Table 1.

Description of articles included in the case study review

Study	Location	Description	Results
Ryan et al22 23	USA: Albuquerque, New Mexico	One of the first pharmacy-run HIV PrEP clinics in the USA was established in July 2015. The half-day weekly clinic generally sees 10–14 patients per week. Over 200 patients have been seen overall.	There were no HIV seroconversions among those who started PrEP. Of the first 136 clients, 2 tested HIV-positive at baseline and 127 were started on PrEP (TDF/FDC). One discontinued due to side effects. No significant elevation in serum creatinine was noted over time. Average adherence was <1 missed doses per month and a median compliance rate of 0.99.
Havens et al21	USA: Omaha, Nebraska	P-PrEP allowed pharmacists to serve as PrEP providers through a CPA. Pharmacists received education on HIV risk assessment, testing, risk reduction counselling and administration of PrEP. Eligible participants received a 90-day F/TDF prescription and had the option to continue PrEP care at the university-based HIV clinic or at one of three participating sites (community pharmacy, university-based primary care clinic or community primary care clinic). Follow-up visits were every 3 months after PrEP initiation, and laboratory monitoring was performed, including screening for HIV, chlamydia and gonorrhoea.	60 participants enrolled in the P-PrEP programme and started F/TDF. The majority, 91.7% (55/60), were men, 83.3% (50/60) were white, 80% (48/60) were commercially insured and 89.8% (54/60) had completed some college or higher. The mean age of participants was 34 years (range 20–61 years), and 88.3% (53/60) identified as MSM.
Khosropour et al16	USA: Jackson, Mississippi	The pharmacist evaluated patients for medical contraindications to PrEP, but no baseline labs were obtained. The pharmacist provided a PrEP prescription and scheduled a clinical appointment for patients within 6 weeks, at which time they were evaluated by a clinician and completed baseline labs.	The pharmacist evaluated 69 patients for PrEP; 57% were MSM, 77% were black and 65% were uninsured. All patients received a PrEP prescription; 83% the same day and 97% within 5 days. Fifty-three (77%) of 69 clients filled the prescription; 87% of whom filled it within 1 week. Only 23 (43%) of 53 clients who filled their prescription attended their initial clinical appointment within 6 weeks. There were no differences in PrEP initiation or retention by patient sex/gender.
Lopez et al17	USA: San Francisco, California	A community pharmacy and the DPH developed a CPA that allowed community pharmacists to initiate PrEP and PEP. Pharmacists were trained by DPH staff members on HIV testing and counselling and implementation of the PrEP protocol, including PEP initiation and STI testing. A DPH physician reviewed patients’ charts regularly and communicated with PrEP pharmacists as needed.	In the first year, 6 patients received PEP and 53 completed a PrEP initiation visit, of whom 96% (n=51) filled their prescription. Forty-seven per cent (n=24) of clients who started PrEP self-identified as Hispanic or Latino, 10% (n=5) were black or African-American and 82% (n=42) identified as MSM.
Sawkin and Shah18	USA: Kansas City, Missouri	Clinical pharmacists were trained to provide PrEP education and medication management outlined within a CPA. The screening visit includes rapid HIV testing, hepatitis C screening, urinalysis, pregnancy testing, complete blood count with differential, comprehensive metabolic profile, STI screening and hepatitis B serology. Once deemed eligible, pharmacists prescribe TDF/FDC for up to 90 days to ensure medication safety and efficacy. Patients return every 3 months for labs including rapid HIV testing, a basic metabolic panel and STD screening.	In the first year, the PrEP clinic had >50 actively managed patients.
Tung et al19 20	USA: Seattle, Washington state	The One-Step PrEP clinic, at a private pharmacy and under physician oversight (1 first year resident physician, 3 pharmacists, ancillary staff), provides PrEP with a single patient encounter. Pharmacists meet with patients individually, take a medical and sexual history, make a risk assessment, perform laboratory testing, provide patient education and prescribe and dispense oral PrEP (TDF/FTC) when appropriate.	Of 714 patients evaluated, 695 (97.3%) initiated PrEP. Mean duration of PrEP use was 302 days. Same-day medication start: 513 (74%). Drop-out rate: 25%. STI diagnoses: 207 in 135 patients. HIV diagnoses: 2 at initial evaluation, 0 during active engagement, 1 after being lost to follow up.

CPA, collaborative practice agreement; DPH, Department of Public Health; MSM, men who have sex with men; P-PrEP, pharmacist-led PrEP; PrEP, pre-exposure prophylaxis; STI, sexually transmitted infection.