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 to review the published evidence. They identified 649 potentially relevant journal articles 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).
Once they had conducted the scoping review of the literature, our researchers went on to explore the barriers and facilitators of community pharmacy PrEP delivery for UK pharmacists and community members identified as being at elevated risk of acquiring HIV. They also used the COM-B model to do this.
During this part of the study, the team interviewed 17 community pharmacists and 24 community members, including Black African women, transgender people, and female street sex workers.
Barriers
The barriers to pharmacy-based PrEP delivery identified included:
Capability barriers
- Lack of knowledge
- Training and skills among pharmacy staff
- Lack of PrEP awareness among clients and staff
- Unclear roles of pharmacists in delivering public health services
Opportunity barriers
- Lack of staff time and capacity
- 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
Facilitators
Facilitators included:
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
- Preference for pharmacy-based delivery
- Believing that pharmacy delivery would be more discrete and less stigmatising
Our researchers are now working on developing a pharmacy PrEP delivery intervention to pilot in five pharmacies in the Bristol, North Somerset, South Gloucestershire region to test the feasibility of PrEP delivery via pharmacies.
Papers
- Facilitators and barriers to community pharmacy PrEP delivery: a scoping review
- Qualitative exploration of the barriers and facilitators to community pharmacy PrEP delivery for UK pharmacists and underserved community members using the COM-B model of behaviour change
Lead collaborators
- Dr Sarah Denford, University of Bristol
- Professor Caroline Sabin, University College London (HPRU Blood Borne and Sexually Transmitted Infections)
- Dr John Saunders, University College London (HPRU Blood Borne and Sexually Transmitted Infections)
- Dr Joanna Copping, Bristol City Council
- Dr Sarah Cochrane, Unity Sexual Health
- Dr Lindsey Harryman, Unity Sexual Health
- Lottie Lawson, South Gloucestershire Council
- Judith Paulton, Avon Local Pharmaceutical Committee
