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- Title
Examination of HIV Preexposure Prophylaxis Need, Availability, and Potential Pharmacy Integration in the Southeastern US.
- Authors
Harrington, Kristin R. V.; Chandra, Christina; Alohan, Daniel I.; Cruz, Diego; Young, Henry N.; Siegler, Aaron J.; Crawford, Natalie D.
- Abstract
Key Points: Question: What is the potential reach of pharmacies in helping to expand preexposure prophylaxis (PrEP) access across the southeastern US? Findings: In this cross-sectional study of 6 states in the southeastern US, pharmacies had greater ability to meet the need for PrEP among residents of the southeastern US compared with current PrEP-prescribing locations. States that could see the greatest benefit from expansion of PrEP prescribing to pharmacies included Kentucky, South Carolina, and Tennessee. Meaning: These findings suggest a substantial potential increase in HIV prevention and care services if services were expanded to pharmacies across the southeastern US. This cross-sectional study evaluates the current burden of HIV in communities across the southeastern US with current preexposure prophylaxis (PrEP)-prescribing locations and pharmacies and calculates the ratio of location to need. Importance: Daily preexposure prophylaxis (PrEP) use can prevent up to 99% of HIV infections; however, PrEP uptake is low due to poor access to PrEP-prescribing locations for populations at increased risk for HIV, especially in the southeastern US. Pharmacies are a feasible option to increase PrEP access, but little is known about how they could complement current PrEP-prescribing locations. Objective: To examine geographic distributions of current PrEP-prescribing locations compared with pharmacies and the facility to need ratios (PFNRs) according to HIV risk in the Southeast and describe the potential reach of pharmacies to expand PrEP access. Design, Setting, and Participants: Data for this cross-sectional study of PrEP-prescribing locations and pharmacies were compiled from January 1 to December 31, 2021. States or specific counties in the Southeast included in this study were jurisdictions identified as high-priority areas for the Ending the HIV Epidemic in the US (EHE) initiative. Exposure: Expansion of HIV prevention services to pharmacies. Main Outcomes and Measures: Choropleth maps of 5-year HIV risk per 100 000 persons were developed for EHE jurisdictions in the southeastern US. PrEP-prescribing locations (obtained from a national database of PrEP prescribers) and pharmacies (obtained from state pharmacy boards) were overlayed on HIV risk maps. The PFNRs by state were calculated as number of facilities (PrEP-prescribing locations or pharmacies) divided by 5-year HIV risk per 100 000 persons. Lower PFNRs indicated lower geographic availability of locations to meet the needs of the population at risk for HIV. The PFNRs for current PrEP-prescribing locations vs pharmacies were compared. Results: Among the 2 southeastern states and 13 counties in 4 southeastern states included, PrEP-prescribing locations were unequally distributed across EHE areas, with substantially fewer in areas at high risk for HIV. Pharmacies were evenly dispersed across areas regardless of HIV risk. The mean PFNR across all states for current PrEP-prescribing locations was 0.008 (median, 0.000 [IQR, 0.000-0.003]); for pharmacies, it was 0.7 (median, 0.3 [IQR, 0.01-0.1]). The PFNRs were at least 20.3 times higher for pharmacies compared with PrEP-prescribing locations. States with the greatest potential increase in PFNRs with expansion to pharmacies included Kentucky, South Carolina, and Tennessee. Conclusions and Relevance: The findings of this cross-sectional study suggest that expanding HIV prevention services to pharmacies in EHE areas in the Southeast could significantly increase capacity to reach individuals at increased risk of HIV transmission. Legislation aimed at allowing pharmacists to prescribe PrEP and provide HIV prevention services may be an important next step in ending the HIV epidemic.
- Subjects
SOUTHERN States; HIV infection epidemiology; HIV prevention; DRUG delivery systems; HIV infections; AIDS education; HEALTH services accessibility; DRUGSTORES; CROSS-sectional method; ATTITUDE (Psychology); PHARMACY management; POPULATION geography; PRE-exposure prophylaxis; COMPARATIVE studies; RISK perception; RESEARCH funding; DESCRIPTIVE statistics; DATA analysis software; NUCLEAR medicine; PHARMACY; MEDICAL needs assessment; TRANSPORTATION; INSURANCE
- Publication
JAMA Network Open, 2023, Vol 6, Issue 7, pe2326028
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.26028