Patient perception of community pharmacists prescribing pre-exposure prophylaxis for HIV prevention

ObjectiveThe primary objective of this study was to determine patients’ perceptions of pharmacists prescribing pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention.DesignAn anonymous, 26-item, cross-sectional survey was administered to individuals and data collection occurred during a 12-week period from January to March 2019.Setting and participantsIndividuals were recruited to complete the survey in person at 5 locations of a large grocery-chain pharmacy in Washington, D.C. and Maryland. Inclusion criteria included individuals who were at least 18 years old and able to read and write English. Exclusion criteria included persons living with HIV or acquired immunodeficiency syndrome.Outcome measuresIn order to measure perception, participants were asked on the survey to select their level of agreement using a Likert scale from 1 to 5 (1 = strongly disagree, 5 = strongly agree). Researchers analyzed overall perception in addition to differences in perception based on various demographic characteristics.ResultsIn total, 117 surveys were collected and analyzed. Most participants were comfortable with pharmacists prescribing PrEP. Notable statistically significant findings included participants who interacted with pharmacists through medication therapy review (4.4, 3.1 [P < 0.05]) and vaccinations (4.3, 3.1 [P < 0.05]) were more likely to agree with pharmacists prescribing PrEP than participants who had no previous interactions with pharmacists. Participants who had previously used PrEP were more likely to agree with pharmacists prescribing PrEP than those who had not used PrEP before.ConclusionThis study provided a glimpse into patients’ perceptions of pharmacists prescribing PrEP. Patients were generally favorable of pharmacists prescribing PrEP; however, there are still barriers to overcome before prescribing PrEP for HIV prevention can feasibly occur in the community setting.     

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.     

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).

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.     

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.     

Implementation and evaluation of an interprofessional physical assessment skills workshop for Wisconsin pharmacists

BackgroundPharmacists have a critical, expanding role in health care delivery. In particular, pharmacists in community pharmacy and ambulatory care settings are important and frequent access points for health care services.ObjectiveWe describe the interprofessional development and implementation of an interactive, broadly applicable physical assessment skills–based continuing pharmacy education program to provide an avenue for the attainment of this warranted set of skills for pharmacists who desire to provide advanced patient care services in their respective practices.MethodsPharmacists, in collaboration with family medicine and emergency medicine physicians, developed workshop content, design, and flow. The structure of the workshops consisted of didactic training, hands-on practical application, simulated practice, and case-based certification examinations.ResultsOn a postworkshop survey, all respondents answered “agree” or “strongly agree” when asked if the workshops were useful, advanced their skills, and advanced their confidence. It was also found that more than 50% of the participants used their physical assessment skills monthly and 11% daily. The most common assessment performed was obtaining an accurate manual blood pressure.ConclusionThe interprofessional development and implementation of workshops dedicated to physical assessment skills education is feasible and led to the incorporation of these skills into pharmacists’ practice, particularly in the community and ambulatory care settings.     

Pharmacists and the next generation of HIV pre-exposure prophylaxis

The use of pre-exposure prophylaxis (PrEP) has curtailed transmission of human immunodeficiency virus (HIV) in most industrialized nations. Despite the availability of PrEP, HIV infections continue to occur. Access and adherence are major limitations to PrEP. Long-acting injectable antiretroviral agents are now being added to the HIV armamentarium. Long-acting agents offer the advantage of less frequent dosing with intramuscular administration versus oral dosing. Cost, injection site pain, and needle hesitancy may be detriments to the use of these agents in certain patients. More studies are needed to completely discern the role of various products and future long-acting agents as options for PrEP. Even when we consider their limitations, long-acting agents may provide an eventual opportunity to transform the delivery of PrEP. Pharmacists should be aware of the potential impact of PrEP and the advantages and disadvantages of these new long-acting agents. In addition, pharmacists should proactively advocate for and contribute to PrEP expansion efforts.     

Pharmacists as providers of HIV pre-exposure prophylaxis

The efficacy of HIV pre-exposure prophylaxis (PrEP) has been demonstrated in four clinical trials to date; however, the success of PrEP is largely dependent on high levels of medication adherence. Due to their extensive experience and expertise in medication adherence counseling, as well as their ability to monitor and manage medication adverse effects and drug?Cdrug interactions, clinical pharmacists are well-equipped to play a key role in effective PrEP utilization. Here we discuss reasons favoring the establishment of a protocol-based, pharmacist-run PrEP clinic.     

