Acceptability and Implementation Considerations for Community Pharmacy–Based Delivery of Pre-Exposure Prophylaxis and Antiretroviral Therapy in Dar es Salaam: A Sequential Explanatory Mixed-Methods Design

Acceptability and Implementation Considerations for Community Pharmacy–Based Delivery of Pre-Exposure Prophylaxis and Antiretroviral Therapy in Dar es Salaam: A Sequential Explanatory Mixed-Methods Design | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Acceptability and Implementation Considerations for Community Pharmacy–Based Delivery of Pre-Exposure Prophylaxis and Antiretroviral Therapy in Dar es Salaam: A Sequential Explanatory Mixed-Methods Design George Msema Bwire, Annabel Itaeli, Japhet Killewo, Christopher R. Sudfeld This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9530938/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 11 You are reading this latest preprint version Abstract Background Community pharmacies (CPs) may provide a decentralized platform for refills of pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART). However, evidence on their acceptability and implementation requirements remains limited. This study assessed the acceptability of using CP for PrEP and ART refills and explored stakeholder perspectives on feasibility to inform potential scale-up in urban Tanzania. Methods A sequential explanatory mixed-methods design study of community pharmacies was conducted in Dar es Salaam, Tanzania. Quantitative surveys were first conducted among women engaged in transactional sex and people living with HIV (PLHIV) to assess the acceptability and feasibility of obtaining PrEP or refilling ART through CPs. These findings then informed qualitative data collection, which included in-depth interviews with women engaged in transactional sex (TS), pharmacists, pharmacy owners, and key informants such as policymakers, as well as focus-group discussions with PLHIV. Qualitative data were analyzed thematically to contextualize and explain the quantitative results. Results Nearly 74.2% of the 93 women engaged in TS expressed willingness to receive PrEP from CPs. Among PLHIV, 66.0% of the 341 participants reported willingness to refill ART at community pharmacies. Across both groups, major concerns included stigma related to HIV status or perceived sexual behavior and potential user fees. Qualitative findings (N = 27) highlighted perceived advantages of pharmacies such as proximity, shorter waiting times, flexible opening hours, and the ability to obtain services discreetly within routine care settings. However, participants emphasized that acceptability would depend on assured confidentiality, free or affordable treatment, private consultation spaces, and specialized HIV training for pharmacy staff. Stakeholders further identified regulatory and financing uncertainties, infrastructure constraints, workforce shortages, medication misuse risks, and the need for digital health record systems as implementation challenges. Conclusions CPs were perceived as promising complementary platforms for PrEP delivery, particularly to improve prevention access among high-risk populations, and for ART refills mainly among stable clients. However, successful integration into national HIV programs will require robust regulatory frameworks, sustainable financing, provider training, and systems to safeguard confidentiality and continuity of care. Implementation research is needed to evaluate feasibility, impact, and safety. Community pharmacies HIV service delivery pre-exposure prophylaxis Antiretroviral therapy Tanzania Background HIV remains a major global public health challenge, with an estimated 39 million people living with HIV worldwide and approximately 1.3 million new infections occurring annually despite major advances in treatment and prevention [ 1 ]. Although large-scale antiretroviral therapy (ART) programs have reduced AIDS-related mortality by more than 60% since 2004, persistent HIV transmission underscores the need to strengthen biomedical prevention strategies alongside treatment scale-up. Global HIV responses increasingly emphasize antiretroviral-based interventions, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), delivered as part of combination prevention approaches [ 2 ]. Oral PrEP can reduce sexual HIV acquisition by up to 99%, while timely PEP is highly effective following sexual or parenteral exposures [ 3 ]. Sub-Saharan Africa continues to experience the greatest burden of HIV, driven by structural barriers such as stigma, limited health system