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Chandra C, Hudson AF, Alohan DI, Young HN, Crawford ND. Implementation Science of Integrating Pre-Exposure Prophylaxis in Pharmacist-Led Services in the United States. Curr HIV/AIDS Rep 2024; 21:197-207. [PMID: 38775937 DOI: 10.1007/s11904-024-00700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Racial inequities in HIV in the United States (US) are pervasive. Pre-exposure prophylaxis (PrEP) is one of the most effective yet underutilized HIV prevention strategies, and stark inequities in PrEP uptake exist. Lack of access to PrEP clinics is a major barrier to access that could be overcome by integrating pharmacists into the provision of PrEP services including prescribing and dispensing. METHODS A number of reviews have shown promise in folding pharmacies into the expansion of PrEP services, but this review extends those by examining the implementation science evidence of pharmacist-led PrEP services in the US. We reviewed literature over the past five years of the implementation science of pharmacist PrEP services (2018-2023) and present seminal findings in this area. RESULTS Only two studies are anchored within an implementation science framework despite all studies assessing common implementation science constructs. Overwhelming evidence supports feasibility and adoption of PrEP services in pharmacies yet gaps in workflow integration, scalability and sustainability exist. CONCLUSION Continuing to build the implementation science evidence of pharmacy-based PrEP services is critical to standardize our measures across varying contexts and inform policy efforts that support pharmacy-based PrEP services.
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Affiliation(s)
- Christina Chandra
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alexis F Hudson
- Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Daniel I Alohan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Henry N Young
- Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA
| | - Natalie D Crawford
- Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Mugambi ML, Odhiambo BO, Dollah A, Marwa MM, Nyakina J, Kinuthia J, Baeten JM, Weiner BJ, John‐Stewart G, Barnabas RV, Hauber B. Women's preferences for HIV prevention service delivery in pharmacies during pregnancy in Western Kenya: a discrete choice experiment. J Int AIDS Soc 2024; 27 Suppl 1:e26301. [PMID: 38965978 PMCID: PMC11224584 DOI: 10.1002/jia2.26301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 05/16/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Pharmacy-delivered HIV prevention services might create more options for pregnant women to use HIV prevention tools earlier and more consistently during pregnancy. We quantified preferences for attributes of potential HIV prevention services among women of childbearing age in Western Kenya. METHODS From June to November 2023, we administered a face-to-face discrete choice experiment survey to women aged 15-44 in Kenya's Homa Bay, Kisumu and Siaya counties. The survey evaluated preferences for HIV prevention services, described by seven attributes: service location, travel time, type of HIV test, sexually transmitted infection (STI) testing, partner HIV testing, pre-exposure prophylaxis (PrEP) and service fee. Participants answered a series of 12-choice questions. Each question asked them to select one of two service options or no services-an opt-out option. We used hierarchical Bayesian modelling levels to estimate each attribute level's coefficient and understand how attributes influenced service choice. RESULTS Overall, 599 participants completed the survey, among whom the median age was 23 years (IQR: 18-27); 33% were married, 20% had a job and worked regularly, and 52% had been pregnant before. Participants, on average, strongly preferred having any HIV prevention service option over none (opt-out preference weight: -5.84 [95% CI: -5.97, -5.72]). The most important attributes were the availability of PrEP (relative importance 27.04% [95% CI: 25.98%, 28.11%]), followed by STI testing (relative importance 20.26% [95% CI: 19.52%, 21.01%]) and partner HIV testing (relative importance: 16.35% [95% CI: 15.79%, 16.90%]). While, on average, participants preferred obtaining services at the clinic more than pharmacies, women prioritized the availability of PrEP, STI testing and partner HIV testing more than the location or cost. CONCLUSIONS These findings suggest the importance of providing comprehensive HIV prevention services and ensuring PrEP, STI testing and partner HIV testing are available. If pharmacies can offer these services, women are likely to access those services at pharmacies even if they prefer clinics.
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Affiliation(s)
| | - Ben O. Odhiambo
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Kenyatta National HospitalNairobiKenya
| | | | | | | | - John Kinuthia
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | - Jared M. Baeten
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Gilead SciencesFoster CityCaliforniaUSA
| | - Bryan J. Weiner
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Grace John‐Stewart
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| | - Ruanne Vanessa Barnabas
- Harvard Medical School and Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA
| | - Brett Hauber
- The Comparative Health OutcomesPolicy and Economics (CHOICE) InstituteDepartment of PharmacyUniversity of WashingtonSeattleWashingtonUSA
- Pfizer, IncNew York CityNew YorkUSA
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Roche SD, Were D, Crawford ND, Tembo A, Pintye J, Bukusi E, Ngure K, Ortblad KF. Getting HIV Pre-exposure Prophylaxis (PrEP) into Private Pharmacies: Global Delivery Models and Research Directions. Curr HIV/AIDS Rep 2024; 21:116-130. [PMID: 38517671 PMCID: PMC11129962 DOI: 10.1007/s11904-024-00696-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE OF REVIEW To provide an overview of the current state of HIV pre-exposure prophylaxis (PrEP) delivery via private sector pharmacies globally, to discuss the context-specific factors that have influenced the design and implementation of different pharmacy-based PrEP delivery models in three example settings, and to identify future research directions. RECENT FINDINGS Multiple high- and low-income countries are implementing or pilot testing PrEP delivery via private pharmacies using a variety of delivery models, tailored to the context. Current evidence indicates that pharmacy-based PrEP services are in demand and generally acceptable to clients and pharmacy providers. Additionally, the evidence suggests that with proper training and oversight, pharmacy providers are capable of safely initiating and managing clients on PrEP. The delivery of PrEP services at private pharmacies also achieves similar levels of PrEP initiation and continuation as traditional health clinics, but additionally reach individuals underserved by such clinics (e.g., young men; minorities), making pharmacies well-positioned to increase overall PrEP coverage. Implementation of pharmacy-based PrEP services will look different in each context and depend not only on the state of the private pharmacy sector, but also on the extent to which key needs related to governance, financing, and regulation are addressed. Private pharmacies are a promising delivery channel for PrEP in diverse settings. Countries with robust private pharmacy sectors and populations at HIV risk should focus on aligning key areas related to governance, financing, and regulation that have proven critical to pharmacy-based PrEP delivery while pursuing an ambitious research agenda to generate information for decision-making. Additionally, the nascency of pharmacy-based PrEP delivery in both high- and low-and-middle-income settings presents a prime opportunity for shared learning and innovation.
