PrEP Services in Pharmacies Across Southeastern US Would Increase Treatment Capacity for HIV

Expanding HIV prevention services to pharmacies in high-risk areas across the southeastern United States could significantly improve the capacity to reach and treat individuals with an increased risk of HIV transmission, according to a new study published in the Journal of the American Health Association.

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Investigators compiled data from January 1 to December 31, 2021, by mapping local HIV risk with preexposure prophylaxis (PrEP)-prescribing locations and pharmacies in the southeastern United States. Areas included were jurisdictions identified as high-priority areas for the Ending the HIV Epidemic in the US (EHE) initiative.

Pharmacy data were obtained by purchasing data from state Boards of Pharmacy for active pharmacy locations at the state or county level. PrEP prescribing locations were determined from PrEP Locator, a national, publicly available database.

The main indicator of the study, PrEP facility to need ratios (PFNRs), were calculated by state as the total number of facilities (PrEP prescribing locations or pharmacies) divided by 5-year HIV risk per 100,000 persons, with lower PFNRs indicating lower geographic availability of locations to meet the needs of the population at risk for HIV, the investigators explained.

After conducting the study, researchers determined that the mean PFNR across all states for current PrEP-prescribing locations was 0.008 (median, 0.000 [IQR, 0.000-0.003]). For pharmacies, it was 0.7 (median, 0.3 [IQR, 0.01-0.1]), with a resulting overall fold increase of 80.9 across all regions if pharmacies were integrated into the provision of HIV prevention services.

Turning to specific states and counties in the southeast, the 5-year HIV risk ranged from 200 to greater than 400 cases per 100,000 persons in the immediate zip code tabulation areas (ZCTA) around Jacksonville and Tampa, Florida, the results of the study showed.

Though there were PrEP-prescribing locations in areas with high risk, there were many ZCTAs with a high HIV incidence with no PrEP prescribing locations. This contrasts with metropolitan areas, such as Miami-Dade and Broward counties in Florida, where pharmacies were evenly spread out, according to the investigators.

If PrEP services were expanded to pharmacies across high-risk regions in Florida, there would be a 27.8-fold increase in the PFNR, the results of the study indicate.

In Georgia, Fulton and DeKalb counties had the greatest 5-year HIV-risk, with most ZCTAs having greater than 300 cases per 100,000 persons. PrEP-prescribing locations were mainly centered in the downtown Atlanta area and the northern regions of Cobb, Fulton, and Gwinnett counties, the study results show. The highest risk of an absence of PrEP-prescribing locations were in the southern areas of Fulton and DeKalb counties.

Mecklenburg County, North Carolina, had 2 ZCTAs at the highest 5-year HIV risk, and much of the region around Charlotte had dispersed HIV risks. PrEP prescribing locations were mainly around the city of Charlotte, with few to none in outlying areas. If pharmacies offered HIV prevention services in Mecklenburg County, the PFNR would increase by 23.5-fold, the study authors wrote.

Multiple other states and counties, including Shelby County in Tennessee, South Carolina, and Kentucky, would also significantly benefit from expanded HIV prevention services, the study found. In Shelby County, expanding HIV prevention services to pharmacies would increase the PFNR by 33.1-fold. Across the state of South Carolina, expanding HIV prevention services could increase the PFNR by 98.3-fold. In Kentucky, expanding services would increase the PNFR by 169.7-fold, the results of the study show.

The investigators discussed how, despite large increases in the number of PrEP prescribing locations in recent years, these findings suggest that the US South remains understaffed with providers and clinicians who can offer PrEP.

They further discussed that although the PFNR accurately characterizes the available PrEP prescribing locations based on the HIV incidence of the area, it is limited due to its inability to inform how many locations are needed to appropriately serve each area. They note that additional considerations should be taken into account in future analyses of this problem.

“Expanding HIV prevention services to pharmacies in EHE areas in the southeastern US could significantly increase capacity to reach individuals who are at elevated risk for HIV transmission. Legislation aimed at allowing pharmacists to prescribe PrEP and provide HIV prevention services is a crucial next step in ending the HIV epidemic,” the study authors concluded.

Reference

Harrington KRV, Chandra C, Alohan DI, et al. Examination of HIV preexposure prophylaxis need, availability, and potential pharmacy integration in the southeastern US. JAMA Netw Open. 2023;6(7):e2326028. doi:10.1001/jamanetworkopen.2023.26028