Exploring the Implementation of Community Pharmacist‐Initiated Human Immunodeficiency Virus Post‐Exposure Prophylaxis: A Cross‐Sectional Survey Study

ABSTRACT Background In 2022, North Carolina (NC) passed a bill authorizing immunizing pharmacists to dispense HIV post‐exposure prophylaxis (PEP) pursuant to a statewide protocol. This survey evaluated NC community pharmacists' knowledge, acceptability, appropriateness, and feasibility of pharmacist‐initiated HIV PEP pursuant to the statewide protocol, and evaluated the barriers and facilitators to the implementation. Methods An online 15‐min Qualtrics (Qualtrics, Provo, UT) survey was emailed to practicing NC community pharmacists registered with the NC Board of Pharmacy. Data was collected between March and April 2025. Descriptive statistics are reported. Results A total of 569 pharmacists responded (response rate = 9.3%), with 447 eligible pharmacist responses. Respondents were predominantly white (81%, n = 362), female (67.8%, n = 303), and practicing at a national chain pharmacy (38.4%, n = 174). Fifty percent ( n = 280, 50%) of pharmacists noted that they were unaware of the NC standing protocol authorizing pharmacists to dispense HIV PEP. Most pharmacists felt slightly knowledgeable about current HIV PEP regimens (48.5%, n = 216), and most pharmacists (68.7%, n = 307) were slightly or very willing to initiate HIV PEP according to the statewide protocol. Respondents perceived the benefits of pharmacist‐initiated HIV PEP to be increased access to preventative care in the community (69.9%, n = 391) and reduced transmission of HIV (64.6%, n = 361), and the most commonly perceived barriers include a lack of time (68%, n = 304) and staff to incorporate this into the workflow (65.8%, n = 294). Pharmacists also perceived a lack of training (52.3%, n = 234) and a lack of financial reimbursement for HIV PEP (50.3%, n = 225) as barriers to implementation. Discussion Despite limited awareness of the statewide protocol, most pharmacists are willing to dispense HIV PEP pursuant to the statewide protocol. Insurance coverage for pharmacist time to assess the patient and dispense HIV PEP along with training for community pharmacists on how to implement pharmacist‐initiated HIV PEP into practice is needed.