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Affiliation(s)
- Stephanie D Roche
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA.
| | | | - Natalie D Crawford
- Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Angela Tembo
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jillian Pintye
- School of Nursing, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Seattle, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle, USA
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Katrina F Ortblad
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
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Rousseau E, Sikkema KJ, Julies RF, Mazer K, O'Malley G, Heffron R, Morton JF, Johnson R, Celum C, Baeten JM, Bekker L. Exploring adolescent girls and young women's PrEP-user profiles: qualitative insights into differentiated PrEP delivery platform selection and engagement in Cape Town, South Africa. J Int AIDS Soc 2024; 27:e26254. [PMID: 38695101 PMCID: PMC11063778 DOI: 10.1002/jia2.26254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/15/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Adolescent girls and young women (AGYW), a priority population for HIV prevention in Africa, show high interest but difficulty in sustained effective use of pre-exposure prophylaxis (PrEP). With ongoing PrEP scale-up focused on increasing access, it is important to understand what influences AGYW's choice of PrEP delivery platforms. METHODS The POWER implementation study in Cape Town provided PrEP between 2017 and 2020 to AGYW (16-25 years) from four differentiated delivery platforms: mobile clinic, government facility, courier delivery or community-based youth club. Healthcare providers at government and mobile clinics provided PrEP (initiation and refills) as part of comprehensive, integrated sexual and reproductive health services. Courier and youth club platforms provided light-touch PrEP refill services incorporating rapid HIV self-testing. We conducted in-depth interviews with a purposive sample of AGYW who had ≥3 months of PrEP-use and accessed ≥2 PrEP delivery platforms. The thematic analysis explored AGYW's preferences, decision-making and habits related to PrEP access to inform market segmentation. RESULTS We interviewed 26 AGYW (median age 20) PrEP-users between November 2020 and March 2021. AGYW PrEP-users reported accessing different services with, 24 accessing mobile clinics, 17 courier delivery, 9 government health facilities and 6 youth clubs for their PrEP refills. Qualitative findings highlighted four potential behavioural profiles. The "Social PrEP-user" preferred PrEP delivery in peer spaces, such as youth clubs or adolescent-friendly mobile clinics, seeking affirmation and social support for continued PrEP use. The "Convenient PrEP-user" favoured PrEP delivery at easily accessible locations, providing quick (courier) or integrated contraception-PrEP refill visits (mobile and government clinic). The "Independent PrEP-user" preferred PrEP delivery that offered control over delivery times that fit into their schedule, such as the courier service. The "Discreet PrEP-user" highly valued privacy regarding their PrEP use (courier delivery) and avoided delivery options where unintentional disclosure was evident (youth club). Comfort with HIV self-testing had minimal influence on PrEP delivery choice. CONCLUSIONS Market segmentation of AGYW characterizes different types of PrEP-users and has the potential to enhance tailored messaging and campaigns to reach specific segments, with the aim of improving sustained PrEP use and HIV prevention benefits.
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Affiliation(s)
- Elzette Rousseau
- Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
| | - Kathleen J. Sikkema
- Department of Sociomedical SciencesMailman School of Public HealthColumbia UniversityNew York CityNew YorkUSA
| | - Robin F. Julies
- Department of PsychologyUniversity of the Western CapeCape TownSouth Africa
| | - Katelyn Mazer
- Department of EpidemiologyFielding School of Public HealthUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Gabrielle O'Malley
- Department of Global HealthMedicine and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Renee Heffron
- Department of MedicineHeersink School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Jennifer F. Morton
- Department of Global HealthMedicine and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Rachel Johnson
- Department of Global HealthMedicine and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Connie Celum
- Department of Global HealthMedicine and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Jared M. Baeten
- Department of Global HealthMedicine and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
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Angibaud M, Jourdain M, Girard S, Rouxel L, Mouhib A, Nogueira A, Rat C, Huon JF. Involving community pharmacists in interprofessional collaboration in primary care: a systematic review. BMC PRIMARY CARE 2024; 25:103. [PMID: 38561676 PMCID: PMC10983710 DOI: 10.1186/s12875-024-02326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The World Health Organization supports interprofessional collaboration in primary care. On over the past 20 years, community pharmacists had been taking a growing number of new responsibilities and they are recognized as a core member of collaborative care teams as patient-centered care providers. This systematic review aimed to describe interprofessional collaboration in primary care involving a pharmacist, and its effect on patient related outcomes. METHODS A systematic review of randomized controlled trials cited in the MEDLINE, EMBASE, PsycInfo and CINAHL in English and French was conducted from inception to November 2022. Studies were included if they described an intervention piloted by a primary care provider and included a pharmacist and if they evaluated the effects of intervention on a disease or on patient related outcomes. The search generated 3494 articles. After duplicates were removed and titles and abstracts screened for inclusion, 344 articles remained. RESULTS Overall, 19 studies were included in the review and assessed for quality. We found 14 studies describing an exclusive collaboration between physician and pharmacist with for all studies a three-step model of pharmacist intervention: a medication review, an interview with the patient, and recommendations made to physician. Major topics in the articles eligible for inclusion included cardiovascular diseases with blood pressure, diabetes, dyslipidemia, and risk of cardiovascular diseases. Positive effects concerned principally blood pressure. CONCLUSIONS Collaboration involving pharmacists is mainly described in relation to cardiovascular diseases, for which patient-centered indicators are most often positive. It underscores the need for further controlled studies on pharmacist-involved interprofessional collaboration across various medical conditions to improve consensus on core outcomes measures.
