One-stop sexual health: PrEP services at your local pharmacy
BETA is reporting from the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) this week in Seattle—bringing you the latest news, updates, and research on HIV treatment and prevention.
Over a million adults in the U.S. could benefit from the HIV-prevention method of pre-exposure prophylaxis (PrEP), yet estimates have found that less than 100,000 people in the U.S. are currently accessing PrEP. Part of the problem may be due to the limited number of PrEP-friendly providers across the nation—health centers and clinicians who are familiar with, and willing, to provide PrEP services. Pharmacists—who work across centers that range from community clinics, to pharmacies in grocery stores, to stand-alone retail centers—may be an untapped resource as potential PrEP service providers.
This was the subject up for discussion at a recent session at CROI, where two presenters shed light on the feasibility of pharmacist-delivered PrEP services.
A One-Step PrEP program that works
Elyse Tung, a pharmacist from the University of Washington, shared a model of care called “One-Step PrEP.” The program operates under a Collaborative Drug Therapy Agreement (CDTA), which allows pharmacists to provide patient care services under the supervision of a physician medical director. Pharmacists do initial PrEP screenings, counseling, prescribing and dispensing, all routine follow-up care, and all sexually transmitted infection (STI) testing and treatment.
“It was implemented at Kelley-Ross Pharmacy, which is actually located right here in Seattle, about four blocks from here. What One-Step PrEP allows is for patients to walk into the pharmacy, see a pharmacist, get all their initial screens completed, and if they qualify, walk out of the pharmacy with medication in hand,” said Tung.
In the first year of the One-Step PrEP program’s operation, from March 2015 to March 2016, 245 clients initiated PrEP at the pharmacy. Only 57 patients reported already having a primary care physician when they first received services, which suggests that the pharmacy was reaching a patient population that wasn’t established in medical care elsewhere. Most people who accessed PrEP through the pharmacy were men who have sex with men (84%) and over a quarter (28%) reported having a partner living with HIV.
The One-Step PrEP program detected and treated sexually transmitted infections during the 1-year study period, including chlamydia, gonorrhea and syphilis. Most (75%) clients stayed in the program for the duration of the study. Out of the 25% of people who did discontinue PrEP services at the pharmacy, most did so because of insurance restrictions, said Tung.
Almost all (97%) of the PrEP clients paid nothing for their PrEP medication, said Tung, explaining that dedicated PrEP staff at the pharmacy helped patients take advantage of state-funded and industry-funded patient assistance programs.
Tung also reported that one goal of the study was to determine the financial viability of the PrEP program—in other words, the clinic’s costs versus its revenues. “A return on investment was seen at 8.4 months [after the clinic opened],” said Tung.
“In conclusion,” said Tung, “A pharmacy-run HIV PrEP clinic in a community setting is feasible through CDTA. There was a higher than expected response from men who have sex with men. This clinic does identify an unmet need with more than sufficient patient demand to support such services.”
Are pharmacists willing to provide PrEP?
Jordan Broekhuis, from the University of Nebraska, described a separate study with pharmacists in the Midwest—Nebraska and Iowa—who answered completed surveys about their knowledge and attitudes toward prescribing PrEP.
A total of 140 pharmacists took the survey. More than half (58%) reported working in an urban setting, 30% reported working in a rural area, and 12% reported working in a suburban area. Only 9% reported having specialty training in infectious diseases.
Less than half of pharmacists surveyed (42%) were familiar with the use of FTC/TDF (Truvada) as PrEP. A quarter (25%) were aware of the current CDC guidelines for PrEP use. Respondents who were older, and in practice longer, were significantly less likely to be familiar with the use of PrEP.
Over half (54%) of the sample said they were “fairly likely” or “very likely” to provide PrEP services to clients at risk for HIV. Slightly less than 20% of those surveyed said they were “not at all likely” to be willing to provide PrEP services.
Broekhuis asked pharmacists who took the survey to weigh in about their concerns about providing PrEP. Over 50% of respondents were “moderately” or “very” concerned about the following issues: drug resistance, disruption to the workflow, losing clients to follow-up, inadequate compensation, time burdens, and adherence to medications.
“Most [pharmacists] were willing to provide PrEP through this model of a collaborative practice agreement, under a protocol physician,” said Broekhuis. “Provision of PrEP-focused continuing education may lead to increased willingness to participate in PrEP programs.”
Return to BETA all this week for continued CROI coverage and more PrEP news.