Patient perspectives of pharmacists prescribing HIV pre-exposure prophylaxis: A survey of patients receiving antiretroviral therapy

BackgroundGroundbreaking new laws granting community pharmacists the authority to prescribe human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) medications have the potential to substantially expand PrEP access in high-risk communities. However, whether patients will be accepting of pharmacists as PrEP providers is underexplored within the literature.ObjectivesTo assess patient perspectives of pharmacist PrEP prescribing and identify potential barriers to acceptance of pharmacist-prescribed PrEP.MethodsAdult patients currently receiving antiretroviral therapy for HIV prophylaxis or treatment at a specialty pharmacy were surveyed telephonically from January 2020-April 2020. A 4-point Likert scale was used to measure perceptions in addition to open-ended questions.ResultsThe participation rate was 87.5%. Of the 49 included patients, 100% agreed/strongly agreed that pharmacists were knowledgeable about medications, but they were less likely to strongly agree that pharmacists were knowledgeable about HIV drugs (14.3% vs. 75.5% for other drugs, P < 0.001). Most (93.9%) of the patients agreed/strongly agreed that they would feel comfortable seeking a pharmacist for PrEP information or HIV testing. With respect to PrEP prescribing, 16.3% disagreed that they would feel comfortable having a pharmacist prescribe their first fill of PrEP, preferring to speak to their physician or expressing concerns that pharmacists have inadequate training. All patients expressed a desire for additional HIV/PrEP training requirements for pharmacists before allowing them to prescribe PrEP. A portion of the respondents (18.4%) expressed concerns that the increased availability of PrEP would lead to persons becoming lax about barrier protection. However, 100% of the patients agreed/strongly agreed that having pharmacist-prescribed PrEP would benefit their community.ConclusionPatients receiving antiretroviral therapy reported overall favorable perceptions of pharmacist PrEP prescribing; however, some concerns relating to pharmacists’ level of training in HIV exist. This may be ameliorated through increased pharmacist education, including how to counsel patients seeking PrEP on behavioral risk reduction.     

Pharmacy-based pre-exposure prophylaxis support among pharmacists and men who have sex with men

ObjectiveTo understand the perceptions and support for pharmacy-based pre-exposure prophylaxis (PrEP) delivery among pharmacists and men who have sex with men (MSM).DesignA qualitative study from April 2017 to December 2018.Setting and participantsThe researchers used purposive sampling to identify MSM participants and AIDSVu to identify pharmacists in high–human immunodeficiency virus (HIV) zip codes in the metropolitan Atlanta area. Eight MSM and 6 pharmacists consented to participate in the study.Outcome measuresPerceptions and support for PrEP delivery in pharmacies.ResultsBoth MSM and pharmacists expressed strong support for in-pharmacy PrEP screening and dissemination. MSM reported that pharmacies were more convenient and accessible compared with physician’s offices. However, they also noted that privacy and training of pharmacy staff were important for them to consider being screened for PrEP in a pharmacy. Pharmacists also believed training was important and felt comfortable counseling on HIV prevention for their current patients.ConclusionThese data support early evidence that pharmacies are a promising venue to improve PrEP access for MSM. To implement PrEP screening in pharmacies, proper training of pharmacy staff and a designated space to ensure privacy are critical. Future studies should test the feasibility of screening for PrEP in pharmacies for black MSM.     

Assessing the use of an infographic on pre-exposure prophylaxis for Wisconsin community pharmacists

