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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] [MESH Headings] [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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2
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Meyerson BE, Agley J, Crosby RA, Bentele KG, Vadiei N, Linde-Krieger LB, Russell DR, Fine K, Eldridge LA. ASAP: A pharmacy-level intervention to increase nonprescription syringe sales to reduce bloodborne illnesses. Res Social Adm Pharm 2024; 20:778-785. [PMID: 38734511 PMCID: PMC11180557 DOI: 10.1016/j.sapharm.2024.04.019] [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: 03/14/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Pharmacy syringe sales are effective structural interventions to reduce bloodborne illnesses in populations, and are legal in all but two states. Yet evidence indicates reduced syringe sales in recent years. This study was designed as a feasibility test of an intervention to promote syringe sales by pharmacies in Arizona. METHODS A four-month pilot among three Arizona pharmacies measured feasibility and acceptability through monthly surveys to 18 enrolled pharmacy staff members. RESULTS Pharmacy staff reported increased ease of dispensing syringes across the study. Rankings of syringe dispensing as 'easiest' among 6 measured pharmacy practices increased from 38.9 % at baseline to 50.1 % post intervention module training, and to 83.3 % at pilot conclusion. The majority (72.2 %) of pharmacy staff agreed that intervention materials were easy to use. Over 70 % indicated that the intervention was influential in their "being more open to selling syringes without a prescription to someone who might use them for illicit drug use," and 61.1 % reported that in the future, they were highly likely to dispense syringes to customers who would use them to inject drugs. A vast majority (92 %) reported being likely to dispense subsidized naloxone if available to their pharmacy at no cost. CONCLUSIONS An education-based intervention was found to be feasible and acceptable to pharmacy staff and had an observed impact on perceptions of ease and likelihood of dispensing syringes without a prescription to people who may use them to inject drugs.
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Affiliation(s)
- B E Meyerson
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, Tucson, University of Arizona, USA; Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, USA.
| | - J Agley
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, Tucson, University of Arizona, USA; Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - R A Crosby
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, Tucson, University of Arizona, USA; College of Public Health, University of Kentucky, Lexington, KY, USA
| | - K G Bentele
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, Tucson, University of Arizona, USA; Southwest Institute for Research on Women, College of Social and Behavioral Sciences, University of Arizona, Tucson, AZ, USA
| | - N Vadiei
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, Tucson, University of Arizona, USA; Pharmacotherapy Division, University of Texas at Austin, Austin, TX, USA
| | - L B Linde-Krieger
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, Tucson, University of Arizona, USA; Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, USA
| | - D R Russell
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, Tucson, University of Arizona, USA; Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - K Fine
- Arizona Pharmacy Association, Phoenix, AZ, USA
| | - L A Eldridge
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, Tucson, University of Arizona, USA; Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
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Gonzalez PR, Black EK, Trenaman S, Wilby KJ. Improving equity of services for sexually transmitted infections through community pharmacies: A scoping review. J Am Pharm Assoc (2003) 2024; 64:197-203.e2. [PMID: 37940091 DOI: 10.1016/j.japh.2023.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Pharmacists have the potential to improve care for marginalized populations. Stigmatized and racialized groups may not find traditional health services accessible in other settings. Research focused on health care access for these populations is fundamental in understanding how to improve health equity. OBJECTIVES This scoping review aimed to determine how health equity is addressed within services offered through community pharmacies for sexually transmitted infections (STIs). METHODS This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist. A comprehensive search strategy was developed with an academic librarian to capture studies containing search terms related to each of the following 3 topics: STIs, pharmacy, and underserved groups. PubMed and Embase were both searched up to July 2023 and search results were uploaded to the screening software Covidence. Two researchers independently screened titles, abstracts, and full texts. Articles were included if they reported evaluation of a pharmacy-based sexual health service and addressed health equity in service design or implementation. RESULTS A total of 8 articles were identified that described services implemented for underserved groups. Four populations were identified: injection drug users, men who have sex with men, racial minorities, and those with low socioeconomic status. Equity was addressed through 2 mechanisms: location-based implementation of services in areas of high target population density or through specific targeting of marginalized populations in recruitment and promotion. All studies involved interventions for the prevention or testing services rather than assessment and treatment. CONCLUSIONS Equity is not being readily addressed in pharmacy-based services for STIs yet evidence exists that considering equity in the design and implementation of services may improve reach to underserved populations.