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Affiliation(s)
- Morgane Angibaud
- Primary Care Federative Department, Faculty of Medicine, Nantes Université, Nantes, France.
- National Institute for Health and Medical Research, INSERM U1302 Team 2, INCIT, Team 2, Nantes, France.
| | - Maud Jourdain
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Solene Girard
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Louise Rouxel
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Adam Mouhib
- Clinical Pharmacy Unit, Faculty of Pharmacy, Nantes Université, Nantes, France
| | - Antoine Nogueira
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Cédric Rat
- National Institute for Health and Medical Research, INSERM U1302 Team 2, INCIT, Team 2, Nantes, France
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Jean-François Huon
- Nantes Université, CHU Nantes, Pharmacie, F-44000, France
- UMR INSERM 1246 SPHERE "methodS in Patient-centered Outcomes and HEalth ResEarch, Nantes Université, Université de Tours, Tours, France
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6
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Harrison C, Family H, Kesten J, Denford S, Scott A, Dawson S, Scott J, Sabin C, Copping J, Harryman L, Cochrane S, Horwood J. Facilitators and barriers to community pharmacy PrEP delivery: a scoping review. J Int AIDS Soc 2024; 27:e26232. [PMID: 38494652 PMCID: PMC10945033 DOI: 10.1002/jia2.26232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is an effective medication to reduce the risk of acquiring HIV. PrEP is available free of charge in the UK from sexual health clinics. Expanding PrEP delivery to community pharmacies holds promise and aligns with UK government goals to eliminate new cases of HIV by 2030. The aim of this scoping review was to describe the existing evidence about the barriers to and facilitators of community pharmacy oral PrEP delivery, for pharmacists and pharmacy clients, as aligned with the Capacity Opportunity, Motivation Behaviour (COM-B) Model. METHODS Five bibliographic and five review databases were searched from inception to August 2023. Literature of any study design was included if it discussed barriers and facilitators of community pharmacy PrEP delivery. Trial registrations, protocols and news articles were excluded. RESULTS A total of 649 records were identified, 73 full texts were reviewed and 56 met the inclusion criteria, predominantly from high-income/westernized settings. Most of the included literature was original research (55%), from the United States (77%) conducted during or after the year 2020 (63%). Barriers to PrEP delivery for pharmacists included lack of knowledge, training and skills (capability), not having the necessary facilities (opportunity), concern about the costs of PrEP and believing that PrEP use could lead to risk behaviours and sexually transmitted infections (motivation). Facilitators included staff training (capability), time, the right facilities (opportunity), believing PrEP could be a source of profit and could reduce new HIV acquisitions (motivation). For clients, barriers included a lack of PrEP awareness (capability), pharmacy facilities (opportunity) and not considering pharmacists as healthcare providers (motivation). Facilitators included awareness of PrEP and pharmacist's training to deliver it (capability), the accessibility of pharmacies (opportunity) and having an interest in PrEP (motivation). DISCUSSION To effectively enhance oral PrEP delivery in UK community pharmacies, the identified barriers and facilitators should be explored for UK relevance, addressed and leveraged at the pharmacy team, client and care pathway level. CONCLUSIONS By comprehensively considering all aspects of the COM-B framework, community pharmacies could become crucial providers in expanding PrEP accessibility, contributing significantly to HIV prevention efforts.
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Affiliation(s)
- China Harrison
- National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West)BristolUK
- National Institute for Health and Care ResearchHealth Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Hannah Family
- National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West)BristolUK
- National Institute for Health and Care ResearchHealth Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Joanna Kesten
- National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West)BristolUK
- National Institute for Health and Care ResearchHealth Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Sarah Denford
- National Institute for Health and Care ResearchHealth Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Anne Scott
- National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West)BristolUK
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Sarah Dawson
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Jenny Scott
- Centre for Academic Primary Care (CAPC)Bristol Medical SchoolUniversity of BristolBristolUK
| | - Caroline Sabin
- Institute for Global HealthUCLRoyal Free CampusLondonUK
- NIHR HPRU in Blood‐Borne and Sexually Transmitted Infections at UCLLondonUK
| | - Joanna Copping
- Communities and Public HealthBristol City CouncilCollege Green BristolBristolUK
| | - Lindsey Harryman
- Unity Sexual HealthUniversity Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - Sarah Cochrane
- The Riverside ClinicRoyal United Hospitals Bath NHS Foundation TrustBristolUK
| | - Jeremy Horwood
- National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West)BristolUK
- National Institute for Health and Care ResearchHealth Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
- Centre for Academic Primary Care (CAPC)Bristol Medical SchoolUniversity of BristolBristolUK
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Ahmed A, Dujaili JA, Chuah LH, Hashmi FK, Le LKD, Chatha ZF, Khanal S, Awaisu A, Chaiyakunapruk N. Cost-Effectiveness Analysis of Pharmacist Adherence Interventions in People Living with HIV/AIDS in Pakistan. Healthcare (Basel) 2023; 11:2453. [PMID: 37685487 PMCID: PMC10487586 DOI: 10.3390/healthcare11172453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Background: Evidence has shown the positive impact of pharmacist involvement on the adherence and health outcomes of people living with HIV/AIDS. However, whether such intervention provides value for money remains unclear. This study aims to fill this gap by assessing the cost-effectiveness of pharmacist interventions in HIV care in Pakistan. Methods: A Markov decision analytic model was constructed, considering clinical inputs, utility data, and cost data obtained from a randomized controlled trial and an HIV cohort of Pakistani origin. The analysis was conducted from a healthcare perspective, and the incremental cost-effectiveness ratio (ICER) was calculated and presented for the year 2023. Additionally, a series of sensitivity analyses were performed to assess the robustness of the results. Results: Pharmacist intervention resulted in higher quality-adjusted life years (4.05 vs. 2.93) and likewise higher annual intervention costs than usual care (1979 USD vs. 429 USD) (532,894 PKR vs. 115,518 PKR). This yielded the ICER of 1383 USD/quality-adjusted life years (QALY) (372,406 PKR/QALY), which is well below the willingness-to-pay threshold of 1658 USD (446,456 PKR/QALY) recommended by the World Health Organization Choosing Interventions that are Cost-Effective. Probabilistic sensitivity analysis reported that more than 68% of iterations were below the lower limit of threshold. Sensitivity analysis reported intervention cost is the most important parameter influencing the ICER the most. Conclusion: The study suggests that involving pharmacists in HIV care could be a cost-effective approach. These findings could help shape healthcare policies and plans, possibly making pharmacist interventions a regular part of care for people with HIV in Pakistan.