Safety of oral tenofovir disoproxil fumarate-based HIV pre-exposure prophylaxis use in lactating HIV-uninfected women

Introduction: In settings where HIV is prevalent in heterosexual populations, pregnancy and postpartum breastfeeding periods can be associated with substantial HIV acquisition risk. Pre-exposure prophylaxis (PrEP) with daily oral tenofovir disoproxil fumarate (TDF)/emtricitabine is an attractive HIV prevention option for women who are lactating but data are limited on its safety during the lactation period.

Areas covered: We provide a concise synthesis and summary of current evidence on the safety of TDF-based PrEP during breastfeeding. We conducted a review, searching Pubmed database and major PrEP conferences for primary studies with TDF-based PrEP exposure during postpartum breastfeeding.

Expert opinion: TDF-based oral PrEP is an effective female-controlled HIV prevention option. There is evidence supporting the safety of TDF use for infant outcomes during breastfeeding in antiretroviral treatment regimens for HIV and hepatitis B virus, and more limited, but consistently safe, data from use of TDF as PrEP. The potential for risk is arguably outweighed for at-risk individuals by HIV prevention benefits, including indirect protection to the infant as a result of preventing HIV in the breastfeeding mother. As PrEP delivery is scaled up in heterosexual populations in high HIV prevalence settings and for at-risk persons in other settings, implementation science studies can provide a framework to increase the accrual of safety, acceptability, and use data related to PrEP during lactation.     

Identifying criteria for assessing the quality of medicines use review referral documentation by community pharmacists

Aims and objectives The medicines use review (MUR) service was introduced in April 2005 for England and Wales as part of the new community pharmacy contractual framework. Following a MUR, community pharmacists are required to document their interventions and refer any unresolved issues to the patient's general medical practitioner using a structured template. The patient also receives a copy of this form. Anecdotal feedback suggests that there is considerable variation in the quality of this documentation. The aim of this study was to develop explicit criteria against which the quality of MUR referral documentation can be assessed. Setting This study forms part of the Welsh School of Pharmacy's ongoing monitoring and evaluation of its MUR accreditation assessment. Method A two‐round electronic Delphi technique was used to develop a consensus of the key quality indicators to assess the quality of MUR referral documentation. Statements were generated following a systematic review of the literature plus interviews. Sixteen panellists who responded to an invitation to participate in the study were involved in the Delphi process (these were 10 out of 14 MUR accreditation tutors who were invited to take part and six pharmacy practitioners from a possible 22 primary care organisations in Wales) to rate the usefulness of these statements as a measure of pharmacists' referral skills. Consensus was defined a priori as > 70% of participants scoring the statement as 1–3 on an ordinal scale from 1–9 (where 1 is definitely and 9 is definitely not). Key findings The first round of the electronic Delphi survey comprised 30 statements of which consensus was gained for 19. Following the second round, consensus was achieved for 20 statements. Conclusion These criteria could be used to assess the quality of referral documentation following MUR and to provide feedback to pharmacists on their referral skills. However, further studies are needed to test the validity of the MUR quality indicators with community pharmacists and GPs and the feasibility of using this tool in practice.     

Adherence challenges with drugs for pre-exposure prophylaxis to prevent HIV infection

Background There are 34 million people living with human immunodeficiency virus (HIV) worldwide and each year this number increases. Until a vaccine is discovered, the prevention of new HIV infections remains an urgent priority. Several trials studying the use of oral and topical agents for the prevention of HIV infection have already been completed. Adherence has proved to be a major challenge in achieving product efficacy. Aim of the review To provide the clinical pharmacist with an understanding of the oral pre-exposure prophylaxis (PrEP) and topical microbicide product pipeline whilst emphasizing the critical importance of adherence to these drugs to avert HIV infection. Methods PubMed/Medline and the web-based clinical trials registry (ClinTrials.gov) were searched using appropriate key words. For the time period 1992–2013—all phase II and phase III safety and effectiveness studies—testing agents for prevention of HIV infection were included in the review. Efficacy estimates, adherence estimates and reported challenges with adherence were extracted. Results Twenty-four phase II and III clinical trials were found during review. Of these, 20 trials have been completed, and six trials show effectiveness in preventing HIV infection. The majority of the successful trials were to oral PrEP and to date only one microbicide trial of a vaginal antiretroviral microbicide gel has showed effectiveness. Adherence to study product played a major role in trial outcomes and there are several reasons for non-adherence. These include high on-trial pregnancy rates, low trial retention rates, low participant perception of risk, participant characteristics such as age <25 years, single status, migratory partners and trial fatigue. Study product characteristics such as dosage form, dosing interval, as well as associated adverse events may also influence adherence. Conclusion Moderate to high adherence is critical to demonstrate efficacy of drugs for HIV prevention. For topical agents, intermittent use associated with coitus is more effective than daily use, particularly if sex is infrequent or partners migrant. For oral agents, daily use is effective but the motivation to use the drug and high risk perception is important. In serodiscordant couples, early initiation of highly active antiretroviral therapy in the infected partner affords almost complete protection to the negative partner. Drugs need to be tailored to the population at risk and availability of multiple drug options are important.     