capacity, and inequitable access to services [ 4 ]. In Tanzania, approximately 1.5 million adults are living with HIV, with an estimated annual incidence of 0.18%, corresponding to around 60,000 new infections [ 5 ]. On the other hand, Tanzania has made substantial progress in ART delivery, with 97.9% of diagnosed individuals receiving treatment and 94.3% of those on ART achieving viral suppression [ 6 ]. However, service delivery remains concentrated in public-sector facilities, creating challenges related to long waiting times, transportation costs, and stigma for clients [ 7 ]. These same barriers constrain access to PrEP, which is primarily offered through public facilities and targeted programs, leaving many individuals, particularly those in underserved settings, without convenient prevention options [ 8 ], [ 9 ]. Differentiated service delivery models have been promoted to decentralize HIV treatment and prevention and improve client-centered care [ 10 ], [ 11 ], [ 12 ]. Community pharmacy represents a promising platform for expanding access to PrEP and ART refills because of their wide reach, extended operating hours, and perceived privacy. In Tanzania, these outlets serve nearly 70% of rural and semi-urban populations, and more than 6,000 are registered nationwide [ 13 ]. Expanding pharmacy-based delivery of PrEP and ART services could improve adherence and retention, reduce pressure on overburdened facilities, and strengthen Tanzania’s combination prevention strategy through task sharing with pharmacists [ 14 ]. Leveraging community pharmacies for ART and PrEP delivery has the potential to reduce structural and social barriers, expand reach to underserved populations, and strengthen Tanzania’s combination prevention strategy. This study assessed the acceptability of community pharmacy-based PrEP delivery and ART refills and explored stakeholder perspectives on the feasibility to inform potential scale-up of decentralized HIV prevention and treatment services. Methods Study design and setting This study employed a sequential explanatory mixed-methods design, in which quantitative surveys were first conducted among women engaged in transactional sex and people living with HIV (PLHIV) to assess acceptability to obtain PrEP or refill ART through community pharmacies in the Dar es Salaam Region of Tanzania beginning in September 2025,, followed by qualitative methods to explore experiences, perceptions, and contextual factors influencing feasibility and implementation. Dar es Salaam was selected as the study setting because it is Tanzania’s largest urban center and commercial hub, with rapid urbanization and a high concentration of health service delivery points. According to national census data, the region has a population exceeding five million, representing the largest share of Tanzania’s total population of more than 60 million [ 15 ]. Tanzania’s HIV epidemic is generalized, with an estimated adult HIV prevalence of approximately 4.4%, while Dar es Salaam has a comparable prevalence of about 4.2% [ 5 ]. Evidence from Dar es Salaam indicates that HIV prevalence among females engaged in transactional sex is substantially higher than in the general population, with estimates of approximately 15% [ 16 ]. In addition, an estimated 6,000 females engaged in transactional sex reside in the Dar es Salaam Region [ 17 ]. Study population The primary study populations comprised females engaged in transactional sex, defined as the exchange of sexual services for money, goods, or other material benefits, selected to represent individuals at high risk of HIV acquisition, as well as PLHIV. Eligible females engaged in transactional sex were aged 18 years or older, resided in Dar es Salaam, and reported exchanging sex for money, goods, or material support within the past six months; those unable to provide informed consent were excluded. PLHIV were eligible if they were aged 18 years or older, receiving ART at selected HIV clinics in Dar es Salaam, and willing to participate. [ 16 ][ 17 ]Participants engaged in transactional sex were included in both the cross-sectional quantitative survey and qualitative in-depth interviews (IDIs). PLHIV participated in the quantitative component and focus group discussions (FGDs). To complement these perspectives, community pharmacists, pharmacy owners, and institutional stakeholders involved in HIV prevention, pharmaceutical service delivery, and regulation were included through key informant interviews (KIIs). For females engaged in transactional sex, given the hidden