Preferences of Gay and Bisexual Men for Pharmacy-Based HIV Testing and Over-the-Counter HIV Tests

Location Preferences for Accessing Long-Acting Injectable Pre-Exposure Prophylaxis (LA-PrEP) Among Men Who Have Sex With Men (MSM) Currently on Daily Oral PrEP

We investigated men who have sex with men's (MSM) location preferences for long-acting injectable pre-exposure prophylaxis (LA-PrEP). MSM (n = 1076) who completed the 2021 American Men's Internet Survey, were currently prescribed oral PrEP, and expressed LA-PrEP interest reported location preferences for receiving LA-PrEP: healthcare provider (HCP) setting, pharmacy, or at-home. HCP settings were preferred by 60% of participants; 26% preferred home and 14% preferred pharmacy. In adjusted models, high healthcare stigma was associated with preferring pharmacy and at-home versus HCP, while high friends/family stigma was associated with preferring HCP settings versus pharmacy. Healthcare access history was associated with preference for HCP setting versus home. Being 25 to 29 or 30 to 29 years old versus 40+ was associated with preferring HCP versus home. Private insurance was associated with location preferences. Findings support the need for multiple LA-PrEP service locations to best reach MSM and highlight multiple complex factors that influence such preferences.

Availability and accessibility of HIV self-tests and self-sample kits at community pharmacies in the Netherlands

BACKGROUND

In 2016 the WHO declared HIV self-testing and self-sampling an effective and safe test option that can reduce testing barriers. HIV self-tests and self-sampling kits (HIVST/HIVSS) are available for purchase at Dutch community pharmacies since 2019. We investigated the availability and accessibility of HIVST/HIVSS in community pharmacies, and factors associated with test availability.

METHODS

An online survey among all Dutch community pharmacies (n = 1,987) was conducted between April and June 2021. Availability of HIVST/HIVSS and experiences of pharmacists with the test offer were analyzed with descriptive statistics. The association of pharmacy and pharmacists' characteristics with HIVST/HIVSS availability was explored by logistic regression analysis.

RESULTS

In total, 465 pharmacists completed the questionnaire. Of the responding pharmacists, 6.2% (n = 29) offered HIVST/HIVSS. The majority (82.8%) sold between 0 and 20 tests per year. In total, pharmacies sold an estimated 370 HIVST/HIVSS per year. Pharmacies having HIVST/HIVSS available were less often located in moderately-urbanized to rural neighborhoods (OR 0.35, 95%CI 0.16-0.77 versus highly-urbanized), and were less often located in moderate-to-low SES neighborhoods (OR 0.40, 95%CI 0.18-0.88 versus high-SES). Reasons for not offering HIVST/HIVSS by pharmacists were no or little demand (69.3%), and not being familiar with these tests (17.4%). 52% of the pharmacists provided information about testing to test buyers. Reported options to improve the test offer were giving advice about (performing) the test to test buyers (72.4%), placing tests visible on the counter (51.7%), and advertisement (37.9%).

CONCLUSION

HIVST/HIVSS have a limited practical availability in Dutch community pharmacies since their introduction in 2019, especially in lower-urbanized and lower-SES areas. Further research is needed to explore how to expand access to HIVST/HIVSS through community pharmacies in the Netherlands, and how to tailor it to the needs of pharmacy clients.

A scoping review of the minority stress processes experienced by sexual and gender minority individuals in pharmacy settings: Implications for health care avoidance

BACKGROUND

Sexual and gender minority (SGM) people may avoid or delay health care interactions. The minority stress model describes distal (discrimination, violence) and proximal (expectation of rejection, concealment, internalized self-dislike) stress processes as possible contributors to the health disparities and avoidance behaviors observed when encountered in health care settings. Pharmacies are accessible health care settings, yet the extent to which SGM individuals experience minority stress processes while using services at the pharmacies is unknown.

OBJECTIVE

This scoping review aimed to identify distal and proximal minority stress processes experienced by SGM individuals and health care avoidance behaviors related to pharmacies or pharmacists.

METHODS

An electronic search of PubMed, Embase, and PsycINFO databases was conducted to search for relevant literature up to September 2022. The search was supplemented with a review of reference lists and contact with experts in the field. Articles were included in the review if they described SGM individuals' perceived experiences within pharmacies or with pharmacists and reported an outcome that could be mapped to a distal or proximal minority stress process.

RESULTS

Eleven articles met the eligibility criteria and were included in the review. Of these, 6 reported the presence of distal stress processes, such as perceived stigma, negative pharmacy staff attitudes, and a lack of awareness of population needs. For proximal stress processes, 5 articles reported on concealment, 4 reported on expectation of rejection, and 1 reported on internalized transphobia. Developing rapport and increasing competence were identified as ways to help mediate the impact of minority stress processes.

CONCLUSION

Minority stress processes and avoidance behaviors are experienced by SGM individuals that relate to pharmacies and pharmacists. Coordinated efforts between professional stakeholders are required to reduce minority stress processes and ensure pharmacy-based services are accessible to all individuals.