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.     

Using the Internet to develop an international learning community of pharmacists

Until recent years, the level of interaction across a profession, necessary to provide for an optimum learning environment which supports professional development, has only been significantly possible in face-to-face interaction and has therefore been place and time dependent. With the explosive development of the Internet, communication barriers are breaking down and international interaction, networking and collaboration is becoming increasingly possible. This short report describes the manner in which an Internet-based postgraduate study programme, entitled Enhancing Pharmacy Practice has made use of these communication opportunities to develop an international learning community of pharmacists. Programme evaluation data collected from surveys completed online by participants and content analysis of online discussion groups during the first four modules of the programme, demonstrates that there is a high level of interaction amongst participants. It also suggests that this interaction has contributed to the learning experience and professional growth of the participants and impacted positively upon their practice.     

Perspectives on pre-exposure prophylaxis for people who inject drugs in the context of an hiv outbreak: A qualitative study.

BackgroundThere is an ongoing HIV outbreak amongst people who inject drugs (PWID) in Glasgow, Scotland, and one response which has not yet been widely implemented is the provision of Pre-exposure prophylaxis (PrEP). PrEP is the use of HIV anti-retrovirals prior to HIV infection to provide a barrier to infection. This has been shown to be effective amongst various at-risk populations in preventing HIV spread. The present study aimed to explore views of PWID who might benefit from PrEP provision and Service Providers working with PWID to understand will to use PrEP and literacy of PrEP, contributing to the development of a PrEP service.MethodsA qualitative approach was taken, with semi structured interviews conducted in Glasgow at two third sector service sites. 11 Service Providers and 21 PWID participated in the study. Data was analysed thematically.ResultsParticipants, both PWID and Service Providers, were keen to engage with PrEP and perceived substantial potential benefits of PrEP for this population. Potential barriers to engagement were identified as a lack of health literacy, motivation, and self-ascribed risk, as well as the overwhelming unpredictability of substance use. Participants wanted PrEP to be provided within already existing structures, particularly community pharmacies, and for promotion and provision to involve peers.ConclusionThis sample reported willingness to engage with PrEP, and suggested there is a specific need amongst PWID for PrEP. However, PWID have specific lived experienced contexts and needs, and are burdened by social and economic marginalisation and inequality at every level. This contrasts them from other populations currently being provided with PrEP, and must be considered in the development of provision.     

Educating Australian pharmacists about the use of online information in community pharmacy practice

Objectives Community pharmacists practice in an information technology‐rich society, however many have not been educated in internet use for professional practice. The aims of this study were to investigate how community pharmacists use the internet in their practice; to develop an intervention to address their educational needs; and to examine the benefits and weakness of a flexible delivery programme. Method We conducted two focus groups investigating community pharmacists' internet use and education needs. We subsequently developed and provided a four‐module educational course on CD ROM, ‘Advanced web skills for pharmacists: finding quality on the internet’. In total, 147 pharmacists participated. A survey was conducted to evaluate the impact of the course. Key findings The focus group findings provided a clear rationale for an educational intervention. One‐hundred and four pharmacists completed the course. Participating pharmacists were highly positive about the learning experience, in particular the provision of education by flexible delivery. Many reported specific changes to practice. They also described the time‐consuming nature of the course as the biggest barrier to further education. Conclusions This project demonstrates the need for community pharmacists to have access to internet education. Flexible CD ROM‐based learning provided a successful delivery medium.