and stigmatized nature of this population and the lack of a formal sampling frame, respondent-driven sampling was used for both the survey and interviews. Initial participants (“seeds”) were identified through community networks and recruited peers until the quantitative sample size and qualitative data saturation were reached. PLHIV were recruited from HIV clinics using a systematic sampling approach. After completion of the quantitative survey, females engaged in transactional sex and PLHIV were subsequently invited to participate in IDIs and FGDs, respectively. For stakeholder perspectives, IDIs were conducted with community pharmacists and pharmacy owners. Purposive sampling was used to recruit these participants, along with other institutional stakeholders involved in HIV prevention, pharmaceutical service delivery, and regulation [ 18 ]. Selection of participants was based on professional roles, experience, and relevance to the implementation of community pharmacy–based PrEP and ART refill services [ 19 ]. Sample size estimation Quantitative sample sizes were calculated using the standard cross-sectional formula \(\:n={Z}^{2}p(1-p)/{E}^{2}\) [ 18 ]. For females engaged in transactional sex, a 95% confidence level (Z = 1.96), a margin of error ( E ) of 10%, and an estimated population of approximately 6,000 females involved in transactional sex in Dar es Salaam [ 17 ], were assumed, yielding a minimum required sample size of 90 participants and a minimum of 340 for PLHIV with a margin of error of 5.5%. For the qualitative component, purposive sampling was used to recruit participants based on their roles, experience, and relevance to community pharmacy–based HIV service delivery, including women engaged in transactional sex, PLHIV, community pharmacists and pharmacy owners in Dar es Salaam, and national and regional policymakers and regulators. The qualitative sample size was guided by the principle of data saturation, with recruitment continuing until no new themes emerged. Data collection process The quantitative questionnaire was developed based on Theoretical Framework of Acceptability, the acceptability–appropriateness–feasibility framework acceptability [ 19 ], [ 20 ], and was further informed by constructs adapted from prior research evidence [ 10 ], [ 12 ], [ 21 ], [ 22 ], [ 23 ]. These frameworks and research evidence guided the inclusion of domains assessing perceived acceptability and feasibility to use pharmacy-based ART and PrEP refill services, and the perceived practicality of implementing such services within community pharmacy settings. Separate structured questionnaires were administered to females engaged in transactional sex and to PLHIV. The PrEP questionnaire, given to females engaged in transactional sex, included items on PrEP awareness, willingness to obtain PrEP from community pharmacies, preferred service characteristics, perceived benefits, concerns such as stigma and cost, and support needs. The ART questionnaire, administered to PLHIV receiving care at HIV clinics, assessed willingness to refill ART at community pharmacies, prior awareness of pharmacy-based ART services, perceived advantages and barriers, service preferences, and desired additional pharmacy-based services ( Supplementary file 1 ). The qualitative component employed semi-structured interviews to explore experiences and contextual factors influencing the acceptability and feasibility of community pharmacy–based PrEP refill services. Separate interview guides were developed for females involved in transactional sex, PLHIV and for key stakeholders (including community pharmacists, pharmacy owners, and institutional representatives). Guides for females engaged in transactional sex and PLHIV explored experiences accessing HIV services, perceptions of pharmacy based PrEP and ART delivery, stigma related concerns, and conditions influencing acceptability, while stakeholder guides included additional probes on regulatory, operational, workforce, infrastructure, financing, and data system considerations. For stakeholders, additional probes explored regulatory, operational, and system-level considerations relevant to pharmacy-based ART and PrEP delivery. The tools were pre-tested with a small sample of participants from a non-study site to assess clarity, comprehension, and acceptability. Based on feedback, minor revisions were made prior to full deployment, including rewording of selected items to improve clarity, simplifying technical terminology related to ART and PrEP, adjusting the sequence of