Implementation and acceptance of pharmacists' prescribing of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP).

BACKGROUND

Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) is highly effective at reducing the risk of acquiring HIV. PrEP is underused due, in part, to prescriber inaccessibility. The overall aim of this study was to evaluate the impact of pharmacist PrEP management (including prescribing and monitoring) on clinical and acceptance outcomes in patients who are at high risk for HIV exposure.

METHODS

Pharmacist-led PrEP management was guided by a prescribing protocol and implemented at 10 community pharmacies in Nova Scotia over 6 months. Baseline and follow-up bloodwork determined HIV status, coinfection(s), and other eligibility criteria for initial and refill PrEP prescriptions. Patient acceptance was measured according to the theoretical framework for acceptability of health care interventions.

RESULTS

Forty-five participants met eligibility criteria, and 37 remained for the study duration. Around half of the participants had never used PrEP before, and all identified as men who have sex with men or transgender women. Participants were highly accepting of the service and agreed that pharmacist-led PrEP management should always be available. Few reported privacy or stigma/discrimination concerns. All participants remained HIV-negative during study participation, and participants with coinfections were linked with care ( = 4).

INTERPRETATION

The service was acceptable and effective for patients. Future work is required to reach underserved populations, particularly individuals with injection-related HIV risk factors.

CONCLUSIONS

Pharmacist-led PrEP management can provide an alternative way to obtain PrEP for higher-risk patients. This study resulted in a regulation change on July 1, 2024 that authorized pharmacists to prescribe PrEP in Nova Scotia.