National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), Bristol, UK.
National Institute for Health and Care Research, Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
J Int AIDS Soc. 2024 Mar;27(3):e26232. doi: 10.1002/jia2.26232.
Pre-exposure prophylaxis (PrEP) is an effective medication to reduce the risk of acquiring HIV. PrEP is available free of charge in the UK from sexual health clinics. Expanding PrEP delivery to community pharmacies holds promise and aligns with UK government goals to eliminate new cases of HIV by 2030. The aim of this scoping review was to describe the existing evidence about the barriers to and facilitators of community pharmacy oral PrEP delivery, for pharmacists and pharmacy clients, as aligned with the Capacity Opportunity, Motivation Behaviour (COM-B) Model.
Five bibliographic and five review databases were searched from inception to August 2023. Literature of any study design was included if it discussed barriers and facilitators of community pharmacy PrEP delivery. Trial registrations, protocols and news articles were excluded.
A total of 649 records were identified, 73 full texts were reviewed and 56 met the inclusion criteria, predominantly from high-income/westernized settings. Most of the included literature was original research (55%), from the United States (77%) conducted during or after the year 2020 (63%). Barriers to PrEP delivery for pharmacists included lack of knowledge, training and skills (capability), not having the necessary facilities (opportunity), concern about the costs of PrEP and believing that PrEP use could lead to risk behaviours and sexually transmitted infections (motivation). Facilitators included staff training (capability), time, the right facilities (opportunity), believing PrEP could be a source of profit and could reduce new HIV acquisitions (motivation). For clients, barriers included a lack of PrEP awareness (capability), pharmacy facilities (opportunity) and not considering pharmacists as healthcare providers (motivation). Facilitators included awareness of PrEP and pharmacist's training to deliver it (capability), the accessibility of pharmacies (opportunity) and having an interest in PrEP (motivation).
To effectively enhance oral PrEP delivery in UK community pharmacies, the identified barriers and facilitators should be explored for UK relevance, addressed and leveraged at the pharmacy team, client and care pathway level.
By comprehensively considering all aspects of the COM-B framework, community pharmacies could become crucial providers in expanding PrEP accessibility, contributing significantly to HIV prevention efforts.
暴露前预防（PrEP）是一种有效减少感染艾滋病毒风险的药物。在英国，性健康诊所可免费提供 PrEP。将 PrEP 服务扩展到社区药房具有潜力，符合英国政府到 2030 年消除新的艾滋病毒感染病例的目标。本范围综述的目的是根据能力-机会-动机-行为（COM-B）模型，描述与药剂师和药房客户提供社区药房口服 PrEP 相关的障碍和促进因素的现有证据。
从创建到 2023 年 8 月，对五个书目和五个综述数据库进行了搜索。如果文献讨论了社区药房提供 PrEP 的障碍和促进因素，则纳入任何研究设计的文献。排除试验注册、方案和新闻文章。
共确定了 649 条记录，对 73 篇全文进行了审查，其中 56 篇符合纳入标准，主要来自高收入/西化国家。纳入的文献大多为原始研究（55%），来自美国（77%），且均在 2020 年或之后开展（63%）。阻碍药剂师提供 PrEP 的因素包括缺乏知识、培训和技能（能力）、没有必要的设施（机会）、担心 PrEP 的成本以及认为 PrEP 可能导致风险行为和性传播感染（动机）。促进因素包括员工培训（能力）、时间、合适的设施（机会）、相信 PrEP 可以成为利润来源并可以减少新的 HIV 感染（动机）。对于客户，障碍包括缺乏 PrEP 意识（能力）、药房设施（机会）和不将药剂师视为医疗保健提供者（动机）。促进因素包括 PrEP 意识和药剂师提供 PrEP 的培训（能力）、药房的可及性（机会）和对 PrEP 的兴趣（动机）。
为了在英国社区药房有效加强口服 PrEP 的提供，应探索并解决已确定的障碍和促进因素在英国的相关性，并在药剂师团队、客户和护理途径层面加以利用。
通过全面考虑 COM-B 框架的各个方面，社区药房可以成为扩大 PrEP 可及性的重要提供者，对艾滋病毒预防工作做出重大贡献。