Support and perceived barriers to implementing pre-exposure prophylaxis screening and dispensing in pharmacies: Examining concordance between pharmacy technicians and pharmacists

OBJECTIVES

Recent legislation to expand pre-exposure prophylaxis (PrEP) screening and dispensing in pharmacies may significantly improve PrEP access for people at a high risk of human immunodeficiency virus (HIV) transmission. Studies have shown that pharmacists show wide support for PrEP expansion in pharmacies. However, pharmacy technicians are often the first point of contact for patients in pharmacies and are required to implement many of the tasks to ensure patients of a pharmacy receive adequate services. The purpose of this study was to assess pharmacists' and pharmacy technicians' perspectives regarding the implementation of PrEP screening and dispensing.

METHODS

We qualitatively examined whether pharmacy technicians' (n = 6) support and perceived barriers to screening and dispensing PrEP in pharmacies were concordant with those of pharmacists (n = 7). Pharmacy staff were recruited from high-risk HIV neighborhoods in Atlanta, GA using AIDSVu (Atlanta, GA). Two independent coders used MAXQDA (Berlin, Germany) and performed thematic data analysis and unitization to determine agreement.

RESULTS

Pharmacists and pharmacy technicians expressed strong willingness and support for screening and dispensing PrEP in pharmacies. Both groups expressed concerns about the time and the resources needed to perform PrEP screening and dispensing. Technicians, however, also reported concerns about privacy for patients, the need for community support and awareness of pharmacy-based PrEP screening, and recommended scheduling of PrEP screening activities during a limited part of the day to facilitate screening. Pharmacists reported fewer barriers but reported a need for more training of pharmacy staff to assist with PrEP screening and dispensing implementation.

CONCLUSION

Pharmacy technicians discussed more barriers compared with pharmacists who were largely centered around practical considerations (i.e., logistics and workflow) that may affect the success of PrEP screening and dispensing. Given technicians' pivotal role in the pharmacy, implementation of pharmacy-based PrEP services should address technicians' perceived barriers in addition to those of pharmacists.

A Scoping Review of Patient Preferences for HIV Self-Testing Services in the United States: Implications for Harm Reduction

PURPOSE

Despite marked progress in the ability to test for, treat, and prevent HIV, the epidemic remains a significant public health concern, especially among key populations including prisoners; sex workers; transgender individuals; gay, bisexual, and other men who have sex with men (MSM); and Black and Latinx MSM. This scoping review was conducted to provide an overview of the current research describing patient preferences for HIVST in the United States to understand what key populations value about HIVST and why they are willing to use it. A targeted search for published literature on patient preferences for HIVST was conducted using Ovid Medline, PsychINFO, and an HIVST research database.

RESULTS

We reviewed 700 abstracts and 139 full texts. We found 19 articles published between January 2014 and April 2020 that included findings related to HIVST preferences. Overall, HIVST was preferred to more traditional testing. Six primary factors emerged as important HIVST values including: 1) convenience, 2) type of test; 3) cost, 4) stigma reduction, 5) risk reduction, and 6) self-control. Linkage to care was also identified as a key factor when considering HIVST as an option. Much of what makes HIVST attractive to individuals is their ability to self-determine how HIVST can be best integrated into their lives as a harm reduction tool for stigma and sexual risk mitigation.

CONCLUSION

While there is substantial evidence suggesting HIVST is feasible for use and there are aspects of HIVST that are beneficial and preferred over traditional testing approaches, there is a lack of rigorous implementation studies exploring how best to scale up HIVST in community settings. HIVST has the potential to be a powerful biobehavioral HIV prevention and harm reduction tool to empower individuals to engage with testing on their own terms while providing pathways to prevention and care support.

Preferred Methods of HIV and Sexually Transmissible Infection Screening Delivery Among a Rural Sample of Men Who Have Sex with Men

Despite the national HIV and sexually transmissible infection (STI) rates growing in rural areas, rural populations-particularly men who have sex with men (MSM), have limited access to secondary (i.e., HIV/STI screening) prevention activities compared with their urban counterparts. We conducted semistructured in-depth interviews with 23 rural MSM residing in Oklahoma and Arkansas to assess their (1) experiences with HIV and STI testing; (2) perceptions of at-home testing; and (3) preferences for receiving results and care. Barriers to accessing HIV/STI screening included lack of medical providers within rural communities, privacy and confidentiality concerns, and perceived stigma from providers and community members. To overcome these barriers, all participants recognized the importance of screening paradigms that facilitated at-home screening, medical consultation, and care. This included the ability to request a testing kit and receive results online, to access affirming and competent providers utilizing telemedicine technology, as well as prompt linkage to treatment. These narratives highlight the need for systems of care that facilitate HIV and STI screening within rural communities, which do not require participants to access services at traditional physical venues.

