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Implementation of pre-exposure prophylaxis at a community pharmacy through a collaborative practice agreement with San Francisco Department of Public Health

      Abstract

      Objective

      To discuss the design and implementation of a community pharmacy–initiated HIV pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) program developed in collaboration with the San Francisco Department of Public Health (SFDPH).

      Setting

      A community pharmacy in San Francisco and the SFDPH developed a collaborative practice agreement (CPA) that allowed community pharmacists to initiate PrEP and PEP to prevent HIV acquisition and increase uptake in vulnerable populations.

      Practice description

      A community pharmacy in San Francisco’s Mission District, an urban, historically Hispanic/Latino/Latinx neighborhood. The primary collaborative practice team consisted of 1 community pharmacy technician, 4 community pharmacists, and 1 designated overseeing physician at SFDPH.

      Practice innovation

      The pharmacy and the SFDPH collaborated together for 20 months from start to implementation of the CPA and the PrEP program. An interdisciplinary team of pharmacists, pharmacy personnel, public health physicians, and health department staff members worked together to design, launch, and maintain the program. Pharmacists were trained by SFDPH staff members on HIV testing and counseling and implementation of the PrEP protocol, including PEP initiation and sexually transmitted disease testing. A Department of Public Health secure portal was used to share patient information. An SFDPH physician reviewed patients’ charts regularly and communicated with PrEP pharmacists as needed.

      Results

      Between April 2018 and the end of March 2019, 6 patients received PEP and 53 patients completed a PrEP initiation visit, of whom 96% (n = 51) filled their prescription. Approximately 47% (n = 24) of clients who started PrEP self-identified as Hispanic or Latino, 10% (n = 5) were black or African American, and 82% (n = 42) identified as men who have sex with men.

      Conclusion

      Implementation of a CPA between a community pharmacy and a local health department enabled the launch of pharmacist-delivered PrEP, further expanding the landscape of access points to vulnerable populations in San Francisco.
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      Biography

      Maria I. Lopez, PharmD, AAHIVP, President of Clinical Pharmacy Services, Mission Wellness Pharmacy, San Francisco, CA

      Biography

      Jennifer Cocohoba, PharmD, MAS, BCPS, Professor of Clinical Pharmacy, Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA

      Biography

      Stephanie E. Cohen, MD, MPH, Medical Director, San Francisco City Clinic, Section Director, HIV and STD, Disease Prevention and Control, San Francisco Department of Public Health, San Francisco, CA; Assistant Clinical Professor, Division of Infectious Diseases, University of California, San Francisco, CA

      Biography

      Nikole Trainor, MPH, MCHES, CPTII, GTZ Program Coordinator, PrEP Health Educator, Community Health Equity & Promotion, San Francisco Department of Public Health, San Francisco, CA

      Biography

      Montica M. Levy, MPH, Biomedical HIV Prevention Coordinator, San Francisco City Clinic, Population Health Division, Disease Prevention and Control, San Francisco Department of Public Health, San Francisco, CA

      Biography

      Betty J. Dong, FASHP, FAPHA, FCCP, AAHIVP, Professor of Clinical Pharmacy and Family and Community Medicine, Departments of Clinical Pharmacy and Family and Community Medicine, Schools of Medicine and Pharmacy, University of California, San Francisco, CA