Pharmacists Can Address Gaps in Long-Acting PrEP Care for HIV

NEW ORLEANS — A collaborative drug therapy management (CDTM) program introduced by pharmacists helped improve access to long-acting HIV prevention in at-risk individuals, a researcher reported here.

In the EquiPrEP study, the addition of a CDTM pharmacist in a municipal hospital system decreased the time to prior authorization for long-acting pre-exposure prophylaxis (PrEP) from 5 to 2 days (P=0.015), said Anthony Gerber, PharmD, of New York City Health+Hospitals/Bellevue.

And the time required to enroll patients prescribed the long-acting injectables in an assistance program was reduced as well (P=0.021), according to findings presented at the American Society of Health-System Pharmacists midyear meeting.

“There were a lot of barriers to when the patient saw the physician and … to actually getting PrEP,” Gerber told MedPage Today. These included issues with retention, prior authorizations that physicians didn’t have time to complete or appeal, and uninsured patients who were eligible for patient assistance programs, but did not have a way to complete the process.

“When I came on board, I tried to really bridge the gap and make sure that once I saw the patient, the patient got their medication,” he said. Gerber saw patients personally, prescribed their medication, appealed prior authorization denials, and monitored patients closely throughout injection appointments.

A second study presented at the meeting, from researchers led by Dima Dandachi, MD, of the University of Missouri-Columbia, showed that men who have sex with men and transgender men who chose long-acting PrEP were most likely to be influenced by their providers. And most cited convenience as a reason for choosing or switching to the product.

Monica Gandhi, MD, MPH, medical director of the “Ward 86” HIV Clinic at San Francisco General Hospital, who was not involved with either study, told MedPage Today via email that “as a long-term HIV provider … I have found that pharmacists have been invaluable in helping us to get people with HIV on long-acting antiretroviral therapy or pre-exposure prophylaxis.”

Gandhi added that the studies “demonstrate that we need to work with multidisciplinary teams, specifically pharmacists, to help us get long-acting PrEP more quickly to our patients and to be informed on how to educate patients on its benefits.”

EquiPrEP

For their study, Gerber and his fellow researchers compared patients who enrolled in the EquiPrEP program prior to adding the CDTM pharmacist (February to September 2023) to those who enrolled afterwards (September 2023 to May 2024). Outcomes included the number of interventions, prior authorizations completed, barriers to adherence addressed, and letters of necessity completed.

Before and after the addition of the pharmacist, 79 patients and 43 patients enrolled, respectively. Most were cisgender men (60.6%), followed by cisgender women (16.4%), and transgender women (11.5%). The mean age was 35 years, 68% were Hispanic, and 23.7% were Black. Around half identified as gay, and most were enrolled in Medicaid or uninsured.

Gerber highlighted the role of pharmacists in easing physician workload, and programs like these in addressing major challenges patients face in their community. “It’s a luxury to have someone like me, because it takes the burden a little bit away from the physicians, right?”

He added that these programs are very helpful, “not just in the pharmacy aspect, but the social service of health … A lot of patients will be like, ‘I can’t worry about my health. I gotta feed myself. I gotta get shelter for my family.’ That’s a barrier.”

Limitations included the small sample size and that it was limited to participants in one New York health system, so the results may not be generalizable to other populations.

Factors Influencing Long-Acting PrEP Uptake

The PILLAR study found that a majority of men who have sex with men and transgender men chose long-acting cabotegravir (Apretude) for long-acting PrEP because of convenience and alleviation of adherence concerns and 85% said they were most influenced by their providers.

Convenience was cited by 57% of respondents as a reason for choosing or switching to long-acting PrEP, and not remembering to have to take oral PrEP every day by 54%. Another 51% said not having to worry about missing a dose was a reason.

Most new HIV acquisitions happen in men who have sex with men, the majority of whom are Black and Latino. HIV rates are also higher among transgender people compared with the general U.S. population. Long-acting PrEP, which is delivered via intramuscular injection every 2 months, offers an alternative to daily oral PrEP and has demonstrated superiority in reducing HIV incidence.

In the yearlong PILLAR trial, 201 participants from 17 clinics in multiple states were enrolled from May 2022 to August 2023. Researchers conducted quantitative surveys with all participants and aimed to conduct qualitative interviews with three participants from each clinic.

Most participants were between the ages of 26-49 years, 94% of the overall cohort identified as men who have sex with men, and 6% as transgender men. Overall, 22.9% were Black, 38.8% were Hispanic or Latino, and three-fourths went straight to injectables rather than switching from oral PrEP.

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