PrEP Up Pharmacies: Evidence of a pharmacy-based same-day pre-exposure prophylaxis (PrEP) screening and dispensing model in the United States Southeast

Background : Only 30% of the 1.2 million people indicated for pre-exposure prophylaxis (PrEP) have a prescription. Evidence shows pharmacies can expand access, yet few models have been tested in this region. Methods : We developed and tested the PrEP Up Pharmacies study, which trains pharmacists and pharmacy technicians to direct clients to an in-pharmacy health screening that includes an eligibility screener and for those eligible, a socio-behavioral survey, HIV self testing and counseling. Clients testing negative are offered a 30-day tele-PrEP prescription; those testing positive are linked to HIV care. We assessed uptake at each step, differences by client characteristics, and time from screening to self-testing or the corresponding point. Results : Of 247 pharmacy clients informed about the screener survey, 26% (n=64) were screened and most (71.9%) were willing to complete the socio-behavioral survey. Men were more likely than women (p=0.021) to complete the socio-behavioral survey and there were no differences by race. Most clients were recommended for HIV testing (58.7%) based on self-reported sex and drug use risk behaviors. However, self-HIV testing uptake was low (17.4%); there were no differences in willingness to self-test by race, sex or age. Most clients tested HIV- negative and were offered PrEP (88%), however 71.4% declined PrEP due to low HIV risk perceptions. Two clients obtained tele-PrEP prescriptions within 24-hours, and one was referred to HIV care. Conclusions : Preliminary results support same-day pharmacy-based PrEP delivery and highlight risk perceptions as a barrier. Future efforts will test how additional evidence-based practices impact PrEP uptake in more pharmacies.