Feasibility of pharmacy-delivered patient navigation + virtual buprenorphine + HIV services

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Pharmacies are nationally emerging as frontline public health practicing spaces due to their ubiquity, accessibility to medication and screening, and rapid scalability. Independent pharmacies, in particular, have successfully expanded services with greater ease due to the absence of corporate restrictions, including delivery of harm reduction services. Today, linkage to and retention in buprenorphine treatment and HIV prevention and care remains suboptimal in many underserved, HIV burdened communities. The goal of this application is to further expand public health pharmacy practice by exploring on-demand harm reduction services delivered by pharmacy staff in two communities experiencing healthcare system and local community-based services disruptions during COVID-19 (i.e., Harlem and South Bronx in New York City). Building upon two decades of disparities-focused pharmacy-based intervention research via Pharm-Link Studies (2001-2021), and due to recent innovations including telemedicine-based buprenorphine treatment, our team leveraged the NYC Health+Hospitals Virtual Buprenorphine Clinic (VBC) to investigate Pharm-Link/VBC+ which entails in- pharmacy delivery of opioid use disorder (OUD) services (i.e., low-threshold access to telemedicine-based buprenorphine treatment initiation, naloxone dispensation/overdose prevention counseling) linked with HIV services access (i.e., HIV testing/ counseling, PrEP/PEP dispensation, HIV treatment re/initiation) for community/hospital EHR-recruited PWUO. Pharm-Link/VBC+ will also include public health-minded pharmacy staff trained in harm-reduction and social determinants of health-focused patient navigation (SDH-PN) based on use of a SDH checklist and fostered partnerships between pharmacy and community-based services staff. In brief, the specific aims for this developmental R34 proposal are to: (Aim 1) Develop Pharm-Link/VBC+ using in- depth interviews among 3 stakeholder groups (n=10 per group): frontline providers (pharmacists/ technicians/ clerks, buprenorphine prescribers, HIV providers, community-based organization providers), administrators (pharmacy administrators, health department officials), and PWUO with OUD treatment history; (Aim 2) Assess feasibility and usability of implementing Pharm-Link/VBC+ using (a) semi-structured surveys (baseline, 6-, and 12-weeks) among PWUO (n=30) across 3 sequential waves (n=10 per 12-week wave); and (b) administrative data collected from the study pharmacies and Bellevue Hospital EHR; and (Aim 3) Finalize Pharm-Link/VBC+ for R01 scale-up using focus groups (n=3; 6-8/group) among same 3 stakeholder groups, utilizing findings from Aim 2; and conducted and analyzed sequentially such that each group informs the next. These Aims will be accomplished through existing partnerships with two Black-owned independent pharmacies with demonstrated research capacity. Bolstering multi-sectoral approaches to OUD/HIV services infrastructure in low-income Black and Latinx communities experiencing escalating rates of opioid overdose deaths and high HIV burden aligns with federal guidelines to reduce health inequities among PWUO.