questions to improve flow, and adding brief explanations to Likert-scale response options to enhance participant understanding. Quantitative data were collected using a structured questionnaire administered through the online KoboToolbox platform (Harvard Humanitarian Initiative, Cambridge, MA, USA). Qualitative data were collected through interviews conducted in Kiswahili, the local language, which were audio-recorded and later transcribed verbatim for analysis. Data analysis Data collected using the Kobo Toolbox platform (Harvard Humanitarian Initiative, Cambridge, MA, USA) were exported to Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) for data cleaning and management. Descriptive statistics were employed to summarize all study variables using appropriate measures of central tendency and variability, including means (standard deviation), medians (interquartile range: 25% − 75%), standard deviations, frequencies, and proportions. Variables summarized included sociodemographic characteristics, HIV related service use characteristics, awareness and preferences regarding pharmacy-based PrEP and ART services, and perceived benefits and concerns. Willingness was measured using a 5-point Likert scale and dichotomized as willing (strongly agree/agree) or not willing (neutral/disagree/strongly disagree) [ 24 ]. Chi-square tests were used to assess associations between willingness to obtain PrEP from a community pharmacy and categorical independent variables. These analyses correspond to the assessment of factors associated with willingness presented in Table 1 . Quantitative data were analyzed using R statistical software, with statistical significance set at p < 0.05 [ 25 ]. Table 1 Sociodemographic characteristics of respondents and willingness to receive PrEP through community pharmacy (N = 93). Variable Category Category sample (%) Willing to received PrEP at pharmacy p-value* Yes, n (%) No, n (%) Age (yrs) Mean ± SD: 28.5 ± 6.4 ≤ 22 12 (12.9%) 7 (10.1%) 5 (20.8%) 0.39 23–27 40 (43%) 30 (43.5%) 10 (41.7%) ≥ 28 41 (44.1%) 32 (46.4%) 9 (37.5%) Age at initiation of transactional sex (yrs) Mean ± SD: 25.3 ± 5.4 ≤ 22 26 (28%) 17 (24.6%) 9 (37.5%) 0.31 23–27 43 (46.2%) 35 (50.7%) 8 (33.3%) ≥ 28 24 (25.8%) 17 (24.6%) 7 (29.2%) Duration in sex work (yrs) Median (IQR): 2 (1–4) < 2 37 (39.8%) 27 (39.1%) 10 (41.7%) 1 2–5 41 (44.1%) 31 (44.9%) 10 (41.7%) ≥ 6 15 (16.1%) 11 (15.9%) 4 (16.7%) Average clients per day Median (IQR): 3 (2–5) < 3 40 (43%) 33 (47.8%) 7 (29.2%) 0.11 ≥ 3 53 (57%) 36 (52.2%) 17 (70.8%) Marital status Married 4 (4.3%) 4 (5.8%) 0 (0%) 0.23 Not married 89 (95.7%) 65 (94.2%) 24 (100%) Have children Yes 53 (57%) 41 (59.4%) 12 (50%) 0.42 No 40 (43%) 28 (40.6%) 12 (50%) Employment status Employed 25 (26.9%) 16 (23.2%) 9 (37.5%) 0.17 Not employed 68 (73.1%) 53 (76.8%) 15 (62.5%) Education level No formal education 2 (2.2%) 2 (2.9%) 0 (0%) 0.05 Primary 23 (24.7%) 15 (21.7%) 8 (33.3%) Secondary 48 (51.6%) 37 (53.6%) 11 (45.8%) Diploma 6 (6.5%) 2 (2.9%) 4 (16.7%) Degree or higher 14 (15.1%) 13 (18.8%) 1 (4.2%) Primary work location Street-based 21 (22.6%) 16 (23.2%) 5 (20.8%) 0.99 Brothel 6 (6.5%) 4 (5.8%) 2 (8.3%) Bar/club 30 (32.3%) 22 (31.9%) 8 (33.3%) Hotel/lodge 20 (21.5%) 15 (21.7%) 5 (20.8%) **Others 16 (17.2%) 12 (17.4%) 4 (16.7%) Consistent condom use Always 63 (67.7%) 45 (65.2%) 18 (75%) 0.38 Not always 30 (32.3%) 24 (34.8%) 6 (25%) Experienced violence / coercion Yes 51 (54.8%) 40 (58%) 11 (45.8%) 0.3 No 42 (45.2%) 29 (42%) 13 (54.2%) Other sources of income apart from sex work No 59 (63.4) 46 (66.7%) 13 (54.2%) 0.27 Yes 34 (36.6) 23 (33.3%) 11 (45.8%) Condom use Always 63 (67.7) 45 (65.2%) 18 (75%) 0.38 Not always 30 (32.3) 24 (34.7%) 6 (25%) Time since last HIV test ≤ 2 months 84 (90.3) 61 (88.4%) 23 (95.8%) 0.28 > 2 months 9 (9.7) 8 (11.6%) 1 (4.2%) Ever heard of PrEP No 23 (24.7) 19 (27.5%) 4 (16.7%) 0.29 Yes 70 (75.3) 50 (72.5%) 20 (83.3%) Key: *Chi-square test of association computed for willingness to obtain pre-exposure prophylaxis (PrEP) at pharmacy *Others (e.g., online-based services, private residences, escort agencies, massage parlous or saunas, clients’ homes, and other informal venues For the qualitative component, audio recordings were transcribed verbatim and translated into English before analysis. The qualitative methods were reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines [ 26 ]. Semi structured interview and focus group guides were developed based on the Theoretical Framework of Acceptability and the acceptability, appropriateness, and feasibility