representatives of large retail chain pharmacies (n 1⁄4 2). Overall, pharmacists and medical provider informants shared similar opinions about the central benefits as well as the key challenges related to pharmacist-delivered PrEP and PEP services. Benefits included: com- munity pharmacists are widely accessible, PrEP and PEP protocols are similar to other pre- ventative medications, policy may lead to efficiencies in the health care workforce, and community pharmacists are authorities on medication adherence. Challenges included: implementation issues may limit pharmacist involvement, and missed opportunities to di- agnose and treat other health conditions.

Conclusion: This study characterizes the types of benefits and challenges that can be expected when PrEP and PEP prescribing privileges are extended to community pharmacists. This in- formation may be useful to policymakers and other stakeholders considering legislation to permit direct prescription of PrEP and PEP by pharmacists.