Evaluating the role of pharmacists in providing care with long-acting injectables for HIV and PrEP

Ending the HIV epidemic remains a global public health priority, with ongoing efforts to minimize infections by 2030. Pharmacists play a crucial role in managing HIV prevention (PrEP) with cabotegravir (CAB) and treatment with cabotegravir/rilpivirine (CAB/RPV) by optimizing antiretroviral (ARV) therapies and adherence. An Ohio-based not-for-profit organization with health care clinics and in-house pharmacies has implemented a pharmacist-led program managing long-acting injectable antiretrovirals (LAI-ARVs) using collaborative practice agreements (CPAs) with clinic providers. The innovative workflow addresses LAI-ARV implementation challenges and leverages pharmacist expertise to optimize patient care.

The primary objective of this study is to evaluate the role of ambulatory care pharmacists in a LAI-ARV program by describing approval/denial to the program after primary care provider referral. The secondary objective is to quantify the ambulatory care pharmacist interventions during HIV treatment/PrEP LAI program Referral Review.

A CPA was developed at 5 clinic locations to implement a pharmacist-led LAI-ARV program for the treatment and prevention of HIV. Referral data were retrospectively reviewed to assess approval or denial of potential injectable candidates and to describe pharmacist interventions.

Out of the 1103 referrals reviewed, 893 were approved and 210 were denied. CAB/RPV referrals had more denials due to safety and efficacy concerns. Of the 893 approved referrals, 264 required at least one clinical intervention to address logistic, safety, and efficacy considerations before initiation of LAI-ARV. Pharmacist interventions often address safety concerns such as hepatitis B virus risk, drug interactions, and risk of in adherence to appointments.

This study highlights the impact of pharmacist-led processes in optimizing LAI-ARV therapy through patient-specific evaluation and clinical interventions. Pharmacist involvement ensures appropriate candidate selection, safe therapy implementation, and supports the broader public health efforts to reduce HIV transmission and end the HIV epidemic.