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Josma D, Morris J, Hopkins R, Quamina A, Siegler AJ, Holland D, Sullivan P, Harrington KRV, Alohan DI, Crawford ND. Comparing open-ended question methods to vignette methods to explore willingness to obtain pre-exposure prophylaxis access in pharmacies among black men who have sex with men. AIDS Care 2023; 35:1955-1962. [PMID: 36892947 PMCID: PMC10491733 DOI: 10.1080/09540121.2023.2185193] [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: 03/01/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023]
Abstract
Black men who have sex with men (BMSM) are at higher risk of HIV transmission than any other group; however, their uptake of the highly effective HIV prevention medication, pre-exposure prophylaxis (PrEP), is low. In collaboration with a communitybased organization in Atlanta, Georgia, we explored ten HIV-negative BMSM's willingness to obtain PrEP in pharmacies using standard open-ended and vignette qualitative methods. Three overarching themes were identified: privacy, patient-pharmacist interactions, and HIV/STI screening. While open-ended questions allowed participants to provide broad answers on their willingness to receive prevention services at a pharmacy, the vignette drew out specific responses to facilitate in-pharmacy PrEP delivery. Using both openended questions and vignette data collection strategies, BMSM reported high willingness to screen for and uptake PrEP in pharmacies. However, the vignette method allowed for greater depth. Open-ended questions elicited responses that highlighted general barriers and facilitators of PrEP dispensing in pharmacies. However, the vignette allowed participants to customize a plan of action that would best fit their needs. Vignette methods are underutilized in HIV research and may be helpful in supplementing standard open-ended interview questions to uncovering unknown challenges about health behaviors and obtain more robust data on highly sensitive research topics in HIV research.
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Affiliation(s)
| | - Joseph Morris
- National Center for Emerging, Zoonotic, and Infectious Diseases, Office of Innovation, Development, Analytics, and Evaluation, Centers for Disease Control and Prevention
| | - Roderick Hopkins
- Division of Global Migration and Quarantine (DGMQ), Community Interventions for Infection Control Unit (CI-ICU), Centers for Disease Control and Prevention
| | | | - Aaron J. Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Daniel I. Alohan
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA, USA
| | - Natalie D. Crawford
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA, USA
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Krause KD, Pérez-Figueroa RE, Halkitis PN. Barriers and facilitators related to COVID-19 vaccine acceptance and uptake among people living with HIV. Curr Opin HIV AIDS 2023; 18:142-147. [PMID: 36943471 DOI: 10.1097/coh.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW This review reports on the myriad barriers and facilitators related to COVID-19 vaccine hesitancy and factors contribution to uptake among people living with HIV (PLWH) globally published over the past year (2021-2022). RECENT FINDINGS Across the literature, participants indicated concerns about the safety, efficacy and overall rapid development of the COVID-19 vaccine as a reason for delaying or not being vaccinated. Medical mistrust and perceptions about the risk of COVID-19 immune response and severity also played a role in COVID-19 vaccine hesitancy among PLWH. Almost every study examined different sociodemographic characteristics associated with COVID-19 vaccination acceptance and uptake, and although strong themes emerged around race/ethnicity, sex and educational attainment, the results were mixed across other characteristics, including age. Some studies also examined medical factors specifically related to PLWH including CD4 + cell count and adherence to antiretroviral therapy. SUMMARY The findings highlight individual, structural and social differences in COVID-19 vaccine acceptance and uptake among PLWH, which are varied throughout the world. We call on researchers and interventionists to not just consider the role of medical mistrust and disinformation, but also how emotional, financial and political vulnerability plays into making decisions around COVID-19 vaccine uptake and overall healthcare.
