Pharmacist-led program increases high-risk patients’ access to PrEP
Pre-exposure prophylaxis (PrEP) enables people who are HIV negative but at high risk for contracting HIV to take medication daily to help lower the risk of acquiring the infection. In a study published in a recent issue of Open Forum Infectious Diseases, Havens and colleagues showed that a pharmacist-led PrEP program in Omaha, NE, was a feasible way to increase access to PrEP. With the relative shortage of providers who provide care to HIV populations, pharmacists can step in via collaborative practice agreements (CPAs) to bridge this care gap, especially in rural environments.
PrEP involves a combination of tenofovir and emtricitabine taken once daily. If these medications are not taken daily, their efficacy drops precipitously.
High-risk sex and I.V. drug use are the two activities that can place individuals at risk for HIV infection. When PrEP is used appropriately, HIV transmission is reduced by 99% for high-risk sex and 74% for I.V. drug use. Depending on the type of sex engaged in, it can take up to 20 days for PrEP to reach maximum protection.
Havens and colleagues enrolled 60 patients in their pharmacist-led PrEP program. Participant retention at 3, 6, 9, and 12 months was 73%, 58%, 43%, and 28%, respectively. Of the remaining 28% of patients, none became HIV positive.
Although it is difficult to draw conclusions about the seroconversion status at the 12-month mark of the 72% of patients who left the program, the study did conclude that 28 out of 35 patients who finished the satisfaction questionnaire at the 6-month visit would recommend the pharmacist-led PrEP program to others. Pharmacists also did not report significant workflow disruption while providing this service. Further studies are needed to explore how pharmacists can bolster the participant retention of the program.
PrEP costs approximately $2,000 per month; however, the regimen is generally covered by insurance or, if a patient is uninsured, by a medication assistance program.
PrEP also requires initial HIV screening and additional screening every 3 months to ensure a patient’s HIV-negative status. In rural and underserved areas, this could mean multihour commutes and other time costs that make this option out of reach for people at high risk of contracting HIV.
Pharmacists can be a useful resource to patients as they navigate getting PrEP financed. They can also provide support to patients experiencing adverse effects, most commonly nausea. Moreover, enlisting pharmacists as care providers via CPAs in these environments could increase access to PrEP and significantly reduce the transmission of HIV.
In addition to entering CPAs with physicians, pharmacists are encouraged to lobby their state legislative representatives to enable pharmacists to provide and be reimbursed for this service as a recognized provider. Removing this CPA roadblock is the final step toward allowing pharmacists to practice at a high level to help patients.
For the full article, please visit www.pharmacytoday.org for the November 2019 issue of Pharmacy Today.