Using implementation science to evaluate perceived feasibility of pharmacy-based HIV services in the Southeastern...

The Southern United States accounts for over half of new HIV diagnoses despite representing just over one-third of the population and remains a priority region in the Ending the HIV Epidemic (EHE) initiative. Community pharmacies are accessible, trusted health care sites with potential to expand HIV prevention services, yet limited evidence exists on pharmacy staff perspectives across the Southeast.

Guided by the Consolidated Framework for Implementation Research (CFIR), we assessed implementation related factors and demographic characteristics to identify correlates of perceived feasibility of tailoring HIV services to community pharmacies in EHE priority counties across eight Southeastern states.

We conducted a cross-sectional survey (November 2023-June 2025) of community pharmacy staff in eight Southeast states. Eligible participants were recruited from independent and chain pharmacies using the National Council for Prescription Drug Programs database. Survey items, informed by CFIR, captured constructs across intervention characteristics, outer setting, inner setting, and characteristics of individuals. The primary outcome was perceived feasibility of tailoring HIV services (yes/no). Descriptive statistics summarized all variables, chi-square and Fisher's exact test examined bivariable associations, and modified Poisson regression with robust standard errors estimated adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs).

Of 291 respondents, 48.8% perceived that it was feasible to tailor HIV services to their pharmacy. In adjusted models higher feasibility was associated with being Asian (PR = 1.51; 95% CI: 1.17-1.96) or Black (PR = 1.37; 95% CI: 1.15-1.62), having a private area available for HIV testing (PR = 1.36; 95% CI: 1.01-1.84) and perceiving that there is enough evidence to support HIV testing in pharmacies (PR = 2.12; 95% CI: 1.32-3.58).

Guided by the CFIR, perceived feasibility of pharmacy-based HIV services was strongly associated with intervention characteristics and inner setting factors. Strengthening evidence dissemination and addressing structural barriers may be critical for advancing scalable, pharmacy-based HIV prevention in the US Southeast.