{"doi":"10.1002/jia2.25619","title":"Pharmacy delivery to expand the reach of PrEP in Africa","abstract":"Several African countries have recently integrated pre-exposure prophylaxis (PrEP) into their national HIV prevention programmes and are in the process of scaling-up healthcare facility-based PrEP delivery [1]. To maximize the public health benefit of PrEP, there is need to prioritize access, minimize the costs of delivery and reach HIV at-risk populations. Major barriers to facility-based PrEP delivery exist, including facility-associated HIV stigma, long waiting times, the costs of staffing and providers’ unfamiliarity with delivering prevention interventions [2]. In Africa, PrEP is also being added to public health infrastructures that are sometimes burdened by overcrowding and drug stock outs [3]. Thus, the ability of African health systems to maximize PrEP access necessitates finding novel models of PrEP delivery. In low-resource settings, including a number of African settings, private pharmacies fill an important gap in the medical system and individuals often rely on and prefer the use of pharmacies over healthcare facilities to address their medical needs [4]. Pharmacies can address care needs that are both urgent (e.g. evaluation and medication for sexually transmitted infections) and preventive (e.g. contraception) [5] and have advantages over healthcare facilities, including increased convenience and provider engagement. Compared to providers at healthcare facilities, providers at pharmacies can often spend more time with clients because they do not have to focus on treating sick patients and build better rapport with clients because they are for-profit businesses that rely on repeat services. In low-resource settings, it is common for individuals to first go to a pharmacy to address a medical issue (e.g. symptoms of malaria), then only go to a healthcare facility later if the issue is not resolved [6-8]. Delivery of PrEP through pharmacies is one approach being utilized in the US to improve PrEP accessibility. In Seattle, the Kelley-Ross Pharmacy (a private pharmacy) has developed One Step PrEP, which allows pharmacists to prescribe and manage PrEP care under a collaborative-practice agreement with a local primary care clinic [9]. Thus far this model has been highly successful; from March 2015 to February 2018, 714 clients were evaluated and 695 (97%) initiated PrEP at the Seattle pharmacy. Among clients that initiated PrEP, 74% received PrEP drugs on the same day of their visit, and among clients that refilled PrEP, 90% were found to be PrEP adherent (i.e. their mean proportion of days covered was >80%). Additionally, no clients HIV seroconverted during the period of pharmacy-based PrEP delivery. The success of this collaborative practice agreement for pharmacy PrEP care has inspired replication in other US setting (e.g. Omaha, Nebraska and San Francisco, California) to expand PrEP access and continuation [10]. Development of a similar model for pharmacy-based PrEP delivery in African settings, adapted to local context, could benefit many. Strategic planning for how such a model could be delivered safely and effectively could head off unregulated development of ad hoc PrEP delivery in pharmacies (potentially accompanied with PrEP misinformation). The delivery of PrEP at private pharmacies in Africa is feasible and within the domain of care for pharmacy providers. PrEP delivery has relatively few necessary components – HIV testing, counselling (on PrEP adherence and HIV risk reduction), PrEP prescribing (including assessment of acute HIV infection and PrEP side effects) and drug dispensing (Figure 1) [11] – all of which can be done by pharmacists or pharmaceutical technologists in low-resource settings (especially with remote clinician oversight, like the US model) [12]. Already, many private pharmacies counsel clients on the importance of adherence to medications for hypertension and diabetes, as well as the importance of condom use for pregnancy and sexually transmitted infection prevention. Some pharmacies in s","journal":"Journal of the International AIDS Society","year":2020,"id":64045,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":39,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9531,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":338967,"name":"Peter Mogere","orcid":"0000-0003-0465-5760","position":1,"is_corresponding":false},{"id":255294,"name":"Elizabeth A. Bukusi","orcid":"0000-0002-2031-2808","position":2,"is_corresponding":false},{"id":331198,"name":"Kenneth Ngure","orcid":"0000-0002-8062-0933","position":3,"is_corresponding":false},{"id":299060,"name":"Jared M. Baeten","orcid":"0000-0001-8242-8438","position":4,"is_corresponding":false},{"id":338966,"name":"Katrina F. Ortblad","orcid":"0000-0002-5675-8836","position":0,"is_corresponding":true}],"reference_count":15,"raw_metadata":null,"created_at":"2026-07-18T21:12:32.635050Z","pmid":"32996721","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}