Multiprofessional prescribing and continuity of pre-exposure prophylaxis use: The role of pharmacy and nursing in strengthening access within a universal public health system.

OBJECTIVE

To analyze the association between prescriber professional category and continuity of oral pre-exposure prophylaxis (PrEP) use, identifying the contribution of nursing and pharmacy to strengthening access and retention among vulnerable populations.

METHODS

Cross-sectional study using secondary PrEP monitoring data from Brasília, the Federal District of Brazil, covering new users registered from October 2024 to December 2025. The final sample comprised 2317 individuals with at least one oral PrEP dispensation. Pharmacist prescribing began after training in August-October 2024. Descriptive statistics, Pearson's chi-square test, and multivariate logistic regression were applied (p < 0.05).

RESULTS

Pharmacist care was concentrated in primary care (91.0%; n = 389) and exclusively in the public sector (100.0%; n = 427), while physicians worked predominantly in the private sector (63.1%; n = 779) and nurses in specialized services (73.3%; n = 480). Nursing and pharmacy served proportionally more Black and mixed-race users (60.2% and 57.0%, respectively) than medicine (45.0%). Nursing showed greater reach among incarcerated people, substance users, and sex workers (3.7%, 4.3%, and 5.0%, respectively). Twelve-month continuity was higher among pharmacist-followed users (97.9%; n = 418) than nurses (80.6%; n = 528) and physicians (72.4%; n = 894). Multivariate regression confirmed professional category as an independent predictor of continuity, with higher adjusted Odds Ratios (aOR) and 95% confidence intervals (95% CI) for pharmacist-followed (aOR = 4.25; 95%CI 2.10-8.50; p < 0.001) and nurse-followed users (aOR = 1.65; 95%CI 1.30-2.10; p = 0.002) than the physician-led model.

CONCLUSION

Integration of pharmacist prescribing and the leading role of nursing within the public network may broaden reach among historically vulnerable populations and increase initial continuity, supporting decentralization as a strategy to reduce inequities in access to combination Human Immunodeficiency Virus (HIV) prevention technologies.