BackgroundPre-exposure prophylaxis (PrEP) treatments reduce the risk of contracting human immunodeficiency virus (HIV). However, despite proven effectiveness, PrEP use remains low among populations at risk of contracting HIV. Successful PrEP uptake includes developing partnerships with health care providers to implement PrEP-related tools and interventions. Pharmacists are uniquely positioned health professionals who can provide PrEP services in the community, such as pharmacy-led PrEP clinics, to increase uptake, adherence, and retention. Unfortunately, prior evidence shows that not all pharmacists have enough knowledge about PrEP to provide effective care, resulting in low confidence and discomfort in PrEP-related patient consultations.ObjectivesThis study aimed to assess Wisconsin community pharmacists’ intentions of utilizing an infographic on PrEP for HIV prevention to educate themselves on PrEP and in consultations with patients starting PrEP.MethodsAn adaptative survey, using the Theory of Planned Behavior, was conducted to assess pharmacists’ intentions by measuring their attitudes, subjective norms, and perceived behavioral control. The Fisher exact tests were performed to examine associations between the 3 theoretical constructs against intentions.ResultsPharmacists reported high intentions of utilizing the infographic to educate themselves (62%) and counsel patients starting PrEP (54%). Their attitudes, subjective norms, and perceived behavioral controls were all significantly associated with their intentions. However, their intentions were reported lower than their attitudes, subjective norms, and perceived behavioral control, suggesting that additional factors may influence intentions that were not measured in this study.ConclusionThe results from this study demonstrate Wisconsin community pharmacists’ intentions of using an infographic on PrEP for HIV prevention in practice while measuring their attitudes, subjective norms, and perceived behavioral control. Future research is warranted to explore adapting and using the infographic to better understand its influence in improving pharmacy care among HIV-negative individuals.     

HIV pre-exposure prophylaxis: Exploring the potential for expanding the role of pharmacists in public health

Objectives

The study objectives were to a) assess knowledge and experience; b) describe perceptions and attitudes; and c) identify training needs of community-based pharmacists regarding HIV pre-exposure prophylaxis (PrEP).

Support and perceived barriers to implementing pre-exposure prophylaxis screening and dispensing in pharmacies: Examining concordance between pharmacy technicians and pharmacists

ObjectivesRecent legislation to expand pre-exposure prophylaxis (PrEP) screening and dispensing in pharmacies may significantly improve PrEP access for people at a high risk of human immunodeficiency virus (HIV) transmission. Studies have shown that pharmacists show wide support for PrEP expansion in pharmacies. However, pharmacy technicians are often the first point of contact for patients in pharmacies and are required to implement many of the tasks to ensure patients of a pharmacy receive adequate services. The purpose of this study was to assess pharmacists’ and pharmacy technicians’ perspectives regarding the implementation of PrEP screening and dispensing.MethodsWe qualitatively examined whether pharmacy technicians’ (n = 6) support and perceived barriers to screening and dispensing PrEP in pharmacies were concordant with those of pharmacists (n = 7). Pharmacy staff were recruited from high-risk HIV neighborhoods in Atlanta, GA using AIDSVu (Atlanta, GA). Two independent coders used MAXQDA (Berlin, Germany) and performed thematic data analysis and unitization to determine agreement.ResultsPharmacists and pharmacy technicians expressed strong willingness and support for screening and dispensing PrEP in pharmacies. Both groups expressed concerns about the time and the resources needed to perform PrEP screening and dispensing. Technicians, however, also reported concerns about privacy for patients, the need for community support and awareness of pharmacy-based PrEP screening, and recommended scheduling of PrEP screening activities during a limited part of the day to facilitate screening. Pharmacists reported fewer barriers but reported a need for more training of pharmacy staff to assist with PrEP screening and dispensing implementation.ConclusionPharmacy technicians discussed more barriers compared with pharmacists who were largely centered around practical considerations (i.e., logistics and workflow) that may affect the success of PrEP screening and dispensing. Given technicians’ pivotal role in the pharmacy, implementation of pharmacy-based PrEP services should address technicians’ perceived barriers in addition to those of pharmacists.     

Chemsex is not a barrier to self-reported daily PrEP adherence among PROUD study participants