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Affiliation(s)
- Kristen D Krause
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS)
- Department of Urban-Global Health
| | - Rafael E Pérez-Figueroa
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS)
- Department of Urban-Global Health
| | - Perry N Halkitis
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS)
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, USA
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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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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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8
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Point-of-care HIV and hepatitis screening in community pharmacies: a quantitative and qualitative study. Int J Clin Pharm 2022; 44:1158-1168. [PMID: 36098836 PMCID: PMC9469055 DOI: 10.1007/s11096-022-01444-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/12/2022] [Indexed: 11/27/2022]
Abstract
Background Point-of-care tests can contribute to earlier diagnosis and treatment of infectious diseases, thereby affording the opportunity to prevent chronic stages and the spread to others. As part of the Fast-Track Cities initiative, a pilot study was initiated in community pharmacies in Portugal. Aim To characterize the individuals choosing to have point-of-care testing or screening for human immunodeficiency virus, hepatitis C, and hepatitis B virus infections in community pharmacies, their risk behaviours and motivations to perform the tests, as well as to understand the facilitators and barriers from the perspective of pharmacists. Method A quantitative and qualitative study was conducted. A survey was applied to test users in pharmacies between May and December 2019, and three focus groups were conducted with six, four, and five pharmacists involved in the initiative. Qualitative data were analysed according to thematic content analysis. Results A total of 210 questionnaires were collected (57.9% response rate). Point-of-care test users were predominantly male, mean age of 35 (± 13.0) years, the majority had higher education level, and 22.8% were born outside of Portugal. Almost half of the users were first time tested and the main reason for screening was unprotected sexual intercourse. Pharmacists identified speed, confidentiality, counselling provided to users, pharmacists’ initial training to perform the tests, and trust in the pharmacist as facilitators of these tests. Stigma associated with infections, the procedure, logistical conditions, and the referral process were considered as barriers. Conclusion Pharmacies are a screening site with special importance for individuals who are first tested, heterosexuals, and some migrants. Nevertheless, it is necessary to understand and reduce barriers and increase the support to specific groups.
Supplementary Information The online version contains supplementary material available at 10.1007/s11096-022-01444-1.
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9
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Derrick T, Harrington KRV, Alohan DI, Sullivan PS, Holland DP, Klepser DG, Quamina A, Siegler AJ, Young HN. Integrating and Disseminating Pre-Exposure Prophylaxis (PrEP) Screening and Dispensing for Black Men Who Have Sex With Men in Atlanta, Georgia: Protocol for Community Pharmacies. JMIR Res Protoc 2022; 11:e35590. [PMID: 35138252 PMCID: PMC8867290 DOI: 10.2196/35590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Black men who have sex with men (BMSM) suffer from alarmingly high rates of HIV in the United States. Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV infection by 99% among men who have sex with men, yet profound racial disparities in the uptake of PrEP persist. Low PrEP uptake in BMSM is driven by poor access to PrEP, including inconvenient locations of PrEP-prescribing physicians, distrust of physicians, and stigma, which limit communication about PrEP and its side effects. Previous work indicates that offering HIV prevention services in pharmacies located in low-income, underserved neighborhoods is feasible and can reduce stigma because pharmacies offer a host of less stigmatized health services (eg, vaccinations). We present a protocol for a pharmacy PrEP model that seeks to address challenges and barriers to pharmacy-based PrEP specifically for BMSM. OBJECTIVE We aim to develop a sustainable pharmacy PrEP delivery model for BMSM that can be implemented to increase PrEP access in low-income, underserved neighborhoods. METHODS This study design is a pilot intervention to test a pharmacy PrEP delivery model among pharmacy staff and BMSM. We will examine the PrEP delivery model's feasibility, acceptability, and safety and gather early evidence of its impact and cost with respect to PrEP uptake. A mixed-methods approach will be performed, including three study phases: (1) a completed formative phase with qualitative interviews from key stakeholders; (2) a completed transitional pilot phase to assess customer eligibility and willingness to receive PrEP in pharmacies during COVID-19; and (3) a planned pilot intervention phase which will test the delivery model in 2 Atlanta pharmacies in low-income, underserved neighborhoods. RESULTS Data from the formative phase showed strong support of pharmacy-based PrEP delivery among BMSM, pharmacists, and pharmacy staff. Important factors were identified to facilitate the implementation of PrEP screening and dissemination in pharmacies. During the transitional pilot phase, we identified 81 individuals who would have been eligible for the pilot phase. CONCLUSIONS Pharmacies have proven to be a feasible source for offering PrEP for White men who have sex with men but have failed to reach the most at-risk, vulnerable population (ie, BMSM). Increasing PrEP access and uptake will reduce HIV incidence and racial inequities in HIV. Translational studies are required to build further evidence and scale pharmacy-based PrEP services specifically for populations that are disconnected from HIV prevention resources. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/35590.
