Point-of-care HIV and hepatitis screening in community pharmacies: a quantitative and qualitative study

Assessment Tools for Evaluating Pharmacy Students' Knowledge on HIV Prophylaxis: A Scoping Review

OBJECTIVES

This study aimed to identify and evaluate instruments used to measure pharmacy students' knowledge of HIV prophylaxis, focusing on both preexposure prophylaxis (PrEP) and postexposure prophylaxis.

METHODS

A systematic literature search was conducted using PubMed, Virtual Health Library, Web of Science, Scopus, ScienceDirect, and Embase. Article screening was performed independently by 2 reviewers. Studies assessing pharmacy students' knowledge of HIV prophylaxis were included.

FINDINGS

Eight studies involving 1,797 students, mostly from the U.S., were identified. All had a cross-sectional design, with only one assessing knowledge retention. Six assessment tools focused on PrEP, one on PEP, and one on both. While confidence in PrEP was evident, significant gaps were found in PEP awareness, prophylaxis access, and prescribing guidelines.

SUMMARY

There is a notable shortage of assessment tools for PEP. Further research is needed to develop validated instruments for measuring knowledge and addressing educational gaps. Longitudinal studies with pre- and post-tests are crucial to evaluate educational interventions and enhance pharmacy students' preparedness for HIV prophylaxis.

Bridging the continuity: Practice-enhancing publications about the ambulatory care medication-use process in 2022

PURPOSE

This article identifies, summarizes, and prioritizes literature on the ambulatory care medication-use process (ACMUP) published in 2022 that can describe ambulatory pharmacy practice. The medication-use process (MUP) is the foundational system that provides the framework for safe medication utilization within the healthcare environment and was reimagined to focus on new innovations and advancements in ambulatory pharmacy practice. The ACMUP is defined in this article as having the following components: transitions of care, prescribing, access, dispensing, adherence, and evaluating. Articles evaluating at least one step of the ACMUP were assessed for their usefulness toward practice improvement.

SUMMARY

A PubMed search for articles published in 2022 was conducted in January 2023 using targeted Medical Subject Headings (MeSH) keywords and the table of contents of selected pharmacy journals, providing a total of 4,125 articles. A thorough review identified 49 potentially practice-enhancing articles: 6 for transitions of care, 9 for prescribing, 5 for access, 2 for dispensing, 6 for adherence, and 21 articles for evaluating. Trends from the impact articles are described.

CONCLUSION

It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article continues a series of articles defining and evaluating the currently published literature around the ACMUP. As healthcare continues to advance and care shifts to ambulatory settings, the ACMUP will continue to be a crucial process to evaluate.

Community pharmacies: Key players in point-of-care diagnostics for STI screening in Africa

BACKGROUND

Sexually Transmitted Infections (STIs) rank in the top 5 disease categories for which adults in developing countries seek healthcare services. Community pharmacies offer clients convenience, proximity, extended opening hours, privacy, and efficiency, which could make them desirable locations for HIV and STI screening and treatment. We examined the feasibility of using point-of-care (POC) STI tests for screening HIV and other STIs at community pharmacies.

METHODS

We conducted a prospective cohort study of persons seeking medication and other services at 18 purposively selected community pharmacies in Kampala, Uganda. Study participants comprised two broad categories: i) Symptomatic persons aged 18 years who presented with at least one STI sign or symptom and were purchasing treatment for themselves; ii) persons presenting with no STI symptom who had come to purchase any other medication, including family planning services such as emergency contraception. POC tests were used to test HIV, Chlamydia trachomatis (Ct), Neisseria gonorrhoeae (Ng), Trichomonas vaginalis (Tv), and Syphilis. Test results were returned on-site or via telephone within 48 to 72 hours. Descriptive statistics were used to estimate the prevalence of STIs.

RESULTS

Of the 450 participants enrolled, 235 (52.2%) were symptomatic, 215 (47.8%) were asymptomatic, and 280 (62.2%) were females. STI testing was feasible, with an acceptability rate of 99.8%. 135 (30%) of participants had at least one STI; HIV prevalence was 39 (8.7%), Syphilis prevalence was 14 (3.1%), 50 (11.1%) tested positive for Ng, 39 (8.7%) were positive for Ct while. The prevalence of Tv was 25 (8.9%) (tested among women). A total of 107 (23.8%) participants had used an antibiotic in the preceding month.

CONCLUSION

Our research underscores the potentially pivotal role of community pharmacies in deploying POC diagnostics for STIs and antimicrobial stewardship by decreasing unnecessary antibiotic dispensation across Africa.

Implementation strategies and outcomes in the delivery of HIV test services (HTS) in community pharmacies in Nigeria

BACKGROUND

Studies have shown that training interventions fail when proper strategies are not in place for their implementation. The study described the implementation strategies used in the delivery of the HIV test services (HTS) and measured implementation outcomes in the delivery of the services.

