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Community pharmacies could expand PrEP access to help prevent HIV

Pharmacist holding a prescription

19 November 2024

A new study has found that community pharmacies could play a significant role in expanding access to pre-exposure prophylaxis (PrEP), a highly effective pill for preventing HIV infection. The researchers found that pharmacies could provide a more convenient and discreet option for those who are underserved by the current model of PrEP delivery through sexual health clinics in England.

The stigma surrounding sexual health services and their potentially inconvenient locations prevent some people from accessing PrEP. These barriers may disproportionately affect women, people from global majority communities and transgender people who may be at risk of acquiring HIV but are less likely to access PrEP through sexual health clinics.

The study was carried out by researchers from the Centre for Academic Primary Care, National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation (HPRU) at the University of Bristol. It involved interviewing community pharmacists and members of key at-risk groups to identify the barriers and facilitators of community pharmacy PrEP delivery using the Capability, Opportunity, Motivation, Behaviour (COM-B) model.

The study identified several barriers to pharmacy-based PrEP delivery. These included:

  • A lack of awareness and knowledge about PrEP
  • A lack of PrEP training for pharmacists
  • A lack of privacy and facilities within pharmacies

The study also identified facilitators of pharmacy-based PrEP delivery. These included:

  • Raising awareness of PrEP
  • Providing PrEP specific training for pharmacists
  • Pharmacy accessibility, including proximity within the community, extended opening hours and walk in service
  • The discretion pharmacy PrEP delivery could offer

To make pharmacy PrEP delivery viable, the study suggests developing a behaviour change intervention focusing on raising awareness and educating both pharmacists and community members.

Systemic changes, such as funding and infrastructure improvements will also be necessary to support PrEP delivery via pharmacies as will policy changes allowing pharmacies to access NHS PrEP stock. The researchers are now working on a pilot to test the feasibility of PrEP being accessed via pharmacies .

Dr China Harrison, lead researcher from University of Bristol, NIHR ARC West and NIHR HPRU, said:

“The UK has seen a decline in new HIV diagnosis among gay, bisexual and other men who have sex with men, largely due to PrEP use. However, new HIV diagnoses among heterosexual individuals, particularly those from marginalised communities are increasing.

“Our study highlights the acceptability of pharmacy PrEP delivery for pharmacists and underserved community members offering an important opportunity to expand PrEP delivery and address these health disparities.

“We are now working on a pilot to test the feasibility of PrEP delivery via pharmacies. If successful, pharmacies could help bridge the gap in HIV prevention for underserved communities, bringing the UK closer to its goal of eliminating new HIV infections by 2030”

Professor Jeremy Horwood, principal investigator of the study and researcher from University of Bristol, NIHR ARC West and Centre for Academic Primary Care said:

“Pharmacies offer an untapped potential to reach people who might not feel comfortable accessing PrEP via traditional sexual health services.

“With the right training and support, pharmacies can help close the gap in HIV prevention and ensure that PrEP is accessible to everyone who needs it and work towards reducing new HIV acquisitions across all communities.

“Although pharmacy PrEP delivery is acceptable to pharmacists and community members, there are system and policy barriers that would need to be overcome to make this feasible.”

Paper: Qualitative exploration of the barriers and facilitators to community pharmacy PrEP delivery for UK pharmacists and underserved community members using the COM-B model of behaviour change

Further information

About the Centre for Academic Primary Care

The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of ten forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow on Bluesky: @capcbristol.bsky.social, X: @capcbristol and LinkedIn

About the NIHR

The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

  • Funding high quality, timely research that benefits the NHS, public health and social care;
  • Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
  • Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
  • Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
  • Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
  • Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.

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