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Affiliation(s)
| | - Kristin R V Harrington
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Daniel I Alohan
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - David P Holland
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Division of Medical and Preventative Services, Fulton County Board of Health, Atlanta, GA, United States
| | - Donald G Klepser
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, United States
| | - Alvan Quamina
- National AIDS Education and Services for Minorities Inc, Atlanta, GA, United States
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Henry N Young
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, United States
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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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11
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Crawford ND, Albarran T, Chamberlain A, Hopkins R, Josma D, Morris J, Onwubiko UN. Willingness to Discuss and Screen for Pre-Exposure Prophylaxis in Pharmacies Among Men Who Have Sex With Men. J Pharm Pract 2021; 34:734-740. [PMID: 32067554 PMCID: PMC10443399 DOI: 10.1177/0897190020904590] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the willingness to discuss and be screened for pre-exposure prophylaxis (PrEP) in pharmacies among MSM. METHODS Led by Georgia's Fulton County Board of Health, this study surveyed individuals who attended 2 Atlanta-based Gay Pride events in 2018. This analysis was limited to those who identified as men who have sex with men (MSM) who were not HIV positive and reported never using PrEP. Multivariable regression was used to determine the correlates of willingness to discuss and be screened for PrEP in-pharmacy. RESULTS Most (69%) were willing to discuss PrEP with pharmacy staff and 61.35% were willing to be screened for PrEP in-pharmacy. Those who were interested in PrEP were significantly more willing to discuss PrEP in-pharmacy compared to those not interested in PrEP (prevalence ratio [PR]: 1.65; 95% confidence interval [95% CI]: 1.11-2.48). Race was not associated with willingness to discuss PrEP with pharmacy staff. However, black MSM (BMSM) were less willing to be screened in pharmacies than white MSM, until we accounted for interest in PrEP (PR: 1.27; 95% CI: 1.09-1.48). DISCUSSION Pharmacies may be an optimal setting to expand PrEP access to reach racial minorities who have the highest need but are not being reached. Pharmacy-based PrEP discussions and screening could improve awareness of HIV status and increase PrEP knowledge and uptake. Future studies should determine optimal pharmacy conditions under which PrEP screening and uptake are acceptable for BMSM.
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Affiliation(s)
- Natalie D. Crawford
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Taynel Albarran
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Allison Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Fulton County Board of Health, Atlanta, GA, USA
| | - Roderick Hopkins
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dorie Josma
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Joseph Morris
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Crawford ND, Myers S, Young H, Klepser D, Tung E. The Role of Pharmacies in the HIV Prevention and Care Continuums: A Systematic Review. AIDS Behav 2021; 25:1819-1828. [PMID: 33386509 DOI: 10.1007/s10461-020-03111-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 11/26/2022]
Abstract
The role of pharmacists in the treatment of HIV has expanded beyond medication dispensing to include a host of cost-effective, evidence-based strategies across the HIV prevention and care continuums. However, wide-scale adoption of pharmacy-based HIV prevention and treatment interventions has been slow. We conducted a systematic review to evaluate the evidence on the role of pharmacists across the HIV prevention and care continuums. Thirty-two studies were identified, most of which provided evidence of feasibility of HIV testing and efficacy of non-prescription syringe sale services in pharmacies. However, only two studies implemented an experimental design to rigorously test pharmacy-based strategies. Notably, no pharmacy-based strategies have specifically targeted the highest HIV risk populations such as black and Latinx men who have sex with men, women, or trans populations. Efficacy trials and effectiveness studies should rigorously test existing pharmacy-based strategies to build greater support for wide-scale adoption and implementation. Moreover, in order to integrate pharmacies into the strategy to end the HIV epidemic, studies are needed to ensure that pharmacy-based HIV prevention and treatment services can reach the highest risk populations.
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Affiliation(s)
- Natalie D Crawford
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Ann Arbor, MI, USA.
| | - Sky Myers
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Henry Young
- College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Donald Klepser
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Elyse Tung
- Kelley-Ross Pharmacy, Seattle, WA, 98102, USA
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Lewis CF, Lekas HM, Rivera A, Williams SZ, Crawford ND, Pérez-Figueroa RE, Joseph AM, Amesty S. Pharmacy PEP Access Intervention Among Persons Who Use Drugs in New York City: iPEPcare Study-Rethinking Biomedical HIV Prevention Strategies. AIDS Behav 2020; 24:2101-2111. [PMID: 31925608 DOI: 10.1007/s10461-019-02775-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Biomedical HIV prevention uptake has not taken hold among Black and Latinx populations who use street-marketed drugs. A pilot intervention providing a PEP informational video and direct pharmacy access to a PEP starter dose was conducted among this population. Four study pharmacies were selected to help facilitate syringe customer recruitment (2012-2016). Baseline, post-video, and 3-month ACASI captured demographic, risk behavior, and psychosocial factors associated with PEP willingness, and willingness to access PEP in a pharmacy. A non-experimental study design revealed baseline PEP willingness to be associated with PEP awareness, health insurance, being female, and having a high-risk partner (n = 454). Three-month PEP willingness was associated with lower HIV stigma (APR = 0.95). Using a pre-post approach, PEP knowledge (p < 0.001) and willingness (p < 0.001) increased overtime; however, only three participants requested PEP during the study. In-depth interviews (n = 15) identified lack of a deeper understanding of PEP, and contextualized perceptions of HIV risk as PEP access barriers. Pharmacy PEP access shows promise but further research on perceived risk and HIV stigma is warranted.