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Affiliation(s)
- Ali Ahmed
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad 44000, Pakistan
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia
- Swansea University Medical School, Singleton Campus, Swansea University, Wales SA1 8EN, UK
| | - Lay Hong Chuah
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia
| | - Furqan Khurshid Hashmi
- Punjab University College of Pharmacy, University of Punjab, Allama Iqbal Campus, Lahore 54000, Pakistan
| | - Long Khanh Dao Le
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Zeenat Fatima Chatha
- Department of Community Medicine and Global Health, University of Oslo, 0318 Oslo, Norway
| | - Saval Khanal
- Health Economics Consulting, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Ahmed Awaisu
- Department of Clinical Pharmacy & Practice, College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
| | - Nathorn Chaiyakunapruk
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84108, USA
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Gionfriddo MR, Owens KM, Leist SE, Schrum LT, Covvey JR. Attitudes, beliefs, knowledge, and practices for over-the-counter syringe sales in community pharmacies: A systematic review. J Am Pharm Assoc (2003) 2023; 63:1472-1489.e3. [PMID: 37429389 DOI: 10.1016/j.japh.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/02/2023] [Accepted: 07/06/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Community pharmacies are an important resource for people who inject drugs (PWID) to purchase over-the-counter (OTC) syringes. Access to sterile injection equipment can reduce the transmission of blood-borne illnesses. However, pharmacists and their staff ultimately use discretion over sales. OBJECTIVE To identify staff attitudes, beliefs, knowledge, and practices in the sale of OTC syringes in community pharmacies. METHODS This systematic review was reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and registered with PROSPERO (CRD42022363040). We systematically searched PubMed, Embase, and Scopus from inception to September 2022. The review included peer-reviewed empirical studies regarding OTC syringe sales among community pharmacy staff (pharmacists, interns, and technicians). We screened records and extracted data using a predefined data extraction form. Findings were narratively synthesized, and critical appraisal was conducted using the Mixed Methods Appraisal Tool. RESULTS A total of 1895 potentially relevant articles were identified, and 35 were included. Most studies (23; 63.9%) were cross-sectional descriptive designs. All studies included pharmacists, with seven (19.4%) also including technicians, two (5.6%) including interns, and four (11.1%) including other staff. Studies found relatively high support among respondents for harm reduction-related services within community pharmacies, but less common reports of staff engaging in said services themselves. When studies investigated the perceived positive or negative impacts of OTC syringe sales, prevention of blood-borne illness was widely understood as a benefit, while improper syringe disposal and safety of the pharmacy and its staff commonly reported as concerns. Stigmatizing attitudes/beliefs toward PWID were prevalent across studies. CONCLUSION Community pharmacy staff report knowledge regarding the benefits of OTC syringes, but personal attitudes/beliefs heavily influence decisions to engage in sales. Despite support for various syringe-related harm reduction activities, offerings of services were less likely due to concerns around PWID.
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Kandil C, Hugtenburg J, Heijman T, Bos H, Teichert M, Finkenflügel R, de Coul EO. Availability and accessibility of HIV self-tests and self-sample kits at community pharmacies in the Netherlands. AIDS Res Ther 2023; 20:39. [PMID: 37349835 PMCID: PMC10288660 DOI: 10.1186/s12981-023-00529-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023] Open
Abstract
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.
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Affiliation(s)
- Chaima Kandil
- National Institute for Public Health and the Environment, Center for Infectious Disease Control, P.O. Box 1, Bilthoven, 3720 BA, the Netherlands
| | | | - Titia Heijman
- Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Hanna Bos
- STI Aids Netherlands, Amsterdam, the Netherlands
| | - Martina Teichert
- Royal Dutch Pharmacists Association (KNMP), the Hague, the Netherlands
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Renee Finkenflügel
- Dutch Association of People with HIV (the HIV vereniging), Amsterdam, the Netherlands
| | - Eline Op de Coul
- National Institute for Public Health and the Environment, Center for Infectious Disease Control, P.O. Box 1, Bilthoven, 3720 BA, the Netherlands.
