SEATTLE – A pharmacist-run HIV pre-exposure prophylaxis (PrEP) clinic had a retention rate of 75% and achieved a financial return within the first year of operation.
The Seattle-area project allowed individuals to leave their first appointment with medication in hand, and it drew in many men who had no primary care provider.
The approach is a departure from typical PrEP assignment, in which a patient must navigate a provider, lab testing, a pharmacist, and the need for prior authorization, explained Elyse Tung-Wisner, PharmD, director of clinical services at Kelley-Ross Pharmacy, Seattle. That process can take a few days to a few weeks.
Jim Kling/Frontline Medical News
Elyse Tung-Wisner, PharmD (right) and coauthor Annalisa Thomas, PharmD.
“For years, pharmacists have done glucose testing. A finger stick for an HIV test is a similar model. We applied the same protocol to PrEP,” said Dr. Tung-Wisner, who presented an analysis of the program in a poster session at the Conference on Retroviruses & Opportunistic Infections in partnership with the International Antiviral Society.
In the program, patients can come in, receive counseling, undergo all tests, and the pharmacist can work through all the prior authorizations and patient-assistance programs. “Oftentimes, a patient can leave with medication in hand within an hour,” said Dr. Tung-Wisner.
“As far as we know, we’re the first in the country to have a pharmacist-run HIV PrEP clinic in a community pharmacy setting,” she added.
She and her colleagues presented data on the effectiveness and financial viability of what they term One-Step PrEP. In the program, pharmacists take a medical and sexual history of each patient, perform a risk assessment and laboratory testing, provide education, and prescribe and dispense PrEP if appropriate. The pharmacist also performs all guideline-recommended follow-up care.
From March 2015 through March 2016, 373 patients inquired about PrEP services. A total of 251 patients were evaluated in person and 245 (98%) went on to begin PrEP. Among those who started PrEP, 88% identified as men who have sex with men (mean age, 34 years; range, 18-64).
The program had a 75% retention rate over the first year, with one HIV seroconversion.
The initial start-up costs were recouped at 9 months, suggesting that the program quickly became financially sustainable.
It also reached a highly vulnerable, underserved population. The average men who have sex with men index score was 20, which indicates that the patients were high risk, Dr. Tung-Wisner noted.
And just 23% of the patients who were evaluated in person had a primary care provider. “That suggests we were accessing a patient population that has not already established care anywhere else,” she explained.
The program was run by Kelley-Ross Pharmacye. Dr. Tung-Wisner is an employee of the pharmacy.