Pharmacies are innovative access points to expand HIV care and services, however the scientific evidence describing and evaluating pharmacy-based interventions is limited. This systematic review aimed to synthesize and assess the recent literature on pharmacist roles across the HIV prevention and care continuums and identify key research gaps/priorities. Investigators searched studies published between January 2004 and August 2019 involving non-hospital-based U.S. pharmacy settings/programs. Thirty-two studies underwent complete review and were organized around the following themes: (a) HIV testing; (b) syringe access and harm reduction; (c) post-exposure prophylaxis; (d) pre-exposure prophylaxis; and (e) antiretroviral therapy. Findings suggest pharmacy-based HIV testing is feasible and effective at reaching some populations believed to be at “highest risk” (e.g., people with no prior testing history and people who report high HIV stigma). A small number of studies have examined pharmacists’ attitudes towards selling non-prescription syringes: the majority believe pharmacies to be important resources for people who use/inject drugs; in one study, 59% indicated willingness to provide health information and referrals. The literature on pharmacy involvement with post-exposure and pre-exposure prophylaxis (PrEP) is modest: recent studies have highlighted the benefit and feasibility of PrEP screening and same-day dispensing although important questions (including reimbursement-related concerns) remain. Few studies have utilized pharmacies to promote and/or support ART adherence among people with HIV. Data suggest people who obtain ART from HIV specialized pharmacies are more likely to obtain refills; also, when pharmacists provide more HIV counseling, adherence and viral load improvements are observed.