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Bazzi AR, Shaw LC, Biello KB, Vahey S, Brody JK. Patient and Provider Perspectives on a Novel, Low-Threshold HIV PrEP Program for People Who Inject Drugs Experiencing Homelessness. J Gen Intern Med 2023; 38:913-921. [PMID: 35614171 PMCID: PMC9132566 DOI: 10.1007/s11606-022-07672-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/10/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND HIV outbreaks among people who inject drugs (PWID) and experience homelessness are increasing across the USA. Despite high levels of need, multilevel barriers to accessing antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention persist for this population. The Boston Health Care for the Homeless Program (BHCHP) initiated a low-threshold, outreach-based program to support engagement in PrEP services among PWID experiencing homelessness. METHODS To inform dissemination efforts, we explored patient and provider perspectives on key program components. From March to December 2020, we conducted semi-structured qualitative interviews with current and former BHCHP PrEP program participants and prescribers, patient navigators, and outreach workers (i.e., providers). Thematic analysis explored perspectives on key program components. RESULTS Participants (n = 21) and providers (n = 11) identified the following five key components of BHCHP's PrEP program that they perceived to be particularly helpful for supporting patient engagement in PrEP services: (1) community-driven PrEP education; (2) low-threshold, accessible programming including same-day PrEP prescribing; (3) tailored prescribing supports (e.g., on-site pharmacy, short-term prescriptions, medication storage); (4) intensive outreach and navigation; and (5) trusting, respectful patient-provider relationships. DISCUSSION Findings suggest that more patient-centered services formed the basis of BHCHP's innovative, successful PrEP program. While contextual challenges including competing public health emergencies and homeless encampment "sweeps" necessitate ongoing programmatic adaptations, lessons from BHCHP's PrEP program can inform PrEP delivery in a range of community-based settings serving this population, including syringe service programs and shelters.
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Affiliation(s)
- Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA.
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
| | - Leah C Shaw
- Boston Healthcare for the Homeless Program, Boston, MA, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Seamus Vahey
- Boston Healthcare for the Homeless Program, Boston, MA, USA
| | - Jennifer K Brody
- Boston Healthcare for the Homeless Program, Boston, MA, USA
- Harvard Medical School, Boston, USA
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11
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Alohan DI, Evans G, Sanchez T, Harrington KR, Quamina A, Young HN, Crawford ND. Examining pharmacies' ability to increase pre-exposure prophylaxis access for black men who have sex with men in the United States. J Am Pharm Assoc (2003) 2023; 63:547-554. [PMID: 36470733 PMCID: PMC10065894 DOI: 10.1016/j.japh.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) has not effectively reached black men who have sex with men (BMSM). Using innovative, nontraditional health care settings-such as community pharmacies-may improve PrEP uptake among BMSM. OBJECTIVE To examine correlates of patient willingness to be screened for PrEP (via human immunodeficiency virus [HIV] testing and risk assessment) in pharmacies among BMSM in the United States. METHODS Data from the 2020 American Men's Internet Survey were analyzed. Using a modified Poisson regression method with robust variance estimates, we examined differences in willingness to screen for PrEP in pharmacies among BMSM. A 95% confidence interval (95% CI) was calculated for each estimated prevalence ratio (PR). RESULTS Of 826 respondents, 637 (77%) were willing to be screened for PrEP in pharmacies. Having a high school degree (PR 0.76 [95% CI 0.62-0.95]), willingness to use PrEP (1.70 [1.41-2.05]), and comfort speaking with pharmacy staff about PrEP (2.5 [1.86-3.51]) were significantly associated with willingness to screen for PrEP in a pharmacy setting. Importantly, there were no observed differences in willingness by age, employment status, annual household income, or insurance status. CONCLUSION Pharmacy-based PrEP access may be an effective strategy to end inequities in HIV, given that our results indicate that most BMSM are willing to be screened for PrEP in pharmacies. Future studies should examine whether willingness to use pharmacy-based HIV prevention services is associated with subsequent uptake of these services among BMSM.
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Affiliation(s)
- Daniel I. Alohan
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Alvan Quamina
- National AIDS Education Services for Minorities, Inc., Atlanta, GA
| | - Henry N. Young
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA
| | - Natalie D. Crawford
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
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12
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Wagner GA, Wu KS, Anderson C, Burgi A, Little SJ. Predictors of Human Immunodeficiency Virus Pre-Exposure Prophylaxis (PrEP) Uptake in a Sexual Health Clinic With Rapid PrEP Initiation. Open Forum Infect Dis 2023; 10:ofad060. [PMID: 36968957 PMCID: PMC10034584 DOI: 10.1093/ofid/ofad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Background Improved pre-exposure prophylaxis (PrEP) uptake is essential for human immunodeficiency virus (HIV) prevention initiatives. Offering PrEP at the time of HIV and sexually transmitted infection (STI) testing can improve uptake. We offered rapid PrEP initiation in a sexual health clinic and assessed predictors of PrEP interest, initiation, linkage, and retention. Methods Between November 2018 and February 2020, PrEP-eligible individuals who presented to a sexual health clinic were offered a free 30-day supply of PrEP plus linkage to continued PrEP care. Univariable and multivariable analyses of demographic and HIV risk data were conducted to determine predictors of PrEP uptake. Results Of 1259 adults who were eligible for PrEP (99.7% male, 42.7% White, 36.2% Hispanic), 456 were interested in PrEP, 249 initiated PrEP, 209 were linked, and 67 were retained in care. Predictors of PrEP interest included younger age (P < .01), lower monthly income (P = .01), recreational drug use (P = .02), and a greater number of sexual partners (P < .01). Negative predictors of PrEP initiation included lower monthly income (P = .04), testing positive for chlamydia (P = .04), and exchanging money for sex (P = .01). Negative predictors of linkage included self-identifying as Black (P = .03) and testing positive for an STI (P < .01). Having health insurance positively predicted both linkage (P < .01) and retention (P < .03). Conclusions A minority of PrEP-eligible HIV and STI testers initiated PrEP when offered, suggesting that easy PrEP access in sexual health clinics alone may not improve uptake. Predictors of uptake included established HIV risk factors and markers of higher socioeconomic status, suggesting that those aware of their risk and with the means to utilize health services engaged best with this model.
