Expanding the Role of Pharmacists in HIV Prevention

A significant unmet need exists for preexposure prophylaxis (PrEP), and a shortage of physicians is seen in many communities, but most individuals live within five miles of a pharmacy.¹ Myers et al.² argue that making PrEP available at pharmacies can fulfill this unmet need. Furthermore, a role expansion for pharmacists can address the physician shortage that disproportionately affects those at most risk for acquiring HIV.³ Although stigma reduces access to primary care for these populations, their communities do not have enough physicians, so this option is unavailable.³

The demand for primary care has been outpacing workforce availability as a result of an increasing population and a decreasing number of providers entering the specialty.⁴ This creates a lack of medication management. An increasing percentage of the population is taking medications for chronic conditions, including PrEP, and these individuals who require consistent follow-up do not have access to primary care.⁴ Pharmacists trained in medication management can provide this support for PrEP. Because of wait times for primary care, pharmacists are best equipped to provide this service; their proximity to individuals increases the likelihood that patients will not be lost to follow-up and will continue to adhere to treatment.³

Pharmacists must be empowered by clinicians to perform HIV-related primary care duties through effective task-shifting. Data from the National Ambulatory Medical Care Survey estimate that about 60% of a physician’s work in preventive medicine can be reallocated to nonclinicians, including pharmacists.⁵ Generally, this requires supervision by a clinician, which can be difficult with the shortage of primary care physicians; however, the increasing presence of retail clinics at pharmacies means that at least one clinician is on staff to serve in a supervisory capacity.⁶

One example of successful implementation took place at the Kelley-Ross Pharmacy in Seattle, Washington, and allowed pharmacists to prescribe PrEP under the supervision of a medical director.¹ This intervention resulted in high initiation and adherence rates and zero HIV seroconversions.¹ This intervention expanded pharmacists’ role in HIV prevention and successfully increased rates of patient participation in these activities.

To support a role expansion for pharmacists, communication within a patient’s health care team must be optimal, especially across multiple health care facilities and organizations, to ensure quality services, ensure adherence to treatment, and improve outcomes.⁷ Ultimately, a patient will not successfully receive HIV screening or adhere to PrEP if his or her health care provider is not empowered to provide these services in an environment free from stigma or judgment.²