An observational survey assessing the extent of PrEP and PEP furnishing in San Francisco Bay Area pharmacies

Rob Bellman,Sheila Mohebbi,Nikki Nobahar,Jacqueline Parizher,Dorie E Apollonio

doi:10.1016/j.japh.2021.08.001

Abstract

BackgroundHuman immunodeficiency virus (HIV) remains prevalent in the United States despite medications that reduce the risk of infection, primarily pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP). In 2019, California authorized pharmacists to furnish PrEP and PEP under Senate Bill 159 (SB-159). ObjectiveAssess implementation of SB159 in San Francisco Bay Area community and mail-order pharmacies. MethodsWe conducted an observational, cross-sectional survey of independent community and mail-order pharmacies in the 9-county San Francisco Bay Area to identify those that were in the process of furnishing, actively furnished, or furnished under a collaborative practice agreement (CPA). We conducted interviews with furnishing pharmacies in April 2021, focusing on the barriers to and successes of implementation, as well as the impact of coronavirus disease 2019 (COVID-19), and qualitatively analyzed them. ResultsOf the 209 pharmacies contacted, 6 furnished under SB-159 (2.9%), 2 were in the process of furnishing under SB-159, and 1 furnished under a CPA. Six pharmacies and 7 pharmacists were interviewed. Barriers to implementation and furnishing included COVID-19, laboratory tests, lack of time and staff, cost to pharmacy, refill limitation, lack of patient awareness, difficulty arranging follow-up care, and vague wording of the policy. Facilitators to implementation included collaborations with clinics and health centers, privacy, increased accessibility, increased need in the patient population, and the pharmacy culture. ConclusionBarriers and facilitators to PrEP and PEP furnishing were consistent across pharmacies, suggesting strategies that could be replicated and potential improvements to SB-159.

Highlights

Human immunodeficiency virus (HIV) remains prevalent in the United States despite medications that reduce the risk of infection, primarily pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP)
Previous studies have not identified the extent of PrEP and PEP furnishing by pharmacists in California under Senate Bill (SB)-159
Given the barriers to implementation that we identified, including lack of patient awareness, this gap might be addressed in part through increased outreach efforts by HIV advocacy groups or increased advertising by the Board of Pharmacy and organizations such as California Pharmacists Association and California Society of HealthSystem Pharmacists, which provide relevant training

Summary

Introduction

Human immunodeficiency virus (HIV) remains prevalent in the United States despite medications that reduce the risk of infection, primarily pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP). In 2019, California authorized pharmacists to furnish PrEP and PEP under Senate Bill 159 (SB-159). Objective: Assess implementation of SB159 in San Francisco Bay Area community and mailorder pharmacies. Methods: We conducted an observational, cross-sectional survey of independent community and mail-order pharmacies in the 9-county San Francisco Bay Area to identify those that were in the process of furnishing, actively furnished, or furnished under a collaborative practice agreement (CPA). Have you completed any training to furnish PrEP/PEP? Program Development and Implementation: Did you play a role in designing the PrEP/PEP furnishing program/protocol/process at this pharmacy?. Can you describe the process of furnishing PrEP/PEP at this pharmacy, starting from when the patient arrives requesting for PrEP/PEP?. What type of PrEP/PEP formulation is furnished at this pharmacy? What is your current role at this pharmacy? How many pharmacists and pharmacy technicians are employed at this pharmacy? Per shift? How long have you worked as a pharmacist/in your current position? Have you completed a residency? If so, what type of residency? Have you completed any training to furnish PrEP/PEP? If yes, what type of training?

Methods

Results

Discussion

Conclusion