“Let’s Build a Relationship and a Common Language so We Can Both Work Towards Getting the Clients What They Need”: Perceptions on Integrating Pharmacies As Partners In HIV Prevention Among Community Organization and Public Health Agency Representatives

Background and Purpose. In 2019, California (CA) passed a first-of-its kind legislation allowing pharmacists to prescribe pre-exposure prophylaxis (PrEP) for HIV prevention independently to improve access in communities disproportionately impacted by HIV. Yet only 11% of CA pharmacists indicated prescribing PrEP in 2022. We sought to examine the multilevel barriers and facilitators to implementing pharmacy-based PrEP services in three Southern CA counties with persistent high HIV rates (Los Angeles, Riverside and San Bernardino Counties). We used the Consolidated Framework for Implementation Research (CFIR) to focus our inquiry on the macro-level factors that influence pharmacy-based PrEP services delivery in these priority counties.

Methods. Using convenience sampling and a validated semi-structured interview guide, we conducted 1-hour interviews from October 2023 to November 2024 among community partners (N=22) working in HIV prevention including community-based organizations and local county public health agencies. Rapid Qualitative Analyses (RQA) was used by four members of our study team.

Results. Three main themes emerged from our analyses that we identified as a barrier, a facilitator, and a mediator in integrating pharmacies as partners in HIV prevention. First, an identified barrier was the perception among our community partners that pharmacy-based PrEP provision had the potential to cause harm (Theme 1). The community partners we interviewed indicated that pharmacists may: a) further stigmatize PrEP-seeking clients who face significant social and economic marginalization; and b) become direct competitors of resources in an already tight and diminishing HIV funding environment. Yet despite their reservations, a major facilitator among the community partners we interviewed was the belief that pharmacies are reliable healthcare access points for community members (Theme 2). Our community partners stated that pharmacists are already: a) fully integrated in the local community; b) trusted sources of health information; and c) well-suited for expanding PrEP access to community members. Finally, we identified a significant mediator that can help bridge the gap between community pharmacies and their neighboring local community organizations and county public health agencies. We found a willingness among our community partners to increase collaboration with the pharmacies in their area (Theme 3) by: a) building linkages to improve patient care; and b) developing partnerships that provide mutual supports and services.

Conclusion and Implications: Ending the HIV epidemic in the U.S. require significant effort from across multiple healthcare sectors and industries. The full integration of novel HIV prevention service delivery models, such as pharmacy-based PrEP provision, is essential to this work. Our study findings suggest that local pharmacies are seen as a reliable, trusted, and well-suited access point for PrEP services by neighboring organizations. Moreover, community organization and public health agency representatives were willing to partner with local pharmacies in HIV prevention. To improve trust and build long-term partnerships with external organizations within the community, local pharmacists must demonstrate their ability to provide HIV-related services with cultural humility as well as ensure that pharmacy-based PrEP services are not meant to duplicate, but rather enhance and support, the HIV prevention services already provided by community organizations in their area.