Advancing pre-exposure prophylaxis (PrEP) access in pharmacies to improve PrEP uptake in disadvantaged areas

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Abstract Optimizing the reach of pre-exposure prophylaxis (PrEP) access for black men who have sex with men (BMSM) is critical to reduce racial inequities in HIV. The overall objective of this R34 application is to develop a culturally appropriate pharmacy PrEP delivery model and examine its feasibility, acceptability, and safety for BMSM who live in high poverty, racial minority neighborhoods. Cohen’s structural theory supports our central hypothesis that increased availability of PrEP screening and prescribing in neighborhoods where BMSM are most impacted by HIV will facilitate PrEP uptake. Findings from the proposed pilot study will support the long- term goal of this program of research, which is to implement an R01 cluster randomized efficacy trial in high poverty, racial minority neighborhoods to increase PrEP uptake among BMSM and reduce racial inequities in HIV. The aims of this R34 feasibility study are to: Aim 1) develop a pharmacy PrEP delivery model by evaluating the barriers to and facilitators of integrating PrEP into existing pharmacy practice among 40 key stakeholders (pharmacists, technicians, PrEP-prescribing physicians and BMSM) and Aim 2) pilot test the pharmacy PrEP delivery model and examine its feasibility, acceptability and safety, and gather early evidence of its impact and cost with respect to PrEP uptake at baseline and in 3-months among BMSM. To accomplish these aims we will conduct a formative phase of in-depth interviews among key stakeholders to inform the intervention development phase, which will establish a pharmacy PrEP delivery model with formalized input from an existing advisory board to be implemented in the pilot study phase among 2 community pharmacies, where we have existing relationships. Pharmacists (n=2) and technicians (n=6) will be trained using an adapted continuing education certified in-pharmacy HIV prevention training. They will complete semi-structured surveys over time (baseline, 3-month and 6-month) to assess the impact of the pharmacy PrEP intervention on pharmacy environment, personnel, and business flow. Social, behavioral surveys will be completed by 60 BMSM. We will follow behaviorally eligible BMSM, who complete their own biological screening in the pharmacy and receive PrEP (n=20) to determine PrEP uptake at 3-months. Development and refinement of this pharmacy PrEP delivery model is significant because it will lay the foundation for pharmacy-based PrEP access that reaches populations historically disconnected from HIV prevention resources. The innovation of this studies lies in its ability to shift the current paradigm of PrEP service delivery for BMSM by 1) creating a model that is achievable for most pharmacists even if they have limited pharmacy-level resources to screen men for PrEP, 2) employing a multi-level approach that examines the impact of the intervention on pharmacy staff and BMSM and 3) testing the use of self-screening in the pharmacy setting.