framework, as well as findings from the initial quantitative phase. Guides were reviewed by the multidisciplinary research team and piloted at a non study site prior to data collection. Interviews and focus group discussions were conducted in Kiswahili by trained qualitative researchers with prior experience in HIV research and community based data collection. Field notes were taken during and immediately after each interview or discussion to document non verbal cues, contextual observations, and preliminary analytic reflections. Interviews and discussions were conducted in private settings to ensure confidentiality. Thematic analysis was conducted through systematic coding, categorization, and iterative refinement of themes, with illustrative quotations selected to exemplify key findings [ 25 ]. Transcripts were independently reviewed by at least two members of the research team to enhance analytic rigor. An initial coding framework was developed deductively from the interview guides and relevant implementation frameworks, and further refined inductively as new themes emerged from the data. Coding discrepancies were discussed and resolved through consensus. Data management and coding were conducted using qualitative analysis NVivo software [ 27 ]. Recruitment continued until thematic saturation was reached. Results Quantitative findings PrEP refill through community pharmacies The quantitative survey included 93 females engaged in transactional sex. Most participants were aged ≥ 28 years (44.1%), and nearly half initiated transactional sex between 23 and 27 years (46.2%). The majority had 2–5 years of sex work experience (44.1%) and reported ≥ 3 clients per day (57.0%). Most were not married (95.7%), 57.0% had children, 51.6% had completed secondary education (21.6% diploma or higher), and 73.1% were not formally employed. In addition, 67.7% reported consistent condom use and 54.8% had experienced violence or coercion. Overall, 74.2% of participants expressed willingness to receive PrEP at a community pharmacy. Willingness did not differ significantly across most sociodemographic or work-related characteristics (all p > 0.05), except for education level, where higher education was associated with greater willingness (p = 0.047). Table 1 . Participant preferences and concerns about PrEP services Most participants obtained PrEP information from health workers (60.2%). Pharmacies were the preferred PrEP access point for 62.4%, and 80.6% favored refill intervals of two months or longer. Interest in long-acting injectable PrEP was high (77.4%), while most had no preference regarding provider sex (89.2%). Major concerns about pharmacy-based PrEP included fear of being judged (98.9%), cost (58.1%), and stigma or discrimination (49.5%). Convenience was noted by 50.5% of participants, whereas fewer reported worries about medication quality (14.0%) or stockouts (6.5%). Nearly all respondents preferred counselling or support services (98.9%), and 45.2% desired peer support (Table 2 ). Table 2 Participant preferences and concerns about PrEP services through community pharmacy (N = 93). Variable Category n (%) Preferred source of pre-exposure prophylaxis (PrEP) information Health worker 56 (60.2) *Others 37 (39.8) Confidence in understanding PrEP Confident 30 (32.3) Not confident 63 (67.7) Preferred PrEP facility Pharmacy 58 (62.4) Non-pharmacy 35 (37.6) Preferred provider sex Male health worker 10 (10.8) No preference 83 (89.2) Preferred refill frequency Monthly 18 (19.4) ≥ 2 months 75 (80.6) Interest in long-acting injectable PrEP Yes 72 (77.4) No 21 (22.6) Peer support for PrEP Yes 42 (45.2) No 51 (54.8) Preference for counselling/support Yes 92 (98.9) No 1 (1.1) **What are the concerns about PrEP services through community pharmacy? More privacy 22 (23.7) Shorter waiting time 1 (1.1) Convenient location 47 (50.5) Fear of being judged 92 (98.9) Lack of trust in pharmacist 24 (25.8) Medication quality concerns 13 (14) Stockouts 6 (6.5) Cost 54 (58.1) Fear of stigma/ discrimination 46 (49.5) Key: PrEP: pre-exposure prophylaxis *Others (including social media platforms, peers/friends, and community outreach worker **Participant was given an option of tick all apply ART refill through community pharmacies Among the 341 PLHIV included in the analysis, 225 (66.0%) reported willingness to refill ART at a community pharmacy. Willingness differed significantly by sex and prior awareness of pharmacy-based ART services: men were more likely than women to report willingness (p = 0.1). No other