Development and implementation of pharmacy PrEP awareness raising and initiation: acceptability and feasibility of a UK pilot.

Objectives: To develop and implement a community pharmacy pre-exposure prophylaxis (PrEP) awareness raising and initiation pilot, informed by a literature review and interviews with pharmacists and community members. Methods: Using the Person-Based Approach and the Capability, Opportunity, Motivation-Behaviour change (COM-B) model, the pilot aimed to improve HIV/PrEP knowledge/capability and motivation through pharmacist and community awareness-raising. Opportunity was addressed by integrating PrEP consultations into pharmacy services and offering STI, HIV, and estimated glomerular filtration rate (eGFR) home test kits. Financial incentives also aimed to motivate pharmacists. Pharmacists identified eligible community members, initiated PrEP discussions, and provided home testing kits. Individuals opting to start PrEP completed the tests and posted them to a local sexual health clinic, where staff reviewed the results, confirmed eligibility, and prescribed PrEP remotely. NHS policy restrictions on pharmacies stocking NHS-procured PrEP informed the delivery model. The pilot evaluation focused on staff training impact, number/type of consultations, and feasibility and acceptability of pharmacy PrEP delivery for staff and community members. Results: The pilot was conducted in five pharmacies across Bristol, North Somerset, and South Gloucestershire from October 2024 to April 2025. A total of 55 consultations were held with individuals aged 18-69 (n=23 male, n=31 female, n=1 transgender). Visit reasons included emergency contraception (n=14), PrEP (n=14), and opioid substitution therapy (n=11). Twenty-eight community members expressed interest in PrEP; 22 accepted a home testing kit, seven returned it, and four were prescribed PrEP. Pharmacists and community members viewed the service positively. Barriers included pharmacists' initial lack of confidence initiating PrEP discussions and limited public awareness of PrEP availability in pharmacies. Conclusion: Community pharmacies represent a promising site for PrEP delivery. Successful scale-up requires pharmacist training, public health education, structural and policy changes to support accessible PrEP provision beyond sexual health clinics to reduce inequities.