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The Role of Community Pharmacies in Providing Access to HIV Post-exposure Prophylaxis (PEP)

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Abstract

HIV affects an estimated 1.2 million individuals in the United States and is disproportionately concentrated among African Americans, Latinos, and people of multiple races. Post-exposure prophylaxis (PEP) substantially decreases HIV transmission when started within 72 h after exposure, but problems of accessibility have hindered its widespread usage in communities at risk for HIV infection. Pharmacy-initiated PEP access was first permitted in New York City in 2017, allowing pharmacists to provide a 7-day supply of PEP without a prescription for consumers at high risk for HIV infection. It was expected that the broad reach and accessibility of community pharmacies would increase timely access to PEP for all individuals, especially those who already face significant barriers to accessing the healthcare system. Since then, eleven other states have followed suit and expanded the scope of outpatient pharmacy practice in order to increase the availability of HIV PEP but prescribing laws in over 75% of the US have not been changed. Much of the existing literature on HIV prevention focuses on PrEP access barriers with limited information on PEP access in the US. In this paper, we review the current status of pharmacist-initiated PEP in the US as part of the End the HIV Epidemic (EHE) initiative.

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References

  1. Centers for Disease Control and Prevention. Volume 28, number 3. Centers for Disease Control and Prevention. May 23, 2023. https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-28-no-3/index.html. Accessed 6 June 2023

  2. Centers for Disease Control and Prevention. HIV declines among young people and drives overall decrease in new HIV infections. Centers for Disease Control and Prevention. May 23, 2023. https://www.cdc.gov/media/releases/2023/p0523-hiv-declines-among-young-people.html. Accessed 6 June 2023

  3. Centers for Disease Control and Prevention. About Ending the HIV Epidemic Initiative, September 2021. https://www.cdc.gov/endhiv/about.html. Accessed 6 June 2023

  4. “Post-Exposure Prophylaxis.” HIV.gov, www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/post-exposure-prophylaxis. Accessed 6 June 2023.

  5. MMWR. Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexposure Prophylaxis. May 15, 1998 / 47(RR-7);1–28

  6. Joyce MP, Kuhar D, Brooks JT. Notes from the Field: Occupationally Acquired HIV Infection Among Health Care Workers — United States, 1985–2013. MMWR. January 9, 2015 / 63(53);1245–1246

  7. Beymer, M. R., Kofron, R. M., Tseng, C. H., Bolan, R. K., Flynn, R. P., Sayles, J. M., Perez, M. J., Jordan, W. C., & Landovitz, R. J. (2018). Results from the post-exposure prophylaxis pilot program (P-QUAD) demonstration project in Los Angeles County. International Journal of STD and AIDS, 29(6), 557–562.

    Article  PubMed  Google Scholar 

  8. https://www.osha.gov/laws-regs/standardinterpretations/2020-08-19-1. Accessed 15 June 2023.

  9. https://www.osha.gov/laws-regs/standardinterpretations/2013-11-27-0. Accessed 15 June 2023.

  10. John, S. A., Quinn, K. G., Pleuhs, B., Walsh, J. L., & Petroll, A. E. (2020). HIV Post-exposure prophylaxis (PEP) awareness and non-occupational PEP (nPEP) prescribing history among U.S. Healthcare Providers. AIDS Behavior., 24(11), 3124–3131. https://doi.org/10.1007/s10461-020-02866-6

    Article  PubMed  Google Scholar 

  11. “HIV Diagnoses.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 24 Oct. 2022, www.cdc.gov/hiv/statistics/overview/diagnoses.html. Accessed 6 June 2023.

  12. Reif, S., Safley, D., McAllaster, C., Wilson, E., & Whetten, K. (2017). State of HIV in the US deep South. Journal of Community Health, 42, 844–853.

    Article  PubMed  Google Scholar 

  13. Lewis, C. F., Lekas, H. M., Rivera, A., et al. (2020). Pharmacy PEP access intervention among persons who use drugs in New York City: IPEPcare study—rethinking biomedical HIV prevention strategies. AIDS and Behavior, 24, 2101–2111. https://doi.org/10.1007/s10461-019-02775-3

    Article  PubMed  Google Scholar 

  14. Goode, J. V., Owen, J., Page, A., & Gatewood, S. (2019). Community-based pharmacy practice innovation and the role of the community-based pharmacist practitioner in the United States. Pharmacy (Basel)., 7(3), 106. https://doi.org/10.3390/pharmacy7030106