demographic, socioeconomic, clinical, or access-related characteristics, including age, marital status, education, employment status, time since HIV diagnosis or ART initiation, clinic travel time, waiting time, medication support systems, or prior refill challenges were significantly associated with willingness (all p > 0.05) Table 3 . Table 3 Participant characteristics and the willingness to refill ART at a community pharmacy (N = 341). Variable Category n (%) Willingness to refill ART at pharmacy p -value* Yes n (%) No n (%) Sex Male 84 (24.6%) 66(29.3%) 18(15.5%) 0.1 Female 257 (75.4%) 159(70.7%) 98(84.4%) Age (years) Median (IQR): 40 (32–47) < 18 2 (0.6%) 2 (0.9%) — 0.46 18–24 29 (8.5%) 20 (8.9%) 9 (7.8%) 25–34 75 (22%) 48 (21.3%) 27(23.3%) 35–44 110 (32.3%) 71 (31.6%) 39(33.6%) 45–54 82 (24%) 57 (25.3%) 25(21.6%) ≥ 55 41 (12%) 27 (12%) 14 (12%) Time since HIV diagnosis (years) Median (IQR): 6 (4–10) 5 years 194 (56.9%) 123(54.7%) 71(61.2%) Marital status Single 84 (24.6%) 58 (25.8%) 26(22.4%) 0.23 Married 179 (52.5%) 121(53.8%) 58(50%) Divorced/Separated 53 (15.5%) 34 (15.1%) 19(16.4%) Widowed 25 (7.3%) 12 (5.3%) 13(11.2%) Have children Yes 293 (85.9%) 197(87.6%) 96(82.8%) 0.23 No 48 (14.1%) 28 (12.4%) 20(17.2%) Employment status Employed 74 (21.7%) 55 (24.4%) 19(16.4%) 0.20 Not employed 72 (21.1%) 44 (19.6%) 28(24.1%) Self-employed 195 (57.2%) 126 (56%) 69(59.5%) Highest education level No formal education 7 (2.1%) 4 (1.8%) 3 (2.6%) 0.94 Primary 186 (54.5%) 121(53.8%) 65(56%) Secondary 121 (35.5%) 82 (36.4%) 39(33.6%) Diploma 17 (5%) 12 (5.3%) 5 (4.3%) Degree or higher 10 (2.9%) 6 (2.7%) 4 (3.4%) Current ARV refill location Public facility 164 (48.1%) 102(45.3%) 62(53.4%) 0.16 Private facility 177 (51.9%) 123(54.7%) 54(46.6%) Time to reach clinic (minutes) Median (IQR): 45 (30–60) < 30 52 (15.2%) 28(12.4%) 24(%) 0.13 30–60 229 (67.2%) 157(69.8%) 72(%) ≥ 60 60 (17.6%) 40(17.8%) 20(%) Time spent at clinic (minutes) Median (IQR): 30 (20–45) < 120 306 (89.7%) 201(89.3%) 105(90.5%) 0.73 ≥ 120 35 (10.3%) 24(10.7%) 11(9.5%) Medication reminder/support Self 266 (78%) 175(77.8%) 91(78.4%) 0.91 Partner 29 (8.5%) 18(8%) 11(9.5%) Family 34 (10%) 24(10.7%) 10(8.6%) Peer/Support group 12 (3.5%) 8 (3.6%) 4 (3.4%) Ever missed ART refill due to clinic challenges Yes 7 (2.1%) 6 (2.7%) 1(0.9%) 0.27 No 334 (97.9%) 219 (97.3%) 115 (99.1%) Key: ART: Antiretroviral therapy IQR: Interquartile range *: Chi-square test Awareness, perceived benefits, and concerns regarding pharmacy-based ART services A total of 341 PLHIV completed questions on awareness, perceived benefits, concerns, and preferences regarding community pharmacy–based ART services. Only 14.7% had previously heard of pharmacy-based ART services, and none had ever received ART from a private pharmacy. Nevertheless, respondents frequently identified practical advantages, including shorter waiting times (63.6%), reduced transportation costs (62.8%), and proximity to home (52.8%). Concerns were common, particularly fear of stigma (74.8%) and confidentiality (61.3%), while approximately one-quarter cited high cost or worries about medication quality. Apprehension about pharmacist expertise (7.0%) and record-keeping (1.2%) were uncommon. Acceptance of long-acting injectable ART was high (91.8%). Interest in additional pharmacy-based services was also substantial, especially general health screening (60.7%) and adherence counseling (57.8%) Table 4 . Table 4 Awareness, experience, perceived benefits, concerns, and preferences regarding community pharmacy–based ART services (N = 341). Variable Category / response n (%) Awareness and experience Heard of pharmacy-based ART services Yes 50 (14.7%) Ever received ART from a private pharmacy Yes 0 (0.0%) *Perceived benefits of receiving ART from a community pharmacy Greater privacy/confidentiality Selected 14 (4.1%) Close to home Selected 180 (52.8%) Shorter waiting time Selected 217 (63.6%) Longer/flexible opening hours Selected 83 (24.3%) Reduced transportation costs Selected 214 (62.8%) Convenience Selected 15 (4.4%) Friendly staff Selected 3 (0.9%) *Concerns and barriers regarding pharmacy-based ART Fear of stigma or being identified Selected 255 (74.8%) High cost of services or medicines Selected 78 (22.9%) Drug stock-outs / unreliable supply Selected 43 (12.6%) Concerns about drug quality Selected 79 (23.2%) Pharmacist lacks HIV expertise Selected 24 (7.0%) Confidentiality not assured Selected 209 (61.3%) Poor record-keeping Selected 4 (1.2%) Would accept long-acting injectable ART (every six month)? Yes 313 (91.8%) No 