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Affiliation(s)
- Gabriel A Wagner
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Kuan-Sheng Wu
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Christy Anderson
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Alina Burgi
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Susan J Little
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
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13
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Smith DJ, McGill L, Carranza D, Adeyemo A, Hakim AJ. Global engagement of pharmacists in test and treat initiatives: Bringing care from clinics to communities. J Am Pharm Assoc (2003) 2023; 63:419-423. [PMID: 36379864 PMCID: PMC9576199 DOI: 10.1016/j.japh.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 01/25/2023]
Abstract
The coronavirus disease 2019 pandemic has placed substantial strain on the global health care workforce, disrupting essential and nonessential services. Task sharing of test and treat services to nontraditional prescribers, such as pharmacists, can facilitate more resilient health care systems by expanding access to health services while simultaneously decreasing the pressure on traditional health care providers. Expansion of pharmacists' scope of work has historically been hindered by sociopolitical, resourcing, and competency considerations; addressing these challenges will be key to including pharmacists in testing and treatment of priority diseases. Sociopolitical considerations include migrating to flexible national legislation and scope of practices as well as engagement with other health care providers and the public to increase the acceptance of pharmacists participating in test and treat services. Resourcing issues include health care financing for test and treat services to parallel established systems or use voucher systems and service competition. In addition, pharmacists can use their training in supply chain management to ease and prevent medication stockouts in test to treat initiatives. Investments in technologies that support disease surveillance, basic reporting, and interoperability with health management information systems can integrate these initiatives into health care systems. Competency considerations comprise test and treat specific education for the pharmacy profession to equip them with the knowledge and confidence to execute successfully. Monitoring and evaluating the outcomes of these services can facilitate the scalability of test and treat initiatives. Pharmacists are uniquely positioned to bring testing and treatment from the clinic to the community.
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Affiliation(s)
- Dallas J. Smith
- Correspondence: Dallas J. Smith, PharmD, Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop: H24-10, Atlanta, GA 30329
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14
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Crawford ND, Lewis CF, Moore R, Pietradoni G, Weidle P. Examining the Multilevel Barriers to Pharmacy-Based HIV Prevention and Treatment Services. Sex Transm Dis 2022; 49:S22-S25. [PMID: 35550478 PMCID: PMC9560970 DOI: 10.1097/olq.0000000000001643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Natalie D Crawford
- From the Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | | | | | - Paul Weidle
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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15
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Goswami S, Barnard M, Bynum LA, Thompson S, Kang M. Psychometric evaluation of the Health Care Provider HIV/AIDS Stigma Scale (HPASS) using Rasch analysis. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:1143-1153. [PMID: 36154959 DOI: 10.1016/j.cptl.2022.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/22/2022] [Accepted: 07/20/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The role of pharmacists is crucial in the care of individuals with HIV/AIDS. However, stigma in health care settings can be a deterrent to providing appropriate care. This paper assessed psychometric properties and convergent validity of the Health Care Provider HIV/AIDS Stigma Scale (HPASS) among pharmacy students in the United States (US) using Rasch analysis. METHODS Students enrolled in four US universities were administered the survey (N = 203). Rasch analysis was conducted for each HPASS subscale (Stereotyping, Discrimination, and Prejudice) to assess dimensionality, model data fit, item difficulty, individual stigma, distribution of items and persons across item-person map, and rating scale function. Convergent validity evidence was established by comparing Pearson's correlation coefficients between HPASS subscales and the AIDS Attitude Scale (AAS) Avoidance subscale. RESULTS Two items in the Prejudice subscale were misfit and therefore removed. The 6-point rating scale did not perform satisfactorily for HPASS subscales. Item difficulty ranges were wide [Stereotyping (-5 to 0.8 logits), Discrimination (-6 to 1 logits), Prejudice (-5 to 0.4 logits)]. Items were biased towards measuring higher levels of stigma. Person separation index was satisfactory (Stereotyping = 2.2; Discrimination = 2.06; Prejudice = 2.17) as was person separation reliability (Stereotyping = 0.83; Discrimination = 0.81; Prejudice = 0.83). Convergent validity was established by showing significant correlations between HPASS subscales and AAS Avoidance (P < .001). CONCLUSIONS Modifying or removing misfit items of HPASS and exploring alternate rating scales for HPASS subscales will help better assess HIV/AIDS related stigma among pharmacy students.
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Affiliation(s)
- Swarnali Goswami
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, 129 Faser Hall, University, MS 38677, United States.
| | - Marie Barnard
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, Faser 234, University, MS 38677, United States.
| | - Leigh Ann Bynum
- Pharmaceutical, Social & Administrative Sciences, Belmont University College of Pharmacy, 1900 Belmont Boulevard, Nashville, TN 37212, United States.
| | - Sara Thompson
- Manchester University Pharmacy Programs, 10627 Diebold Rd. Fort Wayne, IN 46845, United States.
| | - Minsoo Kang
- Department of Health, Exercise Science, and Recreation Management, School of Applied Sciences, University of Mississippi, University, MS 38677, United States.