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Kelly DV, Kielly J, Hughes C, Gahagan J, Asghari S, Hancock S, Burt K, Smyczek P, Charlton C, Nguyen H. Expanding access to HIV testing through Canadian community pharmacies: findings from the APPROACH study. BMC Public Health 2020; 20:639. [PMID: 32380978 PMCID: PMC7203868 DOI: 10.1186/s12889-020-08719-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background There is a need for acceptable and feasible HIV testing options to ensure people living with HIV know their status so they can access care. Pharmacist-provided HIV point-of-care testing (POCT) may overcome testing barriers, including privacy concerns, testing wait times, and improve accessibility. In the APPROACH study, we aimed to develop and assess an HIV POCT program in community pharmacies for future scale up and evaluation. This paper describes the program uptake, participant and pharmacist experiences, and implementation factors. Methods A pharmacist-provided HIV POCT program was offered in 4 pharmacies in two Canadian provinces. A mixed methods design incorporated self-report questionnaire data, participant telephone interviews, pharmacist focus groups, workload analysis, and situational analysis to assess the uptake, acceptability and feasibility of the HIV POCT program. Results Over the 6-month pilot, 123 HIV tests were performed. One new case of HIV was identified; this participant was linked with confirmatory testing and HIV care. Participants were predominantly male (76%), with a mean age of 35 years. This was the first HIV test for 27% participants, and 75% were at moderate to very high risk of undiagnosed HIV infection, by Denver HIV Risk Score. Questionnaires and telephone interviews showed participants were very satisfied with the program; 99% agreed HIV POCT should be routinely offered in pharmacies and 78% were willing to pay for the service. Participants felt the pharmacy was convenient, discreet, and that the pharmacist was supportive and provided education about how to reduce their future risk. Pharmacists felt prepared, confident, and expressed professional satisfaction with offering HIV POCT. Community and public health supports, clear linkage to care plans to refer participants with positive HIV POCT results, and provision of counselling tools were important enabling factors for the program. Pharmacist remuneration, integration with existing healthcare systems, and support for ongoing promotion of HIV POCT availability in pharmacies were identified as needs for future scale-up and sustainability. Conclusions A successful model of pharmacy-based POCT, including linkage to care, was developed. Further research is needed to determine the effectiveness and cost-effectiveness of this approach in finding new diagnoses and linking them with care. Trial registration Retrospectively registered with clinicaltrials.gov (NCT03210701) on July 6, 2017.
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Affiliation(s)
- Deborah V Kelly
- School of Pharmacy, Memorial University of Newfoundland, 75 Tiffany Court, St. John's, NL, A1A 0L1, Canada.
| | - Jason Kielly
- School of Pharmacy, Memorial University of Newfoundland, 75 Tiffany Court, St. John's, NL, A1A 0L1, Canada
| | - Christine Hughes
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jacqueline Gahagan
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | | | | | | | | | - Hai Nguyen
- School of Pharmacy, Memorial University of Newfoundland, 75 Tiffany Court, St. John's, NL, A1A 0L1, Canada
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Crawford ND, Josma D, Morris J, Hopkins R, Young HN. Pharmacy-based pre-exposure prophylaxis support among pharmacists and men who have sex with men. J Am Pharm Assoc (2003) 2020; 60:602-608. [PMID: 32007364 DOI: 10.1016/j.japh.2019.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/02/2019] [Accepted: 12/07/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To understand the perceptions and support for pharmacy-based pre-exposure prophylaxis (PrEP) delivery among pharmacists and men who have sex with men (MSM). DESIGN A qualitative study from April 2017 to December 2018. SETTING AND PARTICIPANTS The researchers used purposive sampling to identify MSM participants and AIDSVu to identify pharmacists in high-human immunodeficiency virus (HIV) zip codes in the metropolitan Atlanta area. Eight MSM and 6 pharmacists consented to participate in the study. OUTCOME MEASURES Perceptions and support for PrEP delivery in pharmacies. RESULTS Both MSM and pharmacists expressed strong support for in-pharmacy PrEP screening and dissemination. MSM reported that pharmacies were more convenient and accessible compared with physician's offices. However, they also noted that privacy and training of pharmacy staff were important for them to consider being screened for PrEP in a pharmacy. Pharmacists also believed training was important and felt comfortable counseling on HIV prevention for their current patients. CONCLUSION These data support early evidence that pharmacies are a promising venue to improve PrEP access for MSM. To implement PrEP screening in pharmacies, proper training of pharmacy staff and a designated space to ensure privacy are critical. Future studies should test the feasibility of screening for PrEP in pharmacies for black MSM.
