The addition of a dedicated pharmacist within a primary care setting may lead to increased uptake of HIV pre-exposure prophylaxis (PrEP) among individuals experiencing homelessness, according to study findings published in the Journal of the American Pharmacists Association.
Researchers conducted a retrospective cohort study to evaluate HIV PrEP uptake and the continuum of care among individuals experiencing homelessness. Included participants (N=40) were aged 18 years and older and had received a prescription for emtricitabine/tenofovir disoproxil fumarate or emtricitabine/tenofovir alafenamide at a primary care setting between March 2020 and April 2021. The researchers compared PrEP uptake among participants who received an initial PrEP prescription before vs after the addition of a clinical pharmacy specialist. The primary outcomes were the number of initial prescriptions, dispensations, and discontinuations of PrEP, as well as participant retention in PrEP care and new HIV diagnoses.
Among participants included in the analysis, the mean age was 36 years, 60% were men, and 38% were Black. Of the participants who received an initial PrEP prescription before (n=10) and after (n=30) the addition of a clinical pharmacy specialist, 10 and 27 had partner who was HIV-positive, and 4 and 12 were diagnosed with a sexually transmitted infection within the previous 6 months, respectively. In addition, the majority of participants in the overall population had a mental health (78%) or substance use disorder (73%) diagnosis.
After the addition of a dedicated clinical pharmacy specialist, the researchers found that the number of participants enrolled in patient assistance programs increased significantly from 44% to 100% (P <.01). There also was an increase in the overall number of PrEP prescriptions initiated, and the rate of first PrEP dispensations significantly increased from 40% to 80% (P =.04). Among all participants, no significant differences were observed in the rate of attendance at 3- and 6-month follow-up appointments before vs after the addition of a clinical pharmacy specialist (13% vs 15%).
Factors associated with never receiving a PrEP prescription included a lack of clinical pharmacy specialist management (risk ratio [RR], 1.72; 95% CI, 0.67-4.42), failure to attend the 3-month (RR, 1.80; 95% CI, 0.58-5.62) or 6-month (RR, 1.35; 95% CI, 0.53-3.47) follow-up appointment, and a lack of enrollment in patient assistance programs (RR, 4.67; 95% CI, 2.30-9.49).
Although none of the participants received an HIV diagnosis, only 14 were tested for HIV infection during the study period.
Limitations of the study include the small number of participants, the low rate of HIV testing, and the possibility that the COVID-19 pandemic affected participant enrollment, the number of PrEP dispensations, and retention in care.
According to the researchers, “The findings of this initial evaluation indicate that further studies are needed to assess the unique and heightened barriers for PrEP use among persons experiencing homelessness.”
McElyea J, Bistransin K, Bana S, et al. Impact of a clinical pharmacist within an HIV pre-exposure prophylaxis (PrEP) program for patients experiencing homelessness. J Am Pharm Assoc. Published online September 8, 2022. doi:10.1016/j.japh.2022.09.003.