    Article  PubMed  PubMed Central  Google Scholar 

  15. Berenbrok, L. A., Tang, S., Gabriel, N., Guo, J., Sharareh, N., Patel, N., et al. (2022). Access to community pharmacies: A nationwide geographic information systems cross-sectional analysis. Journal of the American Pharmacists Association, 62, 1816–1822. https://doi.org/10.1016/j.japh.2022.07.003

    Article  PubMed  Google Scholar 

  16. Mitchell, Travis. “Views of Problems Facing Urban, Suburban and Rural Communities.” Pew Research Center's Social & Demographic Trends Project, Pew Research Center, 30 May 2020, www.pewresearch.org/social-trends/2018/05/22/views-of-problems-facing-urban-suburban-and-rural-communities/

  17. National Alliance of State and Territorial AIDS Directors (NASTAD). “Pharmacist- Initiated PrEP and PEP” Information Sheet. NASTAD.org. https://nastad.org/sites/default/files/2021-11/PDF-Pharmacist-Initiated-PrEP-PEP.pdf Accessed 15 June 2023

  18. Tung, E. L., Thomas, A., Eichner, A., & Shalit, P. (2018). Implementation of a community pharmacy-based pre-exposure prophylaxis service: A novel model for pre-exposure prophylaxis care. Sex Health, 15(6), 556–561.

    Article  PubMed  Google Scholar 

  19. Havens, J. P., Scarsi, K. K., Sayles, H., Klepser, D. G., Swindells, S., & Bares, S. H. (2019). Acceptability and feasibility of a pharmacist-led HIV pre-exposure prophylaxis (PrEP) program in the Midwestern United States. Open Forum Infectious Diseases, 6(10):ofz365. https://doi.org/10.1093/ofid/ofz365.

  20. Lopez, M. I., Cocohoba, J., Cohen, S. E., Trainor, N., Levy, M. M., & Dong, B. J. (2019). Implementation of pre-exposure prophylaxis at a community pharmacy through a collaborative practice agreement with San Francisco Department of Health. Journal of the American Pharmacists Association, 60, 138–144.

    Article  PubMed  Google Scholar 

  21. California Legislative Information. SB 159. HIV: pre-exposure and post-exposure prophylaxis. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB159. Accessed 1 Aug 2023

  22. Colorado General Assembly. HBj20–1061. Human Immunodeficiency Virus Infection Prevention Medications. https://leg.colorado.gov/sites/default/files/2020a_1061_signed.pdf. Accessed 1 Aug 2023

  23. Code of Colorado Regulations. CCR 719–1 Appendix C. Colorado State Board of Pharmacy Statewide Protocol. Pre-Exposure and Post-Exposure Prophylaxis of HIV. https://drive.google.com/file/d/10vcW8Pq-1rjBjQ3Uvm1ZZPGmHiEOPgWB/view. Accessed 1 Aug 2023

  24. Illinois General Assembly. Full Text of HB4430. 102nd general assembly. https://www.ilga.gov/legislation/fulltext.asp?DocName=&SessionId=110&GA=102&DocTypeId=HB&DocNum=4430&GAID=16&LegID=&SpecSess=&Session=. Accessed 1 Aug 2023

  25. Maine Legislature. LD 1115. An Act to improve access to HIV prevention medications. https://legislature.maine.gov/bills/getPDF.asp?paper=SP0378&item=1&snum=130. Accessed 1 Aug 2023

  26. Missouri General Assembly. HB 476. https://house.mo.gov/billtracking/bills191/hlrbillspdf/1034H.01I.pdf. Accessed 1 Aug 2023

  27. Missouri Department of Commerce and Insurance. Division State Board of Pharmacy. 20 CSR 2220–6.025 HIV Post-Exposure Prophylaxis. https://dci.mo.gov/proposed-rule/20CSR2220-6.025.pdf. Accessed 1 Aug 2023

  28. New Mexico Administrative Code. NMAC 16.19.26. Occupational and Professional Licensing Pharmacist Prescriptive Authority. https://www.srca.nm.gov/parts/title16/16.019.0026.html. Accessed 1 Aug 2023

  29. New Mexico Regulation and Licensing Department. Protocol for pharmacist prescribing HIV post-exposure prophylaxis (PEP) therapy in conjunction with point-of-care testing (POCT). https://www.rld.nm.gov/uploads/files/PEPProtocolALONE.pdf. Accessed 1 Aug 2023

