Accessing PrEP through pharmacies to improve HIV prevention
Pre-exposure prophylaxis (PrEP) is a medication that HIV-negative people can take before and after sex to reduce their risk of getting HIV. PrEP is available for free from NHS sexual health clinics in England. However, some people may find it difficult to access PrEP because of the stigma associated with using sexual health services, increasing health inequities.
Women born as women, heterosexual men born as men, ethnic minority communities, trans-people and young people are less likely to take PrEP. Making PrEP available through pharmacies could make accessing it easier for them.
The UK Health Security Agency (UKHSA) identified ‘high street’ pharmacies as important providers of public health services. Pharmacies are ideally placed to reach disadvantaged, marginalised and vulnerable populations. They already play an important role in public and sexual health work in the UK, for example by providing the emergency contraceptive pill and chlamydia screening and treatments.
Project aims
We want to understand if it is possible to use pharmacies to deliver PrEP. This includes identifying the barriers that may stop people from using them.
We also want to understand what training and facilitation pharmacy staff may need to provide this service.
What we hope to achieve
We want to design an intervention that supports people who are at higher risk of HIV to access PrEP through pharmacies. We will find out whether these people would find this type of service acceptable. We will then use the information to plan the design and implementation of PrEP delivery through pharmacies.
We hope to influence policy and clinical practice through our research findings. We will disseminate our findings nationally and internationally by collaborating with public and private bodies, community sector organisations and the global Fast Track Cities Initiative.
What we have done so far
Our researchers searched 10 databases, identified 649 potentially relevant records and after screening for eligibility, reviewed 56. Most of the eligible records were original publications about research conducted during or after the year 2020 in the US. This reflected a change in legislation at the time, allowing PrEP delivery through pharmacies in some states.
The research team mapped the barriers and facilitators of community pharmacy PrEP delivery identified in the literature to the COM-B behaviour change model. According to the COM-B model, behaviour change requires capability (skills and knowledge), opportunity (social and environmental), and motivation (importance and intentions)
Our researchers identified the following barriers to PrEP delivery in pharmacies:
- capability barriers:
- lack of knowledge, training and skills among pharmacy staff
- lack of PrEP awareness among clients and staff
- opportunity barriers:
- lack of staff capacity and time
- lack of privacy in pharmacies
- lack of pharmacy facilities to carry out screening and monitoring
- motivation barriers:
- financial cost of PrEP to pharmacists and clients
- belief that PrEP delivery could lead to risky behaviours and higher rates of STIs
- not considering pharmacists as healthcare providers
The also identified facilitators to improve the prospect of PrEP delivery through pharmacies:
- capability facilitators:
- improving client and pharmacist awareness of PrEP
- provision of PrEP specific training and education
- opportunity facilitators:
- pharmacies having a PrEP appointment system
- using pre-existing pharmacy pathways or services to deliver PrEP
- accessible location and opening hours of community pharmacies
- motivation facilitators:
- having an interest in PrEP
Paper
Facilitators and barriers to community pharmacy PrEP delivery: a scoping review
Read the paperLead collaborators
- Dr Joanna Copping, Bristol City Council
- Dr Sarah Cochrane, Unity Sexual Health
- Dr Lindsey Harryman, Unity Sexual Health
- Dr Sarah Denford, Health Protection Research Unit in Behavioural Science and Evaluation
- Professor Caroline Sabin, Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections
- Dr John Saunders, Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections
- Lottie Lawson, South Gloucestershire Council
- Judith Paulton, Avon Local Pharmaceutical Committee
- Aled Osborne, Brigstowe
ARC West Staff
Dr Joanna Kesten
Research Fellow, Qualitative ResearchPartners on this project
Bristol City Council
The council plays a vital role in the health community as public health is part of its remit. Its role is to prevent disease, promote health, and prolong life among the population of Bristol. Its activities aim to provide conditions in which people can be healthy and it focuses on the population as a whole, not on individual patients or diseases.
South Gloucestershire Council
South Gloucestershire Council has responsibility for public health in its area, including encouraging healthy lifestyle choices, smoking cessation and vaccination uptake.
University Hospitals Bristol and Weston NHS Foundation Trust
University Hospitals Bristol and Weston NHS Foundation Trust is a dynamic group of hospitals in the heart of Bristol and Weston-Super-Mare, with over 100 clinical services across ten sites. They offer care to the people of Bristol, Weston-Super-Mare and the South West, and have an international reputation for cardiac surgery, paediatric services, oncology and bone marrow transplantation. They are the largest centre for medical training and research in the South West.
University of Bristol
The University of Bristol is internationally renowned and one of the very best in the UK, due to its outstanding teaching and research, its superb facilities and highly talented students and staff. Its students thrive in a rich academic environment which is informed by world-leading research. It hosts the Elizabeth Blackwell Institute for Health Research.