Integrating and Disseminating Pre-Exposure Prophylaxis (PrEP) Screening and Dispensing for Black Men Who Have Sex With Men in Atlanta, Georgia: Protocol for Community Pharmacies

• Type of Material: Article
• Authors: Natalie Crawford, Emory University; Kristin R V Harrington, Emory University; Daniel I Alohan, Emory University; Patrick Sullivan, Emory University; David Holland, Emory University; Donald G Klepser, University of Nebraska; Alvan Quamina, National AIDS Education and Services for Minorities Inc; Aaron Siegler, Emory University; Henry N Young, University of Georgia
• Language: English
• Date: 2022-01-01
• Publisher: JMIR Publications
• Publication Version: Final Published Version
• Copyright Statement: ©Natalie D Crawford, Kristin R V Harrington, Daniel I Alohan, Patrick S Sullivan, David P Holland, Donald G Klepser, Alvan Quamina, Aaron J Siegler, Henry N Young. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 09.02.2022.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.2196/35590
• Title of Journal or Parent Work: JMIR Research Protocols
• Volume: 11
• Issue: 2
• Start Page: e35590
• End Page: e35590
• Grant/Funding Information: We would also like to acknowledge the National Institute of Mental Health for its support under award number R34MH119007.
• Keywords: development; dissemination; sexuality; men who have sex with men; pharmacy; HIV; prevention; access; prophylaxis; screening; race; implementation; pre-exposure prophylaxis; PrEP; MSM; integration; demographic; sex; protocol
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Pharmacy; Health Sciences, Education

Abstract

Background: Black men who have sex with men (BMSM) suffer from alarmingly high rates of HIV in the United States. Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV infection by 99% among men who have sex with men, yet profound racial disparities in the uptake of PrEP persist. Low PrEP uptake in BMSM is driven by poor access to PrEP, including inconvenient locations of PrEP-prescribing physicians, distrust of physicians, and stigma, which limit communication about PrEP and its side effects. Previous work indicates that offering HIV prevention services in pharmacies located in low-income, underserved neighborhoods is feasible and can reduce stigma because pharmacies offer a host of less stigmatized health services (eg, vaccinations). We present a protocol for a pharmacy PrEP model that seeks to address challenges and barriers to pharmacy-based PrEP specifically for BMSM. Objective: We aim to develop a sustainable pharmacy PrEP delivery model for BMSM that can be implemented to increase PrEP access in low-income, underserved neighborhoods. Methods: This study design is a pilot intervention to test a pharmacy PrEP delivery model among pharmacy staff and BMSM. We will examine the PrEP delivery model’s feasibility, acceptability, and safety and gather early evidence of its impact and cost with respect to PrEP uptake. A mixed-methods approach will be performed, including three study phases: (1) a completed formative phase with qualitative interviews from key stakeholders; (2) a completed transitional pilot phase to assess customer eligibility and willingness to receive PrEP in pharmacies during COVID-19; and (3) a planned pilot intervention phase which will test the delivery model in 2 Atlanta pharmacies in low-income, underserved neighborhoods. Results: Data from the formative phase showed strong support of pharmacy-based PrEP delivery among BMSM, pharmacists, and pharmacy staff. Important factors were identified to facilitate the implementation of PrEP screening and dissemination in pharmacies. During the transitional pilot phase, we identified 81 individuals who would have been eligible for the pilot phase. Conclusions: Pharmacies have proven to be a feasible source for offering PrEP for White men who have sex with men but have failed to reach the most at-risk, vulnerable population (ie, BMSM). Increasing PrEP access and uptake will reduce HIV incidence and racial inequities in HIV. Translational studies are required to build further evidence and scale pharmacy-based PrEP services specifically for populations that are disconnected from HIV prevention resources.