Community Pharmacy-Based HIV Preexposure Prophylaxis and Nonoccupational Postexposure Prophylaxis Services in Thailand: A Mixed-Methods Study of Feasibility, Acceptability, and Service Design Requirements

Preexposure prophylaxis (PrEP) and nonoccupational postexposure prophylaxis (nPEP) are effective HIV prevention strategies, but timely access remains challenging. In Thailand, community pharmacies may improve access, but implementation evidence is limited. This preimplementation study assessed the feasibility and implementation readiness of community pharmacy-based PrEP and nPEP services in Thailand and identified the requirements for scalable implementation. A RE-AIM-informed convergent mixed-methods study was conducted. A nationwide online survey of urban participants at increased risk of HIV acquisition from all geographic regions of Thailand (n = 452) was integrated with in-depth interviews, focus group discussions, and stakeholder consultation meetings involving pharmacists, health care providers, policy stakeholders, health information system representatives, and civil society organizations. Quantitative data were analyzed using Stata, qualitative data using thematic analysis, and findings integrated through joint displays. PrEP and nPEP awareness were 76.4% and 71.9%, respectively; previous use was 57.7% and 29.9%, respectively. Preferred settings included private clinics (49.9%), public hospital-affiliated clinics (47.4%), public hospitals (36.7%), private hospitals (28.7%), and pharmacies (26.9%). If services were provided free of charge, 83.7% were willing to use pharmacies. Privacy and confidentiality concerns were the most common barriers (67.7%). These findings indicate conditional acceptability rather than demonstrated uptake of community pharmacy-based PrEP and nPEP services. Although community pharmacies were less preferred than several existing health care settings, high willingness under favorable conditions and stakeholder support suggest a potential complementary role, warranting pilot implementation and real-world evaluation.