Implementation Determinants of HIV Testing and Pre-Exposure Prophylaxis in Community Pharmacies in Philadelphia, PA

Area of Science:

• Public Health
• Implementation Science
• Pharmacy Practice

Background:

• Community pharmacies are vital for expanding access to HIV testing and pre-exposure prophylaxis (PrEP).
• Few US pharmacies have successfully integrated these HIV prevention services.
• Philadelphia, an Ending the HIV Epidemic priority jurisdiction, faces challenges due to restrictive state laws.

Purpose of the Study:

• To investigate implementation barriers and facilitators for pharmacy-based HIV testing and PrEP initiation.
• To identify strategies for overcoming challenges in a state with restrictive pharmacy practice laws.

Main Methods:

• Sequential, exploratory mixed-methods study design.
• 15 in-depth interviews with pharmacists and partners.
• Online survey of 59 pharmacists, students, and technicians.
• Analysis using the Consolidated Framework for Implementation Research.

Main Results:

• HIV testing initiated at three sites, but no sites implemented PrEP.
• Barriers to HIV testing included workload and complex protocols.
• Legal restrictions and reimbursement issues were primary barriers to PrEP implementation.
• Potential solutions include collaborative agreements, standing orders, telePrEP integration, and champions.

Conclusions:

• Pharmacy-based HIV testing and PrEP initiation face significant implementation barriers.
• Addressing legal restrictions, reimbursement, and workflow integration is crucial for success.
• Tailored implementation strategies are needed to optimize sustainability and expand HIV services through pharmacies.