METHODS

The study was conducted between August and November 2019 among 50 selected community pharmacies in Oyo State, Nigeria using a mixed-method quantitative and qualitative data survey design. The implementation strategies and activities used in the delivery of HTS in the pharmacies and during outreaches were described while both observational and survey methods were used to collect data. Implementation outcomes were measured and analysed in terms of penetration, adoption, acceptability, feasibility, fidelity, and appropriateness of the intervention.

RESULTS

Penetration among respondents was 90%. Acceptability of the HTS was high (77.3%) among clients 20-49 years of age with 919 clients participating in the HIV screening. While 919 HIV tests were conducted, only 19 (2.1%) were positive. Adherence to the protocol of delivery of HTS (fidelity) indicated that all the respondents conducted rapid HIV testing, pre-testing counselling (43, 95.6%), post-testing counselling (40, 88.9%), and provision of confidential test results (39, 86.7%). Respondents' responsiveness indicated that 23 (51.1%%) of the respondents could use up to 80% and above of the test strips given within the period. Researchers' observations showed respondents' ability to perform the tests as intended with little challenges. Participants felt that rendering the services was an interesting experience, and fulfilling, and allowed them to improve on their professional deliverables and practice. It also showcased the relevance of pharmacists in rendering HTS, creating awareness of the menace of HIV/AIDS, and helping people to stop the spread.

CONCLUSION

The study showed that HTS is acceptable, appropriate, feasible, and easy to adopt in community pharmacies and penetration was high. For sustainability, community pharmacists should be well remunerated, and need for an established policy to include this scope in community pharmacy practice.

Factors influencing the uptake of public health interventions delivery by community pharmacists: A systematic review of global evidence

BACKGROUND

Community pharmacies are the first point of contact for most people seeking treatment for minor illnesses globally. In recent years, the role of community pharmacists has evolved, and they play a significant role in the delivery of public health interventions (PHIs) aimed at health promotion and prevention such as smoking cessation services, weight management services, HIV prevention, and vaccination. This review aims to explore the evidence on the factors that influence community pharmacists to take up the role of delivery of such interventions.

METHODS

Three electronic databases namely, Embase (1947-December 2023), Medline (1975-December 2023), and Scopus (1823-December 2023) were searched for relevant literature from the inception of the database to December 2023. Reference lists of included articles were also searched for relevant articles. A total of 22 articles were included in the review based on our inclusion and exclusion criteria. The data were analyzed and synthesized using a thematic approach to identify the factors that influence the community pharmacist's decision to take up the role of PHI delivery. Reporting of the findings was done according to the PRISMA checklist.

FINDINGS

The search identified 10,927 articles of which 22 were included in the review. The main factors that drive the delivery of PHIs by community pharmacists were identified as; training and continuous education, remuneration and collaboration with other healthcare professionals. Other factors included structural and workflow adjustments and support from the government and regulatory bodies.

CONCLUSIONS

Evidence from this review indicates that the decision to expand the scope of practice of community pharmacists is influenced by various factors. Incorporating these factors into the design of policies and public health programs is critical for the successful integration of community pharmacists in the delivery of broader public health to meet the rising demand for health care across health systems.

Viral hepatitis testing and treatment in community pharmacies: a systematic review and meta-analysis

Background

The World Health Organization seeks to eliminate viral hepatitis as a public health threat by 2030. This review and meta-analysis aims to evaluate the effectiveness of programs for hepatitis B and C testing and treatment in community pharmacies.

Methods

Medline, Embase, Cochrane CENTRAL, and Global Health were searched from database inception until 12 November 2023. Comparative and single arm intervention studies were eligible for inclusion if they assessed delivery of any of the following interventions for hepatitis B or C in pharmacies: (1) pre-testing risk assessment, (2) testing, (3) pre-treatment assessment or (4) treatment. Primary outcomes were proportions testing positive and reaching each stage in the cascade. Random effects meta-analysis was used to estimate pooled proportions stratified by recruitment strategy and setting where possible; other results were synthesised narratively. This study was pre-registered (PROSPERO: CRD42022324218).

Findings

Twenty-seven studies (4 comparative, 23 single arm) were included, of which 26 reported hepatitis C outcomes and four reported hepatitis B outcomes. History of injecting drug use was the most identified risk factor from pre-testing risk assessments. The pooled proportion hepatitis C antibody positive from of 19 studies testing 5096 participants was 16.6% (95% CI 11.0%-23.0%; heterogeneity I2 = 96.6%). The pooled proportion antibody positive was significantly higher when testing targeted people with specified risk factors (32.5%, 95% CI 24.8%-40.6%; heterogeneity I2 = 82.4%) compared with non-targeted or other recruitment methods 4.0% (95% CI 2.1%-6.5%; heterogeneity I2 = 83.5%). Meta-analysis of 14 studies with 813 participants eligible for pre-treatment assessment showed pooled attendance rates were significantly higher in pharmacies (92.7%, 95% CI 79.1%-99.9%; heterogeneity I2 = 72.4%) compared with referral to non-pharmacy settings (53.5%, 95% CI 36.5%-70.1%; heterogeneity I2 = 92.3%). The pooled proportion initiating treatment was 85.6% (95% CI 74.8%-94.3%; heterogeneity I2 = 75.1%). This did not differ significantly between pharmacy and non-pharmacy settings.

