An HIV pre-exposure prophylaxis (PrEP) program piloted at a pharmacy in Seattle shows promising results for patients.
 
Elyse Tung-Wisner, PharmD, BCACP, RPh, a clinical pharmacist at Kelley-Ross Pharmacy Group, told Pharmacy Times how and why this One-Step PrEP HIV prevention program has been a success.
 
The pharmacy’s preliminary findings were that all patients have remained HIV-negative, and the program’s ability to address adverse effects improved outcomes.
 
The pharmacists also saw that check-ins and refills on a monthly basis led to better HIV medication adherence. In addition, the pilot program encouraged more patients to become interested in pharmacy-based PrEP.

The program also benefitted the pharmacy, as Kelley-Ross believes it found a sustainable model that can make pharmacies break even in less than 12 months if they invest in a similar program. The pharmacy team at Kelley-Ross also worked to research and resolve state-funded coverage for PrEP to help patients afford it.
 
Almost all of the patients (98%) did not have to pay a dime to obtain Truvada. 
 
Here are 4 key takeaways from the PrEP program:

1.Make access to PrEP easy.
The catalyst for the program was hearing common concerns from potential PrEP candidates, Dr. Tung-Wisner told Pharmacy Times.

“By reducing the wait time and by investing in a 45-minute consultation, we have made access easy and have reduced a lot of the stress and anxiety that comes with such a sensitive and private decision,” she said.

Often, a patient interested in PrEP has to go through a 2- to 3-week waiting process. In the pilot program, however, the pharmacist met with the patient for 45 minutes and talked about risk factors and adverse effects while their lab results were processed.

The pharmacists also helped patients research payment methods. 

“Prevention is key, but prevention won’t work if people are not aware of PrEP, or if they feel intimidated by the process of obtaining PrEP,” Dr. Tung-Wisner said. “The more we can do to educate and break down barriers to accessing PrEP, the more new HIV cases we can avoid and the more lives we can change by taking the fear out of sex.”

2.Build trust among the community.
The key to the PrEP pilot program’s success was developing trust, relationships, and partnerships in the community, Dr. Tung-Wisner said. This will help combat any existing stigma surrounding PrEP.
 
“You need to be able to devote enough time to consultations with patients, and you need to be well-versed in the specific concerns and issues of communities that benefit most from PrEP,” Dr. Tung-Wisner added.

3.The MSM Risk Index is a good tool for pharmacists.
The Kelley-Ross pilot program used a number of factors to identify whether a patient was at high risk for HIV.
 
In addition to asking patients questions that would determine whether they would benefit from PrEP, the pharmacists also took an in-depth sexual history examination, using the MSM Risk Index. (MSM encompasses men who are gay, bisexual, or who have sex with men.)
 
The US Centers for Disease Control and Prevention has validated the MSM Risk Index as an appropriate scoring tool that gives patients a number between 0 and 45 based on their risk for HIV transmission. If patients receive a score of 10, they are considered a good candidate for PrEP.
 
Some of the factors involved in this scoring include whether the patients are in a relationship with someone who is HIV-positive, whether they are not in a monogamous relationship, whether they do not regularly use condoms, and whether they inject illicit drugs into their system.
 
Patients who would not qualify for PrEP include those who are HIV-positive or those who have renal dysfunction.

4.Pharmacists are well-positioned to reach this patient population.
As medication experts, pharmacists know how to talk to patients thoroughly about risks and adverse side effects. They also know about the latest medications and are adept at consulting with patients, as well as conducting testing and monitoring for PrEP, Dr. Tung-Wisner noted.

“Many pharmacists, including myself, chose this field because we enjoy working with patients as a trusted consultant in their health care decisions,” she said.

Awareness of pharmacists’ consulting abilities is growing. In Washington State, for example, legislation includes verbiage that recognizes pharmacists as providers, and it will soon require insurance to cover pharmacy consultations, Dr. Tung-Wisner noted.