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16
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Malama K, Logie CH, Narasimhan M, Ouedraogo L, Asmani C, Elamin H, van de Merwe LLA, Hopkins J, Bukusi EA. Short Communication: Awareness of HIV Self-Care Interventions Across Global Regions: Results from a Values and Preferences Survey. AIDS Res Hum Retroviruses 2022; 38:645-648. [PMID: 35579954 PMCID: PMC9419936 DOI: 10.1089/aid.2021.0200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The high burden of HIV in sub-Saharan Africa places significant demands on health care services. Interventions such as HIV self-testing, and pre- and post-exposure prophylaxis (PrEP and PEP) could empower individuals to determine their HIV status and prevent HIV acquisition. In 2018, the World Health Organization disseminated an online, anonymous, global values and preferences survey to adults 18 years of age and older. The survey aimed to inform guidance on awareness, use, and preferences around self-care interventions for sexual and reproductive health. We conducted a cross-sectional analysis using Pearson's chi-squared test to compare awareness of HIV self-testing, PrEP and PEP across five global regions. Our analysis included 814 participants from 110 countries. We noted that respondents from Africa reported higher awareness of HIV interventions than participants from Europe, Latin America and the Caribbean, North America, and Asia. Our finding highlights an opportunity to expand self-care interventions for HIV prevention and management in Africa.
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Affiliation(s)
- Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Address correspondence to: Kalonde Malama, MPH, PhD, Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto M5S 1V4, Canada
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, Includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction—HRP, Geneva, Switzerland, World Health Organization, Geneva, Switzerland
| | - Léopold Ouedraogo
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Chilanga Asmani
- Reproductive, Maternal Health and Ageing Team, Intercountry Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Hafya Elamin
- Reproductive, Maternal Health and Ageing Team, Intercountry Support Team for East and Southern Africa, World Health Organization, Harare, Zimbabwe
| | - L. Leigh-Ann van de Merwe
- Social Health Empowerment, Feminist Collective of Transgender Women of Africa, East London, South Africa
| | | | - Elizabeth Anne Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.,Department of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
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17
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Osae SP, Chastain DB, Young HN. Pharmacist role in addressing health disparities—Part 2: Strategies to move toward health equity. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sharmon P. Osae
- College of Pharmacy University of Georgia Albany Georgia USA
| | | | - Henry N. Young
- College of Pharmacy University of Georgia Athens Georgia USA
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18
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Fadanelli M, Cooper HLF, Freeman PR, Ballard AM, Ibragimov U, Young AM. A qualitative study on pharmacy policies toward over-the-counter syringe sales in a rural epicenter of US drug-related epidemics. Harm Reduct J 2022; 19:1. [PMID: 34996466 PMCID: PMC8742380 DOI: 10.1186/s12954-021-00569-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Expanding access to sterile syringes in rural areas is vital, as injection-related epidemics expand beyond metropolitan areas globally. While pharmacies have potential to be an easily accessible source of sterile syringes, research in cities has identified moral, legal and ethical barriers that preclude over-the-counter (OTC) sales to people who inject drugs (PWID). The current study builds on prior urban-based research by elucidating (1) pharmacy OTC policies and (2) pharmacists’ rationale for, and barriers and facilitators to, OTC syringe sales in a US rural area hard hit by drug-related epidemics. Methods We conducted 14 semi-structured interviews with pharmacists recruited from two Eastern Kentucky health districts. Interview domains included experiences with, and attitudes toward, selling OTC syringes to PWID. Constructivist grounded theory methods were used to analyze verbatim transcripts. Results Most pharmacists operated “restrictive OTC” pharmacies (n = 8), where patients were required to have a prescription or proof of medical need to purchase a syringe. The remainder (n = 6) operated “open OTC” pharmacies, which allowed OTC syringe sales to most patients. Both groups believed their pharmacy policies protected their community and pharmacy from further drug-related harm, but diverging policies emerged because of stigma toward PWID, perceptions of Kentucky law, and belief OTC syringe sales were harmful rather than protective to the community. Conclusion Our results suggest that restrictive OTC pharmacy policies are rooted in stigmatizing views of PWID. Anti-stigma education about substance use disorder (SUD), human immunodeficiency virus (HIV), and Hepatitis C (HCV) is likely needed to truly shift restrictive pharmacy policy.
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Affiliation(s)
- Monica Fadanelli
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Hannah L F Cooper
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | | | - April M Ballard
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Umed Ibragimov
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - April M Young
- University of Kentucky College of Public Health, Lexington, KY, USA
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Community pharmacist engagement in HIV and HCV prevention: Current practices and potential for service uptake. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 4:100088. [PMID: 35479840 PMCID: PMC9029914 DOI: 10.1016/j.rcsop.2021.100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022] Open
Abstract
Background Objective Methods Results Conclusions Pharmacists are largely willing to help people who need HIV/HCV prevention services. Perception of HIV/HCV prevention fit with pharmacist professional identity varies. Cognitive HIV/HCV prevention services are preferred over hands-on clinical services. Pharmacists often engage in gatekeeping to limit sales of non-prescription syringes. Willingness to sell syringes potentially hinges on minimal contact with requestors.
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Rousseau E, Julies RF, Madubela N, Kassim S. Novel Platforms for Biomedical HIV Prevention Delivery to Key Populations - Community Mobile Clinics, Peer-Supported, Pharmacy-Led PrEP Delivery, and the Use of Telemedicine. Curr HIV/AIDS Rep 2021; 18:500-507. [PMID: 34708316 PMCID: PMC8549812 DOI: 10.1007/s11904-021-00578-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW A gap exists between PrEP interest and PrEP uptake in key populations (KP) for HIV prevention that may be ascribed to PrEP delivery services not being acceptable. This review summarizes novel platforms for HIV prevention outside of the traditional health facilities environment. RECENT FINDINGS Mobile health clinics provide highly acceptable integrated, KP-focused services at convenient locations with the potential of high PrEP uptake. Telemedicine and health apps decongest health systems and allow for personal agency and informed decision-making on personal health. Pharmacy-led PrEP delivery provides de-medicalized, confidential PrEP services at extended hours in community locations, from trusted medical professionals. Peer-supported delivery encourages continued PrEP use. Community-based, differentiated and de-medicalized PrEP delivery can address uptake and continued use barriers in key populations. Future research should assess scalability, cost-effectiveness and sustainability of these PrEP delivery platforms, as well as focus on ways to simplify PrEP provision.
