HIV PrEP Presents a Pharmacist Counseling Opportunity

Science and solid research has made us aware of exactly who is at high risk for HIV exposure, and the health care community has done a remarkable job warning at-risk populations and recommending preventive measures.

Science and solid research has made us aware of exactly who is at high risk for HIV exposure, and the health care community has done a remarkable job warning at-risk populations and recommending preventive measures. Still, some HIV-negative individuals remain at high risk, especially if their partners are HIV-positive.

Clinicians now have the option of prescribing pre-exposure prophylaxis (PrEP) therapy to HIV-negative individuals who are at high risk of contracting the virus. When patients are adherent, PrEP reduces transmission risk.

This is where community pharmacists can help public health officials by offering good counseling and repeated reinforcement of the adherence message, which improves outcomes. Ideally, pharmacists need to be knowledgeable about HIV and PrEP to provide the best possible advice to patients.

A team of researchers from Utah—a state that recently reported an increase in HIV infections—addressed pharmacists’ roles in PrEP after conducting a cross-sectional survey of community pharmacists in their state. In addition to assessing pharmacists’ baseline knowledge of PrEP, the authors asked about their intention to counsel patients on it.

Among the 251 pharmacists who responded, these researchers examined beliefs about capabilities, social influence, moral norms, and intention to counsel patients.

Three-quarters of pharmacists possessed the PharmD degree (as opposed to RPh status). These pharmacists were more likely to report intent to counsel, as were pharmacists who had graduated less than 10 years ago. They also tended to be more knowledgeable about HIV.

Regardless of the pharmacists’ sex, rates of intention to counsel were similar.

Pharmacists who responded were much more knowledge about HIV than they perceived themselves to be. Still, the researchers reported that additional training for pharmacists is needed, since some pharmacists had knowledge deficits. In particular, less than half of respondents could identify the exact medication used in PrEP or its recommended dose.

Only one-third were able to identify the individuals most likely to benefit from PrEP (those who have HIV-positive partners, engage in sexual activity with partners of unknown HIV status, use condoms inconsistently, exchange of sex for commodities, or are injection users), with one-fifth skipping the question entirely.

The researchers suggested engaging the pharmacy profession’s opinion leaders to educate and encourage community pharmacist engagement with PrEP counseling. Pharmacists with strong social influence and beliefs about capabilities domains can help others counsel more, and also counsel better.

The findings were published in the August 2016 issue of the Journal of the American Pharmacists Association.