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

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.