by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer
May 4, 2021
Crawford ND, Myers S, Young H, Klepser D, Tung E. The Role of Pharmacies in the HIV Prevention and Care Continuums: A Systematic Review. AIDS Behavior. 2021 June; 25(6): 1819-1828. doi: 10.1007/s10461-020-03111-w. Epub 2021 Jan 2. PMID: 33386509.
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.
Pharmacy-based HIV testing appears to be highly feasible and acceptable to both staff and clients, especially in settings offering other routine prevention services (e.g. vaccinations, hypertension screenings). In comparison, pharmacy-based syringe access services, pre- and post-exposure prophylaxis, and ART/HIV treatment support are interventions that, while highly promising, are less well-studied. In many U.S. areas, and through legislative support, pharmacies have become uniquely positioned as vital community resources that can offer prevention services for people who inject drugs. Rigorous study design and inclusion of implementation science frameworks are critical elements for building a sufficient evidence base to help further raise the visibility of pharmacies in ending the HIV epidemic and promote broader adoption and scale-up.
The author has no conflicts of interest to disclose.
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