Willingness to Discuss and Screen for Pre-Exposure Prophylaxis in Pharmacies Among Men Who Have Sex With Men

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.

Keywords

HIV prevention PrEP MSM health disparities health inequities

Get full access to this article

View all access options for this article.

References

Centers for Disease Control and Prevention. HIV Surveillance Report. 2015. November 2016.

Hall

Song

Tang

, et al. HIV trends in the United States: Diagnoses and estimated incidence. JMIR Public Health Surveill. 2017;3(1):e8.

Paltiel

Freedberg

Scott

, et al. HIV preexposure prophylaxis in the United States: impact on lifetime infection risk, clinical outcomes, and cost-effectiveness. Clin Infect Dis. 2009;48(6):806–815.

Bush

Magnuson

Rawlings

, et al. Racial Characteristics of FTC/TDF for Pre-Exposure Prophylaxis (PrEP) Users in the US, 16–20 June 2016. Boston: ASM Microbe.

Chu

Castellanos

Gonzales

, et al. Social determinants of self-reported pre-exposure prophylaxis use among a national sample of US men who have sex with men. Sex Transm Infect. [published online ahead of print October 10, 2019]. doi:10.1136/sextrans-2019-054177.

Roemer

. The Uninsured in America, First Part of 2012: Estimates for the U.S. Civilian Noninstitutionalized Population under Age 65. Rockville (MD): Statistical Brief (Medical Expenditure Panel Survey (US)); 2001.

Kass

Flynn

Jacobson

, et al. Effect of race on insurance coverage and health service use for HIV-infected gay men. J Acquir Immune Defic Syndr Hum Retrovirol. 1999;20(1):85–92.

Gilead Sciences Incorporated. How can you get help paying for TRUVADA for PrEP? 2017. https://www.truvada.com/how-to-get-truvada-for-prep/truvada-cost. Accessed January 1, 2017.

Lelutiu-Weinberger

Golub

. Enhancing PrEP access for black and Latino men who have sex with men. J Acquir Immune Defic Syndr. 2016;73(5):547–555.

10.

Cahill

Taylor

Elsesser

, et al. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care. 2017:1–8.

11.

Eaton

Kalichman

Price

, et al. Stigma and conspiracy beliefs related to pre-exposure prophylaxis (PrEP) and interest in using PrEP among black and white men and transgender women who have sex with men. AIDS Behav. 2017;21(5):1236–1246.

12.

Buot

Docena

Ratemo

, et al. Beyond race and place: distal sociological determinants of HIV disparities. PLoS One. 2014;9(4):e91711.

13.

Vaughan

Rosenberg

Shouse

, et al. Connecting race and place: a county-level analysis of white, black, and hispanic HIV prevalence, poverty, and level of urbanization. Am J Public Health. 2014;104(7):e77–84.

14.

Dasgupta

Kramer

Rosenberg

, et al. Spatial accessibility to HIV providers in Atlanta, Georgia. AIDS Res Hum Retroviruses. 2015;31(5):473–474.

15.

Clement

Seidelman

, et al. An educational initiative in response to identified PrEP prescribing needs among PCPs in the Southern U.S. AIDS Care. 2017:1–6.

16.

Fallon

Park

Ogbue

, et al. Awareness and acceptability of pre-exposure HIV prophylaxis among men who have sex with men in Baltimore. AIDS Behav. 2017;21(5):1268–1277.

17.

Rosenbluth

Madhavan

Borker

, et al. Pharmacy immunization partnerships: a rural model. J Am Pharm Assoc (Wash). 2001;41(1):100–107.

18.

Joyce

Berbatis

Sunderland

, et al. Analysis of primary prevention services for cardiovascular disease in Australia’s community pharmacies. Aust N Z J Public Health. 2007;31(6):516–519.

19.

Amesty

Crawford

Nandi

, et al. Evaluation of pharmacy-based HIV testing in a high-risk New York City community. AIDS Patient Care STDS. 2015;29(8):437–444.

20.

Crawford

Dean

Rivera

, et al. Pharmacy intervention to improve HIV testing uptake using a comprehensive health screening approach. Public Health Rep. 2016;131(suppl 1):139–146.

21.

Darin

Klepser

, et al. Pharmacist-provided rapid HIV testing in two community pharmacies. J Am Pharm Assoc (2003). 2015;55(1):81–88.

22.

Lecher

Shrestha

Botts

, et al. Cost analysis of a novel HIV testing strategy in community pharmacies and retail clinics. J Am Pharm Assoc (2003). 2015;55(5):488–492.

23.

Tung

Thomas

Eichner

, et al. Implementation of a community pharmacy-based pre-exposure prophylaxis service: a novel model for pre-exposure prophylaxis care. Sex Health. 2018;15(6):556–561.

24.

Havens

Scarsi

Sayles

, et al. Acceptability and feasibility of a pharmacist-led HIV pre-exposure prophylaxis (PrEP) program in the Midwestern United States. Open Forum Infect Dis. 2019;6(10):ofz365.

25.

Lopez

Cocohoba

Cohen

, et al. Implementation of pre-exposure prophylaxis at a community pharmacy through a collaborative practice agreement with San Francisco department of public health. J Am Pharm Assoc. 2020;60(1):138–144.

26.

Onwubiko

UHD

Ajoku

, et al. HIV pre-exposure prophylaxis awareness and use among men who have sex with men and transgender women who have sex with men in a southern HIV hotspot: findings from a cross-sectional survey in Atlanta, GA; 2018. (Submitted, under review)

27.

Kuhns

Hotton

Schneider

, et al. Use of pre-exposure prophylaxis (PrEP) in young men who have sex with men is associated with race, sexual risk behavior and peer network size. AIDS Behav. 2017;21(5):1376–1382.

28.

Crossley

Public perceives pharmacists as some of the most trusted professionals. Pharmacy Times: Pharmacy & Healthcare Communications. Rye Brook, NY: LLS; 2019.

29.

Gebhart

. Provider status: keep the pressure on lawmakers and push for payment. 2016. http://drugtopics.modernmedicine.com/drug-topics/news/provider-status?page=0,4. Accessed January 1, 2016.

30.

Kelig

. Exploring accessibility of community pharmacy services. Innovat pharm. 2015; 6(3):1–4.

31.

Rolle

Rosenberg

Siegler

, et al. Challenges in translating PrEP interest into uptake in an observational study of young black MSM. J Acquir Immune Defic Syndr. 2017;76(3):250–258.