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Tung EL, Thomas A, Eichner A, Shalit P. Implementation of a community pharmacy-based pre-exposure prophylaxis service: a novel model for pre-exposure prophylaxis care. Sex Health 2019; 15:556-561. [PMID: 30401342 DOI: 10.1071/sh18084] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/30/2018] [Indexed: 11/23/2022]
Abstract
Background National guidelines for the provision of HIV pre-exposure prophylaxis (PrEP) to reduce a person's risk of acquiring HIV were made available in 2014. We created a pharmacist-managed HIV PrEP clinic in a community pharmacy setting at Kelley-Ross Pharmacy in Seattle, WA, USA. METHODS The clinic operates under a collaborative drug therapy agreement based on these guidelines. This allows pharmacists to initiate and manage tenofovir disoproxil fumarate/emtricitabine under the supervision of a physician medical director. RESULTS Between March 2015 and February 2018, 714 patients were evaluated and 695 (97.3%) initiated PrEP. Five hundred and thirteen (74%) patients began medication the same day as their initial appointment. Of the prescriptions filled in our pharmacy, 90% of patients had a mean proportion of days covered (PDC) greater than 80%, and 98% had a zero-dollar patient responsibility per month, including uninsured individuals. 19% of patients were lost to follow up, with an effective drop-out rate of 25%. Two hundred and seven diagnoses of sexually transmissible infections were made. There were no HIV seroconversions in the service. CONCLUSION The pharmacist-managed PrEP clinic proved to be a successful alternative model of PrEP care, with high initiation rates and low drop-out and lost-to-follow-up rates. This may benefit individuals who do not access PrEP in traditional health care settings or where PrEP access is scarce. Financial sustainability of the model was dependent on the ability of pharmacists in the clinic to bill insurance plans for their services in accordance with Washington State legislative changes requiring commercial insurances to recognise pharmacists as providers.
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Affiliation(s)
- Elyse L Tung
- Kelley-Ross Pharmacy Group, 904 7th Avenue, Suite 103, Seattle, WA 98104, USA
| | - Annalisa Thomas
- Kelley-Ross Pharmacy Group, 904 7th Avenue, Suite 103, Seattle, WA 98104, USA
| | - Allyson Eichner
- Kelley-Ross Pharmacy Group, 904 7th Avenue, Suite 103, Seattle, WA 98104, USA
| | - Peter Shalit
- Peter Shalit MD and Associates, 901 Boren Avenue, Suite 850, Seattle, WA 98104, USA
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Graber ML, Grice GR, Ling LJ, Conway JM, Olson A. Pharmacy Education Needs to Address Diagnostic Safety. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:7442. [PMID: 31507297 PMCID: PMC6718490 DOI: 10.5688/ajpe7442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/14/2019] [Indexed: 06/10/2023]
Abstract
The American Association of Colleges of Pharmacy, the Accreditation Council for Pharmacy Education, and the Center for the Advancement of Pharmacy Education frame patient safety from the perspective of medication management, which is also the current focus of pharmacy education and training. With the growing appreciation that diagnostic errors represent an urgent and actionable patient safety concern, the National Academy of Medicine has recommended diagnostic safety training for all health care professions. The Society to Improve Diagnosis in Medicine has worked with an interprofessional consensus group to identify a set of 12 key competencies necessary to achieve diagnostic quality and safety that focuses on individual, team-based, and system-related competencies. Much of this already exists in pharmacy education, but pharmacy training programs need to give graduates more guidance on how they contribute to the diagnostic process and the prevention and detection of diagnostic errors. We describe the current state of progress in this regard, and what steps are needed by training programs to provide content and assessment so that graduates achieve the requisite competencies. Governing and advisory bodies need to expand the expectations around patient safety to include diagnostic safety.
