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

Delivering HIV testing and pre-exposure prophylaxis (PrEP) in community pharmacies can expand access to HIV services for populations with limited access to care. However, few pharmacies in the United States have successfully implemented these services. We investigated implementation barriers and facilitators of pharmacy-based HIV testing and PrEP initiation in Philadelphia, an Ending the HIV Epidemic priority jurisdiction with high rates of HIV and bacterial STIs, located in a state with relatively restrictive laws governing pharmacy scope of practice. Using a sequential, exploratory mixed-methods study design, we conducted 15 in-depth interviews with pharmacists and key implementing partners, followed by an online survey of pharmacists, pharmacy students, and technicians (n = 59). Interviews and surveys were analyzed using the Consolidated Framework for Implementation Research. Data were collected from October 31, 2023, to October 17, 2024. Interviewees representing three pharmacy sites had initiated HIV testing, but no sites had yet successfully implemented pharmacy-based PrEP. The primary barriers to delivering HIV testing were based on inner setting barriers (existing work burden, overly complex protocols). Legal restrictions and reimbursement concerns were the primary barriers to implementing pharmacy-based PrEP. Participants described potential solutions and mitigating strategies to these barriers, such as collaborative practice agreements and developing standing orders with medical providers, integration with telePrEP models, streamlined blueprints and protocols, and practice-based champions. Survey respondents indicated high levels of acceptability but lower levels of perceived implementation feasibility. To optimize implementation sustainability and success, implementation strategies need to adequately address legal barriers and reimbursement concerns and be integrated into the pharmacy workflow.