Patients' And Community Pharmacists' Acceptance Of Prescribing Pre-exposure Prophylaxis (prep) For Human Immunodeficiency Virus (hiv) In Nova Scotia, Canada

• By: WILBY, Kyle (Dalhousie University, Canada)
• Co-author(s): Dr Kyle Wilby (Dalhousie University, Halifax, Canada)
  Mr Connor Booker (Dalhousie University, Halifax, Canada)
  Mr Calum MacDonald (Dalhousie University, Halifax, Canada)
  Dr. Tasha Ramsey (Nova Scotia Health, Halifax, Canada)
  Dr Andrea Murphy (Dalhousie University, Halifax, Canada)
  Dr Jennifer Isenor (Dalhousie University, Halifax, Canada)
  Dr Andrea Bishop (Nova Scotia College of Pharmacists, Halifax, Canada)
  Dr Alesha Smith (University of Otago, Dunedin, New Zealand)
  Dr Deborah Kelly (Memorial University of Newfoundland, St. John's, Canada)
  Mr Greg Richard (Dalhousie University, Halifax, Canada)
  Ms Lisa Woodill (Pharmacy Association of Nova Scotia, Halifax, Canada)
  Mr Kirk Furlotte (Community-Based Research Centre, Halifax, Canada)
  
• Abstract:

  Background: Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is highly effective. PrEP is currently recommended for high risk groups such as gay and bisexual men who have sex with men and persons who inject drugs. Pharmacists may increase PrEP accessibility to these vulnerable populations through prescribing services in community pharmacies. Independent PrEP prescribing (without a collaborative practice agreement) is not currently part of community pharmacists' scope of practice in most world regions, including Canada. In the context of increased workloads and responsibilities during the COVID-19 pandemic, it is unknown how accepting community pharmacists are towards providing prescribing services for PrEP. It is also unknown how patients view a PrEP prescribing service and what concerns they may if implemented within community pharmacies.
  
  Purpose: This study aimed to determine patients' and community pharmacists’ acceptance of a PrEP-prescribing service by pharmacists in Nova Scotia, Canada.
  
  Method: Two triangulation mixed methods studies were conducted that consisted of online surveys and qualitative interviews with patients eligible to receive PrEP and Nova Scotia community pharmacists. The surveys and interview guides were underpinned by the seven constructs of the Theoretical Framework of Acceptability (affective attitude, burden, ethicality, opportunity costs, intervention coherence, perceived effectiveness, and self-efficacy). Survey data were analyzed descriptively and with ordinal logistic regression to determine associations between variables. Interview transcripts were deductively coded according to the same constructs and then inductively coded to identify themes within each construct. Data for patients and community pharmacists was analyzed separately.
  
  Results: A total of 148 patients completed the survey and 15 completed the interview. Patients were overwhelmingly positive about PrEP prescribing across all domains of the Theoretical Framework of Acceptability. Patients appreciated the convenience of community pharmacies and believed that this service would enhance their relationship with their existing prescriber (doctor or nurse practitioner) by reducing appointment time required for prescribing PrEP. A total of 214 community pharmacists completed the survey and 19 completed the interview. Pharmacists were positive about PrEP prescribing in the constructs of affective attitude (improved access), ethicality (benefits communities), intervention coherence (practice alignment), and self-efficacy (role). Pharmacists expressed concerns about burden (increased workload), opportunity costs (time to provide the service), and perceived effectiveness (education/training, public awareness, laboratory test ordering, and reimbursement). No significant demographic predictor variables were found within each domain assessed.
  
  Conclusion: A PrEP prescribing service was highly acceptable to patients yet had mixed acceptability to Nova Scotia pharmacists. Based on these findings, it can be concluded that PrEP prescribing by pharmacists represents a model of service delivery that may increase PrEP access to underserved populations. Implementation of this service must consider pharmacists’ workload, education and training, and system factors relating to laboratory test ordering and reimbursement for optimal buy-in from community pharmacists.
  
  Topic Area: Pharmacy Practice Research