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Affiliation(s)
- Mark L Graber
- The Society to Improve Diagnosis in Medicine, Plymouth, Massachusetts
| | | | - Louis J Ling
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Jeannine M Conway
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota
| | - Andrew Olson
- University of Minnesota Medical School, Minneapolis, Minnesota
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Mayer KH, Chan PA, R Patel R, Flash CA, Krakower DS. Evolving Models and Ongoing Challenges for HIV Preexposure Prophylaxis Implementation in the United States. J Acquir Immune Defic Syndr 2018; 77:119-127. [PMID: 29084044 PMCID: PMC5762416 DOI: 10.1097/qai.0000000000001579] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of preexposure prophylaxis (PrEP) for HIV prevention was approved by the Food and Drug Administration in 2012, but delivery to at-risk persons has lagged. This critical review analyzes the current state of PrEP implementation in the United States, by reviewing barriers and innovative solutions to enhance PrEP access and uptake. SETTING Clinical care settings, public health programs, and community-based organizations (CBOs). METHODS Critical review of recent peer-reviewed literature. RESULTS More than 100 papers were reviewed. PrEP is currently provided in diverse settings. Care models include sexually transmitted disease clinics, community health centers, CBOs, pharmacies, and private primary care providers (PCPs). Sexually transmitted disease clinics have staff trained in sexual health counseling and are linked to public health programs (eg, partner notification services), whereas PCPs and community health centers may be less comfortable counseling and feel time-constrained in managing PrEP. However, PCPs may be ideal PrEP providers, given their long-term relationships with patients, integrating PrEP into routine care. Collaborations with CBOs can expand PrEP care through adherence support and insurance navigation. Pharmacies can deliver PrEP, given their experience with medication dispensing and counseling, and may be more accessible for some patients, but to address other health concerns, liaisons with PCPs may be needed. CONCLUSIONS PrEP implementation in the United States is moving forward with the development of diverse models of delivery. Optimal scale-up will require learning about the best features of each model and providing choices to consumers that enhance engagement and uptake.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence, RI
| | - Rupa R Patel
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO
| | - Charlene A Flash
- Section of Infectious Diseases, Division of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, MA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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Janik P, Kosticova M, Pecenak J, Turcek M. Categorization of psychoactive substances into “hard drugs” and “soft drugs”: a critical review of terminology used in current scientific literature. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017. [DOI: 10.1080/00952990.2017.1335736] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Peter Janik
- Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Michaela Kosticova
- Institute of Social Medicine and Medical Ethics, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Jan Pecenak
- Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Michal Turcek
- Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
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20
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Application of the Consolidated Framework for Implementation Research to community pharmacy: A framework for implementation research on pharmacy services. Res Social Adm Pharm 2017; 13:905-913. [PMID: 28666816 DOI: 10.1016/j.sapharm.2017.06.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Community pharmacies are an increasingly important health care setting with opportunities for improving quality and safety, yet little is understood about determinants of implementation in this setting. OBJECTIVE This paper presents an implementation framework for pharmacy based on the Consolidated Framework for Implementation Research (CFIR). METHODS This study employed a critical review of 45 articles on professional services provided in community pharmacies, including medication therapy management (MTM), immunizations, and rapid HIV testing. RESULTS The relevant domains and associated constructs for pharmacy services were as follows. Intervention Characteristics ultimately depend on the specific service; of particular note for pharmacy are relative advantage and complexity. The former because implementation of services can pose a cost-benefit challenge where dispensing is the primary role and the latter because of the greater challenge implementing multi-faceted services like MTM compared to a discrete service like immunizations. "In terms of Outer Setting, pharmacies are affected by patient needs and acceptance, and external policies and incentives such as reimbursement and regulations. For Inner Setting, structural characteristics like pharmacy type, size and staff were important as was pharmacists' perception of their role and available resources to provide the service. Key Characteristics of Individuals include training, preparedness, and self-efficacy of the pharmacist for providing a new service. Few studies revealed relevant Process constructs, but if they did it was primarily related to engaging (e.g., champions). CONCLUSIONS As pharmacists' roles in health care are continuing to expand, a framework to inform implementation research in community pharmacy (and other) settings is crucially needed.
