Online Program

Impact of a pharmacy-based intervention to increase access to use non-occupational post-exposure prophylaxis for HIV prevention among a marginalized population in New York City: The iPEPcare study

Tuesday, November 3, 2015

Alexis Rivera, MPH, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
Abby Rudolph, PhD, PIRE, Calverton, MD
Natalie Crawford, PhD, Epidemiology and Biostatistics, Georgia State University, Atlanta, GA
Silvia Amesty, MD, MPH, MSEd, Center for Family and Community Medicine, Columbia University, College of Physicians and Surgeons, New York, NY
Beena Jani, MD, Farrell Community Health Center, New York, NY
Crystal Fuller, PhD, MPH, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
Background: Uptake of post-exposure prophylaxis (PEP) for non-occupational HIV exposures is low among high-risk populations (excluding men who have sex with men)  We developed a novel pharmacy-based intervention that provides direct access to PEP, forgoing an initial clinic visit. We examined willingness to (1) initiate PEP, and (2) initiate PEP directly acquired from a pharmacy among a vulnerable, low-income population in New York City (NYC).

Methods: Targeted street outreach, word-of-mouth, and pharmacy staff recruitment of syringe customers were used to recruit from high drug use neighborhoods (n=483).  An educational PEP video was viewed and pre-/post-video surveys were conducted to assess PEP willingness. McNemar’s test was used to identify changes in willingness and log-binomial regression was used to determine correlates of (1) willingness to use PEP in general, and (2) willingness to initiate PEP acquired directly from a pharmacy, post-video. 

Results: Among HIV-negative participants (n=410), willingness to use PEP increased significantly post-video (66.8% vs. 95.8%;p<0.0001). After adjustment, those who were willing to take PEP post-video were less likely to be employed (APR: 0.93; 95% CI: 0.87-0.99) and had lower external HIV stigma (APR: 0.99; 95% CI: 0.97-1.0). While willingness to initiate PEP acquired directly from a pharmacy post-video did not differ by correlates explored, the proportion willing to use a pharmacy for direct PEP access significantly increased between pre-, and post-video (76.6% vs. 96.4%;p<0.0001). 

Conclusions: A structural intervention that uses pharmacies to provide PEP without an initial clinic visit may be effective in increasing PEP uptake among a high-risk NYC population.

Learning Areas:

Implementation of health education strategies, interventions and programs

Learning Objectives:
Identify the impact of a pharmacy-based intervention that provides access to post-exposure prophylaxis (PEP) for HIV prevention on willingness to use PEP.

Keyword(s): HIV Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the project director of the study and several other pharmacy-based intervention studies.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.