Implementation of PrEP 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 post-exposure 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 Community pharmacy in San Francisco's Mission District, an urban, historically 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 worked together to design, launch and maintain the program. Pharmacists were trained by SFDPH staff on HIV testing and counseling, implementation of the PrEP protocol, including PEP initiation and sexually transmitted disease (STD) testing. A Department of Public Health secure portal was utilized to share patient information. A SFDPH physician reviewed patients' charts regularly and communicated with PrEP pharmacists as needed. Preliminary 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/Latino, 10% (n=5) were Black/African American. 82% (n=42) identified as men who have sex with men (MSM). 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.