Association between state policies enabling pharmacist-led human immunodeficiency virus pre-exposure prophylaxis and need for human immunodeficiency virus prevention: An ecological analysis.

BACKGROUND

Models of pharmacist-led pre-exposure prophylaxis (PrEP) services have been shown to effectively reach populations disproportionately affected by human immunodeficiency virus (HIV). Pharmacist prescriptive authority for PrEP varies across states, limiting the potential scale up of these models.

OBJECTIVE

We investigated whether states with the most restrictive policies were also the states that could benefit the most from expanded PrEP access.

METHODS

We classified U.S. states and the District of Columbia into 5 distinct policy categories ranked from most restrictive to least restrictive and estimated the association between these categories and the state PrEP-to-need ratio, the ratio of current PrEP users to new HIV diagnoses in the state.

RESULTS

Most states had restrictive policies that limit pharmacists' ability to initiate PrEP for their clients. States with the most restrictive policy of patient-specific collaborative practice agreements may be more likely to benefit from expanded PrEP access compared to states with the least restrictive policy (i.e., unrestricted authority/statute).

CONCLUSION

In the absence of a national strategy or policy to expand pharmacist-led PrEP, state-level efforts are needed to improve access to PrEP in pharmacies.