University of Minnesota, School of Public Health, Minneapolis, MN.
University of California, Los Angeles Luskin School of Public Affairs, Los Angeles, CA.
J Acquir Immune Defic Syndr. 2024 Oct 1;97(2):142-149. doi: 10.1097/QAI.0000000000003470.
Pre-exposure prophylaxis (PrEP) uptake remains low among people who could benefit, some of whom may prefer alternatives to oral PrEP, such as long-acting injectable pre-exposure prophylaxis (LAI-PrEP). We evaluated the potential for LAI-PrEP provision in pharmacies through a mixed methods study of pharmacists in California, where Senate Bill 159 enables pharmacists to independently provide oral PrEP.
In 2022-2023, we conducted an online cross-sectional survey of California pharmacists and pharmacy students (n = 919) and in-depth interviews with pharmacists (n = 30), both of which included modules assessing attitudes about PrEP provision. Using log-binomial regression, we estimated prevalence ratios (PRs) comparing survey participants' willingness to provide LAI-PrEP by pharmacy- and individual-level characteristics. Qualitative interview data were analyzed using Rapid Qualitative Analysis to identify factors that may affect pharmacists' provision of LAI-PrEP.
Half of the survey participants (53%) indicated that they would be willing to administer LAI-PrEP using gluteal injection in their pharmacy. Willingness was higher among participants who worked in pharmacies that provided vaccinations or other injections (56% vs. 46%; PR: 1.2; 95% confidence interval: 1.0-1.4) and/or oral PrEP under Senate Bill 159 (65% vs. 51%; PR: 1.3; 95% confidence interval: 1.1-1.5) than among participants whose pharmacies did not. Interviewed participants reported barriers to LAI-PrEP provision, including the need for increased training and staffing, a private room for gluteal injections, better medication access, and payment for services.
Pharmacies offer a promising setting for increased LAI-PrEP access. However, pharmacists may require additional training, resources, and policy changes to make implementation feasible.
在可能受益的人群中，暴露前预防（PrEP）的使用率仍然很低，其中一些人可能更愿意选择口服 PrEP 的替代方案，如长效注射型暴露前预防（LAI-PrEP）。我们通过对加利福尼亚州药剂师的混合方法研究评估了在药店提供 LAI-PrEP 的可能性，该研究基于参议院法案 159 允许药剂师独立提供口服 PrEP。
在 2022-2023 年，我们对加利福尼亚州的药剂师和药学学生（n=919）进行了在线横断面调查，并对药剂师（n=30）进行了深入访谈，这两项研究均包括评估提供 PrEP 态度的模块。我们使用对数二项回归估计了按药店和个人特征比较调查参与者提供 LAI-PrEP 意愿的患病率比（PR）。使用快速定性分析对定性访谈数据进行分析，以确定可能影响药剂师提供 LAI-PrEP 的因素。
半数调查参与者（53%）表示愿意在其药房通过臀部注射管理 LAI-PrEP。在为疫苗接种或其他注射提供服务的药房工作的参与者（56%比 46%；PR：1.2；95%置信区间：1.0-1.4）和/或根据参议院法案 159 提供口服 PrEP 的参与者（65%比 51%；PR：1.3；95%置信区间：1.1-1.5）比其药房不提供这些服务的参与者更愿意提供 LAI-PrEP。接受访谈的参与者报告了提供 LAI-PrEP 的障碍，包括需要增加培训和人员配备、臀部注射专用房间、更好的药物获取途径和服务付费。
药店为增加 LAI-PrEP 的可及性提供了一个有前景的环境。然而，药剂师可能需要额外的培训、资源和政策变更才能使其实施可行。