BackgroundPre-exposure prophylaxis (PrEP) is a novel HIV prevention method whereby HIV-negative individuals take the drugs tenofovir and emtricitabine to prevent HIV acquisition. Optimal adherence is critical for PrEP efficacy. Chemsex describes sexual activity under the influence of psychoactive drugs, in the UK typically; crystal methamphetamine, gamma-hydroxybutyrate(GHB) and/or mephedrone. Chemsex drug use has been associated with increased HIV transmission risk among gay, bisexual and other men who have sex with men (GBM) and poor ART adherence among people living with HIV. This study assessed whether self-reported chemsex events affected self-reported daily PrEP adherence among PROUD study participants.MethodsThe PROUD study was an open-label, randomised controlled trial, conducted in thirteen English sexual health clinics, assessing effectiveness of Truvada^Ⓡ-PrEP among 544 HIV-negative GBM. The study reported an 86% risk-reduction of HIV from daily PrEP. Participants were asked about chemsex engagement at follow-up visits. Monthly self-reports of missed PrEP tablets were aggregated to assess adherence between visits. Univariable and multivariable regression analyses were performed to test for associations between chemsex and reporting less than seven out of seven intended doses(<7/7ID) in the 7 days before and/or after last condomless anal intercourse(CAI).Results1479 follow-up visit forms and 2260 monthly adherence forms from 388 participants were included in the analyses, with 38.5% visit forms reporting chemsex since last visit and 29.9% follow-up periods reporting <7/7ID. No statistically significant associations were observed between reporting <7/7ID and chemsex (aOR=1.29 [95% CI 0.90–1.87], p = 0.168). Statistically significant associations were seen between reporting <7/7ID and participants perceiving that they would miss PrEP doses during the trial, Asian ethnicity, and reporting unemployment at baseline.ConclusionsThese analyses suggest PrEP remains a feasible and effective HIV prevention method for GBM engaging in chemsex, a practise which is prevalent in this group and has been associated with increased HIV transmission risk.     

Awareness of and willingness to use HIV pre-exposure prophylaxis among community residents

IntroductionHuman Immunodeficiency Virus (HIV) Pre-exposure prophylaxis (PrEP) helps to decrease HIV acquisition and transmission rates. The purpose of this study was to assess awareness of HIV PrEP and willingness to use it, if available, among individuals residing in Buea, Cameroon.MethodsResidents in different communities throughout Buea, Cameroon participated in the study through survey completion with their responses assessed by age, marital status, highest level of education completed, profession, and health area (urban or rural).Results421 participants completed the survey with the majority being 20–29 years of age, single, having secondary or tertiary education, residing in rural Cameroonian areas. Eighty percent of respondents had not previously heard of HIV PrEP. Ninety-five percent of the study sample expressed willingness to use HIV PrEP, if available. Participants ages 40 years old and above were less aware of HIV PrEP than those 39 years old and younger. Primary education, serving in the role of a nurse, doctor, or scientist, along with hospital affiliations were characteristics closely associated with HIV PrEP awareness. Participants younger than 20 years old were less likely to report willingness to use HIV PrEP whereas married participants found HIV PrEP to be a more favorable option.ConclusionsAwareness of HIV PrEP was minimal with healthcare personnel having more familiarity. Willingness to use HIV PrEP decreased by age but higher among married participants. Further promotion of HIV PrEP and facilitating its accessibility can lead to less transmissions of HIV worldwide.     

Improving and validating a rating scale to assess student pharmacists’ perception of professional identity

BackgroundThere are limited data on the psychometric properties of instruments evaluating professional identity (PI) among student pharmacists.ObjectivesThis study analyzed the psychometric properties of an instrument to assess student pharmacists’ perception of their PI.MethodsData from a cross-sectional survey were used to establish validity and reliability evidence of student pharmacists’ perception of PI using Rasch analysis. Linear regression was conducted to evaluate the association of students’ characteristics with their perceived PI. Analyses were conducted in WINSTEPS (SWREG, Minnetonka, MN) and SAS (SAS, Cary, NC).ResultsThe analysis included 118 student pharmacists. Primary analysis suggested inadequate scale functionality; thus, some response categories were merged. With modified item anchors and the removal of the most misfitting item, the data fit the model as measured by student and item infit and outfit mean-squared values. The item-person map showed appropriate distribution of item difficulty, identifying medicine adviser and entrepreneur being the easiest and hardest items to agree with, respectively. Students’ abilities initially mismatched with item difficulty and exhibited a ceiling effect, requiring addition of items reflecting students’ higher perceptions of PIs. Although students’ reliability coefficient (RC) and separation index were 0.98 and 1.73, respectively, RC of the items was 0.94. Students who reported receiving formal PI training were 0.3 times more likely to have high perception of PI than those who did not report training.ConclusionThe instrument exhibited fair validity and reliability evidence for assessing the perception of PI among student pharmacists. Additional items to fill identified item gaps are needed to improve the instrument’s content validity.     