Interpretation

These findings add pharmacies to the growing evidence supporting community-based testing and treatment for hepatitis C. Few comparative studies and high degrees of statistical heterogeneity were important limitations. Hepatitis B care in pharmacies presents an opportunity for future research.

Funding

None.

Sexual health challenges in migrant, immigrant, and displaced populations 2022-2023

PURPOSE OF REVIEW

This article reviews recently published research on sexual health challenges and HIV and sexually transmitted infections (STIs) among migrant, immigrant and displaced people (MIDP) worldwide. We aimed to identify current evidence gaps regarding HIV/STI epidemiology, sexual health needs and interventions.

RECENT FINDINGS

Incidence and prevalence of HIV, hepatitis B virus, hepatitis C virus and syphilis were higher among MIDP compared to host populations. However, research studies are limited in geographical distribution and few routine surveillance data are collected. Barriers to sexual health services use and participation in preventive interventions include low HIV/STI symptom knowledge and risk awareness, and intersectional experiences of stigma/discrimination. Better targeted promotion messages are needed to increase utilization of preventive sexual health interventions.

SUMMARY

Access to, and use of, sexual health services and interventions are evident needs among MIDP. These needs are intertwined with social determinants of health, including cultural/language barriers and stigma. Effective interventions require involvement of multiple stakeholder groups, encouraging engagement and providing social protection. Promising directions for interventions and further research include developing sexual health supportive environments through peer-strategies and provider training in trauma-informed care.

Role of Portuguese community pharmacy and pharmacists in self-care

Portugal recognizes the importance of self-care in its policies and has been actively engaging in health literacy and citizen empowerment. The current National Health Plan for the period 2021-2030 clearly mentions the need to "take greater advantage of the network of community pharmacies throughout the national territory, in favour of the health of the community, from the protection and promotion of health, through health literacy, to the prevention and early detection of disease, and the aggravation of chronic disease, among others". There is recognition of the role of pharmacists and community pharmacies. However, more needs to be done to promote intersectoral collaboration, particularly as community pharmacies are private entities but can nonetheless support the public national health service. Community pharmacies assisted many individuals during the pandemic to test suspect cases free of charge. The fight to end AIDS and viral hepatitis is another example where community pharmacies promote self-testing and ensure efficient screening and referral to diagnosis and treatment. Portugal has already moved to reimburse community pharmacies for services with some of them in areas of self-care including COVID-19 testing. Nevertheless, future challenges include making community pharmacies sustainable. Taking into account that community pharmacies are private entities that can supplement the public health service just as any other provider, it is essential to review payment models, referral mechanisms and access and integration of information from other partners in primary and secondary care.

Estimated cost-effectiveness of point-of-care testing in community pharmacies vs. self-testing and standard laboratory testing for HIV

OBJECTIVE

Point-of-care-testing (POCT) for HIV at community pharmacies can enhance care linkage compared with self-tests and increase testing uptake relative to standard lab testing. While the higher test uptake may increase testing costs, timely diagnosis and treatment can reduce downstream HIV treatment costs and improve health outcomes. This study provides the first evidence on the cost-effectiveness of pharmacist-led POCT vs. HIV self-testing and standard lab testing.

DESIGN

Dynamic transmission model.

METHODS

We compared three HIV testing strategies: POCT at community pharmacies; self-testing using HIV self-test kits; and standard lab testing. Analyses were conducted from the Canadian health system perspective over a 30-year time horizon for all individuals aged 15-64 years in Canada. Costs were measured in 2021 Canadian dollars and effectiveness was captured using quality-adjusted life-years (QALYs).

RESULTS

Compared with standard lab testing, POCT at community pharmacies would save $885 million in testing costs over 30 years. Though antiretroviral treatment costs would increase by $190 million with POCT as more persons living with HIV are identified and treated, these additional costs would be partly offset by their lower downstream healthcare utilization (savings of $150 million). POCT at community pharmacies would also yield over 5000 additional QALYs. Compared with HIV self-testing, POCT at community pharmacies would generate both higher costs and higher QALYs and would be cost-effective with an incremental cost-effectiveness ratio of $47 475 per QALY gained.

CONCLUSIONS

Offering POCT at community pharmacies can generate substantial cost savings and improve health outcomes compared with standard lab testing. It would also be cost-effective vs. HIV self-testing.