Increasing access to PrEP via community pharmacies to improve HIV prevention

Background: Pre-exposure prophylaxis (PrEP) is a highly effective medication that HIV-negative people can take before and after sex to reduce their risk of getting HIV. PrEP is available for free from NHS sexual health clinics in England. However, some people may find it difficult to access PrEP because of the stigma associated with using sexual health services and this can lead to increasing health inequities. Pharmacies are ideally placed to reach disadvantaged, marginalised and vulnerable populations and already play an important role in public and sexual health work in the UK.<br/><br/>Methods: To understand if it is possible to use pharmacies to increase access to PrEP we conducted a scoping review of the international literature informed by COM-B model of behaviour to design a PrEP pharmacy pilot.To review the published evidence we searched 10 databases and identified 649 potentially relevant journal articles and after screening for eligibility, reviewed 56. Most of the eligible records were original publications about research conducted during or after the year 2020 in the US. To explore the barriers and facilitators of community pharmacy PrEP delivery for UK, interviews were conducted with pharmacists and underserved community members identified as being at elevated risk of acquiring HIV.<br/><br/>Results: The study identified several barriers to pharmacy-based PrEP delivery, including a lack of awareness and knowledge about PrEP and lack of PrEP training for pharmacists. Pharmacy PrEP delivery was acceptable for pharmacy staff and community members, but PrEP awareness raising and training is required. <br/><br/>Conclusions: To be feasible, a behaviour change intervention need to address barriers and leverage facilitators to support implementation. To increase capabilities and motivation, training and awareness raising for pharmacy staff and community members is needed. To increase opportunities and motivation, environmental and system changes (e.g. facilities, financial reimbursement) are required.