  30. New York State Department of Health. The licensed pharmacist’s role in initiating HIV post-exposure prophylaxis: overview and frequently asked questions. Published August 2022. https://www.health.ny.gov/diseases/aids/general/pep/docs/pharmacists_role.pdf. Accessed 1 Aug 2023

  31. Nevada Electronic Legislative Information System. SB 325. https://www.leg.state.nv.us/App/NELIS/REL/81st2021/Bill/7959/Text. Accessed 1 Aug 2023

  32. Nevada State Board of Pharmacy. LCB File No. R039–21. https://www.leg.state.nv.us/Register/2021Register/R039-21AP.pdf. Accessed 1 Aug 2023

  33. North Carolina General Assembly. HB 96. https://www.ncleg.gov/Sessions/2021/Bills/House/PDF/H96v5.pdf. Accessed 1 Aug 2023

  34. North Carolina Department of Health and Human Services. North Carolina State Health Director’s Standing Order for Post-Exposure Prophylaxis (PEP) for Human Immunodeficiency Virus, March 28, 2022. https://www.dph.ncdhhs.gov/docs/PEP-StandingOrder-March2022.pdf. Accessed 1 Aug 2023

  35. Oregon State Legislature. HB 2958 (2021). https://legiscan.com/OR/text/HB2958/2021. Accessed 1 Aug 2023

  36. Oregon Secretary of State. OAR 855-020-0110: Prescribing Practices. Pharmacist Prescriptive Authority. https://oregon.public.law/rules/oar_855-020-0110. Accessed 1 Aug 2023

  37. Oregon Board of Pharmacy. Preventative Care: HIV Post-Exposure Prophylaxis. Statewide drug therapy management protocol for Oregon pharmacists. https://www.oregon.gov/pharmacy/Documents/PrevCare_PEP_Protocol_v.6.2023.pdf. Accessed 1 Aug 2023

  38. Utah State Legislature. HB 178. Pharmacy practice modifications. https://le.utah.gov/~2021/bills/hbillenr/HB0178.pdf. Accessed 1 Aug 2023

  39. Utah Division of Occupational Professional Licensing. Utah guidance for pre-exposure and post-exposure prophylaxis of HIV. Published September 2021. https://www.dopl.utah.gov/wp-content/uploads/2022/09/utah-guidance-for-pre-exposure-and-post-exposure-prophylaxis-of-hiv.pdf. Accessed 1 Aug 2023

  40. Virginia General Assembly. HB 2079. Pharmacists: initiation of treatment with and dispensing and administering drugs and devices. http://leg1.state.va.us/cgi-bin/legp504.exe?212+ful+HB2079ER. Accessed 1 Aug 2023

  41. Virginia Department of Health Professionals. Virginia Board of Pharmacy. HIV Post-Exposure Prophylaxis (PEP) Statewide Protocol. https://www.dhp.virginia.gov/pharmacy/docs/protocols/PEPCombinedProtocol12-22-2021.pdf. Accessed 1 Aug 2023

  42. Bellman, R., Mohebbi, S., Nobahar, N., Parizher, J., & Apollonio, D. E. (2022). An observational survey assessing the extent of PrEP and PEP furnishing in San Francisco Bay Area pharmacies. Journal of the American Pharmacists Association (2003), 62(1), 370-377.e3. https://doi.org/10.1016/j.japh.2021.08.001. Epub 2021 Aug 8.

    Article  Google Scholar 

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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  1. Kaylee Scarnati, Katherine Esser have shared first author status equally.

Authors and Affiliations

  1. Division of Infectious Disease/Department of Internal Medicine, University of Toledo, College of Medicine and Life Sciences, Toledo, USA

    Kaylee Scarnati, Katherine Esser & Joan Duggan

  2. Department of Pharmacy Practice, University of Toledo, College of Pharmacy and Pharmaceutical Sciences, Toledo, USA

    Eric G. Sahloff

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  1. Kaylee Scarnati
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All authors contributed to the conception and design of the article. Material preparation, data collection, and analysis were performed by all four authors. The first draft of the manuscript was written by KS and KE, and all authors commented on revisions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Eric G. Sahloff.

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Scarnati, K., Esser, K., Sahloff, E.G. et al. The Role of Community Pharmacies in Providing Access to HIV Post-exposure Prophylaxis (PEP). J Community Health 49, 222–228 (2024). https://doi.org/10.1007/s10900-023-01281-x

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