Pharmacies in HIV Prevention: Fellowship, Fundamentals, and Sustainable Finances

/ ABSTRACT Despite availability of HIV pre-exposure prophylaxis (PrEP) for over a decade, many persons who could benefit from PrEP have not yet accessed PrEP services. Implementation of pharmacy-based PrEP is a promising strategy that presents opportunity to overcome barriers related to clinic distance and stigma and to increase PrEP access, uptake, and continuity of treatment among individuals who would benefit most. Despite the fact that team member and pharmacist Dr. Elyse Tung started the first pharmacy-based PrEP clinic nearly ten years ago, PrEP still is not widely available through pharmacies without a prescription from a doctor or other licensed clinician. As of 2024, not all states allow pharmacists to prescribe medications independently, and many insurance companies erect barriers to providing compensation to pharmacists for this role. Implementation science projects are needed to develop, refine, and evaluate the training and educational support required by pharmacists to expand their scope of practice. Health economics work is also needed to determine whether there are incremental financial benefits for pharmacies to provide injectable PrEP in addition to oral medications and to evaluate the cost-effectiveness of providing PrEP through telehealth. In response to RFA MH-25-185, we propose three specific aims. Aim 1 will build on a current supplement through the Ending the HIV Epidemic (EHE) initiative that is funding a pilot project to evaluate an online virtual community of practice (VCoP) for pharmacists and pharmacy staff to increase their knowledge, capabilities, and comfort in prescribing PrEP. Aims 2 and 3 will conduct financial analyses to provide information for new pharmacy implementation and use time and motion data to compare the costs and benefits of providing injectable PrEP versus oral PrEP and in-pharmacy visits versus telePrEP. This project addresses the Prevent pillar of the EHE plan with a secondary impact on the Diagnose pillar. This project also addresses the NIH HIV/AIDS Research Priorities (NOT-OD-20-018) to reduce HIV incidence by testing new prevention strategies and training the workforce. It is in synergy with the local EHE plan, the Washington State Department of Health, and the National HIV/AIDS Strategy. The national strategy specifically calls out to leverage pharmacists’ knowledge and accessibility in nearly every urban and rural community as part of a comprehensive HIV prevention and care strategy. Ultimately our goal is to provide more PrEP options and motivate pharmacists and pharmacy owners to expand access points for PrEP care in locations and to populations disproportionately impacted by HIV infection in order to end the HIV epidemic. Project Number: 1R01MH140473-01 | Fiscal Year: 2026 | NIH Institute/Center: National Institute of Mental Health (NIMH) | Principal Investigator: Joanne Stekler | Institution: UNIVERSITY OF WASHINGTON, SEATTLE, WA | Award Amount: $729,551 | Activity Code: R01 | Study Section: Special Emphasis Panel[ZRG1 CCHI-M (56)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11167188