An observational survey assessing the extent of PrEP and PEP furnishing in San Francisco Bay Area pharmacies

BackgroundHuman immunodeficiency virus (HIV) remains prevalent in the United States despite medications that reduce the risk of infection, primarily pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP). In 2019, California authorized pharmacists to furnish PrEP and PEP under Senate Bill 159 (SB-159).ObjectiveAssess implementation of SB159 in San Francisco Bay Area community and mail-order pharmacies.MethodsWe conducted an observational, cross-sectional survey of independent community and mail-order pharmacies in the 9-county San Francisco Bay Area to identify those that were in the process of furnishing, actively furnished, or furnished under a collaborative practice agreement (CPA). We conducted interviews with furnishing pharmacies in April 2021, focusing on the barriers to and successes of implementation, as well as the impact of coronavirus disease 2019 (COVID-19), and qualitatively analyzed them.ResultsOf the 209 pharmacies contacted, 6 furnished under SB-159 (2.9%), 2 were in the process of furnishing under SB-159, and 1 furnished under a CPA. Six pharmacies and 7 pharmacists were interviewed. Barriers to implementation and furnishing included COVID-19, laboratory tests, lack of time and staff, cost to pharmacy, refill limitation, lack of patient awareness, difficulty arranging follow-up care, and vague wording of the policy. Facilitators to implementation included collaborations with clinics and health centers, privacy, increased accessibility, increased need in the patient population, and the pharmacy culture.ConclusionBarriers and facilitators to PrEP and PEP furnishing were consistent across pharmacies, suggesting strategies that could be replicated and potential improvements to SB-159.     

Pharmacists’ perspectives on HIV testing in community pharmacies

ObjectiveTo assess the feasibility, readiness, and acceptability of offering rapid human immunodeficiency virus (HIV) testing in community pharmacies.DesignQualitative study.SettingCommunity pharmacies in Indiana from May to September 2012.Participants17 licensed community pharmacists.InterventionSemistructured interviews among a convenience sample of community pharmacists.Main outcome measuresCommunity pharmacists’ self-reported attitudes toward rapid HIV testing in community pharmacies, perceptions of peer acceptability, and opinions about readiness for implementation of the practice in community pharmacies.ResultsParticipants accepted the idea of pharmacy-based HIV testing, describing it as accessible, convenient, and nonstigmatizing. Acceptability was closely linked to positive patient relationships and pharmacist comfort with consultation. Identified challenges to pharmacy-based HIV testing included staffing issues, uneasiness with delivering positive test results, lack of information needed to link patients to care, insufficient consulting space, and need for additional training. Participants indicated that peer beliefs about the acceptability of pharmacist-based HIV testing would vary but that more recently trained pharmacists likely would be more accepting of the practice.ConclusionMost participants felt that offering HIV testing was a reasonable addition to the evolving role of the community pharmacist, pending resolution of personal and institutional barriers.     

Media's effect on shaping knowledge,awareness risk perceptions and communication practices of pandemic COVID-19 among pharmacists

BackgroundCoronavirus disease (COVID-19), an infection of the zoonotic coronavirus, is presenting a healthcare challenge around the globe. This study aims to assess the levels of disease knowledge and risk perception among pharmacists. We also recognize predictors of risk perception and perceived media roles. Methods This is a questionnaire-base cross-sectional study. The questionnaire was developed on a web-based platform and invitations were sent to pharmacists nationwide to participate in the study using social media applications. Results A total of 486 pharmacists participated in this study, where females were dominant (78.6%, n = 382). Most (40.4%, n = 198) pharmacists scored 4 out of 5 in basic disease knowledge, and more than half were able to recognize common methods of spread. Risk was highly perceived among participants, and was predicted by gender, living area, and having children (p < 0,05). Frequency of watching the media and sources of information also influenced both risk perception and perceived media roles. Conclusion Disease awareness among pharmacists, as well as risk perception must be considered for effective risk communication planning. The role of media in shaping perceptions should also be carefully studied to encourage compliance with government containment measures and engagement in preventive behaviors.