Pharmacist-managed HIV pre-exposure prophylaxis clinic: Preliminary outcomes from an urban community health clinic

In July 2012, the FDA approved an indication for the use of tenofovir/emtricitabine for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV. However, its ability to prevent HIV is highly dependent on medication adherence, an issue that clinical pharmacists are adept at addressing. A protocol and standing order were developed at the Kansas City CARE Clinic based on guidance from the CDC addressing PrEP eligibility, safety and monitoring requirements, and when to discontinue therapy. Individuals interested in PrEP were screened by general medicine practitioners trained on PrEP and HIV risk assessment. If eligible for therapy, safety labs were ordered and a follow-up visit was scheduled with a clinical pharmacist to discuss lab results and the PrEP Risk Evaluation and Mitigation Strategy. Medication reconciliations were conducted to address potential drug interactions with medication prescribed by outside providers, and adherence counseling was provided to help ensure optimal medication use. Pharmacists conducted follow-up visits to assess adherence and side effects, provide risk reduction counseling, repeat safety labs, and reassess the need for continued therapy. Three months after the implementation of this clinic, twelve patients have been enrolled and eight have begun therapy. Six patients on therapy have obtained medications through patient assistance programs, and two have obtained medications through private insurance. To date, all patients have reported 100% adherence to therapy. A protocol-based, pharmacist-managed HIV PrEP clinic is a feasible service clinical pharmacists can provide in urban ambulatory care settings.