Community Pharmacies Able to Fill HIV Testing Gaps

A program in which high-risk individuals were offered HIV testing and follow-up support at community pharmacies produced high rates of participation and satisfaction.

A new study shows that community pharmacies may be able to identify early HIV infection and HIV-positive patients who have limited access to care in high-risk populations.

Despite efforts to expand HIV testing and education, Centers for Disease Control and Prevention data from August 2011 indicates that the rate of new infections and late diagnoses has remained stable for more than a decade. One reason the numbers may not be improving is that those at the highest risk for HIV also have the least access to care. The new study, published in the August 22, 2013, issue of AIDS Patient Care and STDs, evaluated the efficacy of moving testing out of traditional health care settings and into pharmacies in high-risk communities as a means of making HIV testing available to more at-risk and hard-to-reach individuals.

Five inner-city pharmacies, located in the New York City boroughs of the Bronx and Manhattan, were chosen to implement a rapid counselor-based HIV testing program from October 2009 to June 2011. Public Health Advocates, trained in HIV testing, counseling, and linkage to care, offered HIV testing to those older than 13 inside and outside pharmacies. Patients who refused were asked why they did not want to be tested. Individuals who had been tested within the last 6 months or who already had a positive diagnosis for HIV were excluded from the study. Eligible patients who agreed to the test were escorted to a private testing area within the pharmacy. While waiting for test results, patients completed risk factor and satisfaction questionnaires and were counseled on risk reduction by the Public Health Advocates. If a patient tested positive, the advocates offered to escort them to the outpatient HIV clinic at the hospital where secondary testing was performed by a specialist.

During 294 testing days, 2805 patients were deemed eligible for testing, and 2030 (72.4%) of these eligible patients agreed to be tested. Of the patients who refused testing, 61.4% said they were not at risk for HIV, and 29.7% said they could not spare the time to be tested. Among those who were tested, 6 tested positive for HIV. Four of those who tested positive were Hispanic, and 4 were men. Only 1 HIV-positive patient refused linkage to care, and most were connected to a specialist in less than an hour.

Almost all patients who were tested (98.6%) reported that being tested inside the pharmacy was easy. Just under a third (30.7%) of participants said they had learned a lot of new information on HIV, and 56% said they had learned a small to moderate amount of new information about HIV.

Based on their results, the researchers suggest that HIV testing in community pharmacies is a viable solution to the challenge of reaching high-risk individuals.

“The pharmacy model would be an important addition to current community-based testing programs to identify individuals that are not being tested through other programs, while providing a professional health venue to help participants feel safe when receiving the test, counseling, and linkage to care services,” they write.