The Pharmacist's Expanding Role in HIV Pre-Exposure Prophylaxis

The efficacy of pre-exposure prophylaxis (PrEP) to prevent HIV has been firmly established; however, the success of PrEP largely depends on access to care as well as high levels of medication adherence. One of the key areas of focus for the National HIV/AIDS Strategy for 2020 in the United States calls for full access to comprehensive PrEP services where appropriate and desired, with support for medication adherence. Despite advances and advocacy for PrEP since approval for adults in 2012, large rates of prescribing disparity exist among gender and race/ethnicity. In 2016, only 3.7% of all PrEP users were women and only 11.2% were black. As one of the most widely accessible health care resources, pharmacists are well positioned to improve patient understanding, promote medication adherence, provide key risk reduction counseling, and enhance PrEP efficacy. Pharmacists' knowledge and accessibility in nearly every urban and rural community can be leveraged as part of a comprehensive HIV prevention strategy to expand access to care and improve population health. As trusted health care professionals, pharmacists develop a strong rapport with patients and may be the key to address current disparities in PrEP prescribing patterns as well as serve as an essential liaison between patients and other members of the multi-disciplinary care team. The purpose of this review is to summarize available data on pharmacist involvement in various models of care providing PrEP services and to identify opportunities to maximize and expand the role of the pharmacist to improve access to PrEP.

The Evolving Role of Pharmacists in Transgender Health Care

Pharmacists are increasingly part of a multifaceted team providing health care to members of the often marginalized transgender (TG) community. Some pharmacists, however, may feel unprepared to care for and interact with TG individuals. By providing comprehensive, respectful, and gender-affirming support, improving physical pharmacy environments with policies and procedures, pharmacists can be trustworthy providers for TG patients. This review focuses primarily on the health issues of TG persons and the pharmacist's role in promoting health, identifying barriers to health care, and providing health care resources for TG persons. The evolution of psychiatric diagnostic criteria, access to health care, and inclusion of TG, lesbian, gay, and bisexual topics in the educational curriculum are presented. Cultural competency and diversity training that addresses gender identity and sexual orientation issues should be important interdisciplinary and interprofessional activities for all health care professional education programs. Pharmacists play a key role in the health care needs of TG persons that include appropriate laboratory monitoring, complex pharmacotherapeutic challenges, and providing unbiased gender-affirming interactions. The pharmacy's physical environment, staff training, and policies and procedures can offer unique services to TG persons.

HIV pre-exposure prophylaxis: Exploring the potential for expanding the role of pharmacists in public health

OBJECTIVES

The study objectives were to a) assess knowledge and experience; b) describe perceptions and attitudes; and c) identify training needs of community-based pharmacists regarding HIV pre-exposure prophylaxis (PrEP).

DESIGN

This was a cross-sectional survey study.

SETTING AND PARTICIPANTS

The survey was administered online to pharmacists practicing in a community setting in the state of Minnesota.

OUTCOME MEASURES

Measures included knowledge of and experience with HIV PrEP, perceptions and attitudes towards pharmacists' involvement, and HIV PrEP-specific training needs for pharmacists.

RESULTS

With a survey response rate of approximately 13% (n = 347), most respondents (76.4%) agreed that HIV PrEP can be beneficial in high-risk populations. Forty-six percent of respondents were not aware of U.S. Food and Drug Administration approval of emtricitabine and tenofovir disoproxil fumarate for PrEP. Most respondents (71.1%) were "not at all familiar" with Centers for Disease Control and Prevention guidelines for PrEP. Twenty-one percent of respondents had sufficient knowledge to counsel patients on PrEP. Experience with counseling on PrEP (21.8%), having dispensed PrEP in the last 2 years (33.1%), fewer years in practice (≤10 years), location of practice site (urban or suburban), and having received HIV continuing education in the last 2 years (33.0%) were associated with more knowledge of HIV PrEP. Top concerns with counseling were knowledge about the medication and behavior modification. The most frequently indicated primary concerns with implementing PrEP initiatives were identifying appropriate candidates and patient adherence.

CONCLUSION

As pharmacists' roles continue to expand, relevant content in pharmacy education and requisite training (including continuing education) are critical to addressing knowledge gaps and competencies that will enable pharmacists engage more effectively in public health efforts such as HIV prevention.

Expanding HIV Testing in African American Communities Through Community-Based Distribution of Home-Test Vouchers

We investigated the implementation feasibility and effectiveness of community-based HIV home-test voucher distribution in three Indianapolis African American communities. Community-based organizations augmented traditional outreach methods to distribute vouchers for home HIV tests redeemable at three pharmacies during three distribution waves from February to April 30, 2015. Voucher redemption served as a proxy indicator of intent to test for HIV. 315 vouchers were distributed and 47 vouchers were redeemed for a 14.9% redemption rate. Distribution was 46% of plan. Vouchers were redeemed at all three pharmacies, and 21% of visits involved redemption of more than one voucher. The original team of seven distributors in three organizations reduced to a remaining five distributors in two organizations by wave 2. This study suggests that outreach organizations could implement HIV home test voucher distribution, and that people would redeem the vouchers at a pharmacy for an HIV test. Future studies should explore how voucher distribution can expand the current HIV testing system.