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Affiliation(s)
- E Rousseau
- Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
| | - R F Julies
- Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - N Madubela
- Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - S Kassim
- Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Marotta PL, Stringer K, Beletsky L, West BS, Goddard-Eckrich D, Gilbert L, Hunt T, Wu E, El-Bassel N. Assessing the relationship between syringe exchange, pharmacy, and street sources of accessing syringes and injection drug use behavior in a pooled nationally representative sample of people who inject drugs in the United States from 2002 to 2019. Harm Reduct J 2021; 18:115. [PMID: 34789270 PMCID: PMC8600731 DOI: 10.1186/s12954-021-00565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Provision of sterile syringes is an evidence-based strategy of reducing syringe sharing and reusing and yet, access to sterile syringes through pharmacies and syringe exchange programs (SEPs) in the United States remains inadequate. This nationally representative study examined associations between obtaining syringes from pharmacies, SEPs, and sterilizing syringes with bleach and risk of syringe borrowing, lending and reusing syringes in a pooled cross-sectional dataset of 1737 PWID from the 2002-2019 National Survey on Drug Use and Health. Logistic regression was used to produce odds ratios (OR) of the odds of injection drug behaviors after adjusting for obtaining syringes from SEPs, pharmacies, the street, and other sources and potential confounders of race, ethnicity, sex, education, and insurance coverage. Obtaining syringes through SEPs was associated with lower odds of borrowing (OR = .4, CI95% = .2, .9, p = .022) and reusing syringes (OR = .3, CI95% = .2, .6, < .001) compared to obtaining syringes on the street. Obtaining syringes from pharmacies was associated with lower odds of borrowing (OR = .5, CI95% = .3, .9, p = .037) and lending (OR = .5 CI95% = .3, .9, p = .020) syringes. Using bleach to clean syringes was associated with increased odds of borrowing (OR = 2.0, CI95% = 1.3, 3.0, p = .002), lending (OR = 2.0, CI95% = 1.3, 3.0, p = .002) and reusing syringes (OR = 2.4, CI95% = 1.6, 3.6, p < .001). Our findings support provision of syringes through pharmacies and SEPs as a gold-standard strategy of reducing sharing and reuse of syringes in the US.
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Affiliation(s)
- Phillip L Marotta
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA.
- School of Social Work, Columbia University, New York, NY, 10027, USA.
- Northeastern University, Boston, MA, 02115, USA.
| | - Kristi Stringer
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Leo Beletsky
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Brooke S West
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Dawn Goddard-Eckrich
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Louisa Gilbert
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Tim Hunt
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Elwin Wu
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Nabila El-Bassel
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
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22
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Ahmed A, Saqlain M, Tanveer M, Blebil AQ, Dujaili JA, Hasan SS. The impact of clinical pharmacist services on patient health outcomes in Pakistan: a systematic review. BMC Health Serv Res 2021; 21:859. [PMID: 34425816 PMCID: PMC8381566 DOI: 10.1186/s12913-021-06897-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/17/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The pharmacist's role shifts from dispensing to bedside care, resulting in better patient health outcomes. Pharmacists in developed countries ensure rational drug use, improve clinical outcomes, and promote health status by working as part of a multidisciplinary team of healthcare professionals. However, clinical pharmacist services on healthcare utilization in low-and middle-income countries (LMICs) like Pakistan are unclear. As a result, we aim to systematically review pharmacists' clinical roles in improving Pakistani patients' therapeutic, safety, humanistic, and economic outcomes. METHODS We searched PubMed, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 28th February 2021. All authors were involved in the screening and selection of studies. Original studies investigating the therapeutic, humanistic, safety, and economic impact of clinical pharmacists in Pakistani patients (hospitalised or outpatients) were selected. Two reviewers independently assessed the risk of bias in studies, and discrepancies were resolved through mutual consensus. All of the included studies were descriptively synthesised, and PRISMA reporting guidelines were followed. RESULTS The literature search found 751 articles from which nine studies were included; seven were randomized controlled trials (RCTs), and two were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having a high ROB. The nature of clinical pharmacist interventions included one or more components such as disease-related education, lifestyle changes, medication adherence counselling, medication therapy management, and discussions with physicians about prescription modification if necessary. Clinical pharmacist interventions reduce medication-related errors, improve therapeutic outcomes such as blood pressure, glycemic control, lipid control, CD4 T lymphocytes, and renal functions, and improve humanistic outcomes such as patient knowledge, adherence, and health-related quality of life. However, no study reported the economic outcomes of interventions. CONCLUSIONS The findings of the studies included in this systematic review suggest that clinical pharmacists play important roles in improving patients' health outcomes in Pakistan; however, it should be noted that the majority of the studies have a high risk of bias, and more research with appropriate study designs is needed.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid I Azam University, Islamabad, Pakistan
| | - Maria Tanveer
- Department of Pharmacy, Quaid I Azam University, Islamabad, Pakistan
| | - Ali Qais Blebil
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
| | - Syed Shahzad Hasan
- School of Applied Sciences, Department of Pharmacy, University of Huddersfield, Huddersfield, UK
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