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21
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Crawford ND, Dean T, Rivera AV, Guffey T, Amesty S, Rudolph A, DeCuir J, Fuller CM. Pharmacy Intervention to Improve HIV Testing Uptake Using a Comprehensive Health Screening Approach. Public Health Rep 2016; 131 Suppl 1:139-46. [PMID: 26862239 DOI: 10.1177/00333549161310s116] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE HIV testing is increasingly available, yet barriers to HIV testing persist for low-income black and Latino people, especially those who use illicit drugs. HIV exceptionalism, or the idea that a positive HIV diagnosis is drastically different from a diagnosis for any other disease, may influence HIV testing-related stigma, resulting in reduced willingness to undergo HIV testing. This pharmacy-based intervention combined HIV testing with less stigmatized chronic disease screening tests (e.g., blood pressure, glucose, and cholesterol) to equate the concept of an HIV diagnosis with other diagnoses. METHODS Three pharmacies located in low-income, minority neighborhoods in New York City were enrolled in an intervention to provide (1) HIV testing, chronic disease screening, and a healthy lifestyles video that normalized all screening tests and destigmatized HIV as a fatal disease (comprehensive arm); (2) HIV testing and the video (video arm); and (3) HIV testing only (control arm). Injection drug users (IDUs) and pharmacy staff recruited un- and underinsured pharmacy customers, IDUs, and IDU peers from 2010 to 2012. Participants in the control group were compared with those in the comprehensive and video intervention groups. RESULTS Participants in the comprehensive arm (prevalence ratio [PR] = 1.61, 95% confidence interval [CI] 1.03, 2.49, p=0.08) and the video arm (PR=1.59, 95% CI 1.00, 2.53, p=0.09) were marginally significantly more likely to receive an HIV test in the pharmacy compared with those in the control arm after adjustment. CONCLUSIONS These findings suggest that adoption of strategies that destigmatize and normalize HIV testing can improve uptake. Implementation of this strategy in low-access, minority communities with high HIV prevalence and among high-risk populations may help reduce racial/ethnic disparities in HIV.
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Affiliation(s)
- Natalie D Crawford
- Emory University, Rollins School of Public Health, Behavioral Sciences and Health Education, Atlanta, GA
| | | | - Alexis V Rivera
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY
| | - Taylor Guffey
- Emory University, Rollins School of Public Health, Behavioral Sciences and Health Education, Atlanta, GA
| | - Silvia Amesty
- Columbia University, Mailman School of Public Health, Department of Population and Family Health, New York, NY; Columbia University, College of Physicians and Surgeons, Center for Family and Community Medicine, New York, NY
| | - Abby Rudolph
- The Calverton Center, Pacific Institute for Research and Evaluation, Calverton, MD
| | - Jennifer DeCuir
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY
| | - Crystal M Fuller
- Nathan Kline Institute for Psychiatric Research, Division of Social Solutions and Services Research, Orangeburg, NY; New York University, School of Medicine, Department of Psychiatry, New York, NY
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Meyerson BE, Carter G, Lawrence C, Jimison L, Rush N, Carter C, Coleman D, King A, Buckner D, Harvey R, Parker T, Gillespie A, Ohmit A. Expanding HIV Testing in African American Communities Through Community-Based Distribution of Home-Test Vouchers. AIDS Patient Care STDS 2016; 30:141-5. [PMID: 26895115 DOI: 10.1089/apc.2015.0243] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Beth E. Meyerson
- Indiana University School of Public Health-Bloomington, Department of Applied Health Science, Bloomington, Indiana
- Rural Center for AIDS/STD Prevention, Bloomington, Indiana
| | - Gregory Carter
- Indiana University School of Public Health-Bloomington, Department of Applied Health Science, Bloomington, Indiana
- Rural Center for AIDS/STD Prevention, Bloomington, Indiana
- Indiana University School of Nursing, Indiana University, Bloomington, Indiana
| | - Carrie Lawrence
- Indiana University School of Public Health-Bloomington, Department of Applied Health Science, Bloomington, Indiana
- Rural Center for AIDS/STD Prevention, Bloomington, Indiana
| | | | - Nate Rush
- Bethlehem House, Indianapolis, Indiana
| | | | | | | | - Debra Buckner
- Marion County Health and Hospitals Corporation, Indianapolis, Indiana
| | | | | | | | - Anita Ohmit
- Indiana Minority Health Coalition, Inc., Indianapolis, Indiana
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