28 (8.2%) *Other services desired at the pharmacy HIV testing and counseling 70 (20.5%) Treatment adherence counseling 197 (57.8%) Sexual and reproductive health services 112 (32.8%) Sexually transmitted infection testing 122 (35.8%) General health screening 207 (60.7%) *Participant was requested to tick all apply Qualitative findings Overview of qualitative participants In total 27 participants were interviewed, the qualitative dataset comprised 7 IDIs with women engaged in transactional sex, 6 IDIs with pharmacists and pharmacy owners, 2 KIIs with policymakers and regulators, and 3 FGDs with PLHIV. Women engaged in transactional sex were interviewed to assess the acceptability of pharmacy-based PrEP delivery; PLHIV participated in FGDs to explore perceptions of ART refills in community pharmacies; pharmacists and pharmacy owners were interviewed to identify operational and infrastructural requirements for implementation; and policymakers were interviewed to examine the regulatory and policy context governing community-based HIV service delivery. Across all qualitative participants, ages ranged from 22 to 52 years, with an overall median age of 32 years (IQR: 27–38). Among women engaged in transactional sex (n = 7), the mean age was 26.7 years (SD 4.2); all were female, the median number of children was one (range 0–1), and three reported current PrEP use while four had never used PrEP. People living with HIV who participated in FGDs (n = 12) had a mean age of 36.1 years (SD 8.4); ten were female and two males, with a median time on ART of five years (IQR: 3–8). Five reported community pharmacies as their first point of contact for care, while seven primarily used health facilities or hospitals. Pharmacists and health-system stakeholders interviewed through IDIs (n = 7) had a mean age of 32.0 years (SD 3.3); five were male and two females, and the median duration of professional experience was six years (IQR: 5–9), with two reporting direct involvement in HIV service delivery. Key informants and policymakers (n = 2) had a mean age of 44 years; one was male and one female, and their median professional experience was seven years ( Supplementary file 2) . Acceptability of PrEP refills at community pharmacies Analysis of interviews with women engaged in transactional sex identified six major themes and eighteen sub-themes related to the acceptability of PrEP delivery through community pharmacies. Overall, participants largely viewed community pharmacies as an acceptable and often preferable setting for PrEP provision compared with hospitals. Pharmacies were valued for their accessibility, shorter waiting times, discretion, and lower perceived costs, which were seen as reducing fears of stigma and unwanted disclosure. However, acceptability was highly conditional on several safeguards. Participants highlighted the need for improved training of pharmacy staff, availability of private counselling spaces, clear and targeted health education for sex workers, and deliberate efforts to dispel misconceptions surrounding PrEP. In the absence of these measures, mistrust in providers, fear of judgment, and persistent misinformation were perceived as likely to undermine uptake and limit the effectiveness of pharmacy-based PrEP delivery models ( Table 5 ). Acceptability of ART refills at community pharmacies Analysis of the focus-group discussions with PLHIV identified eight major themes and twenty-two sub-themes regarding the acceptability of ART refills at community pharmacies among people living with HIV. Participants highlighted potential advantages such as reduced travel distance, shorter waiting times, flexible pharmacy opening hours, and access during emergencies. However, strong concerns emerged around stigma, breaches of confidentiality, possible user fees, and the perceived lack of HIV-specific expertise among pharmacy staff. Hospitals were widely trusted for providing counselling, psychosocial support, and clinical monitoring. Overall, willingness to use community pharmacies was mixed. Participants emphasized that acceptability would depend on ART remaining free of charge, the availability of private and discreet dispensing areas, and the presence of specially trained personnel capable of maintaining confidentiality and providing appropriate clinical support. Without these safeguards, most participants preferred to continue obtaining ART through hospital-based services (Table 6 ). Table 5 Perceived acceptability of community pharmacy–based ART refills among people living with HIV Theme Sub-themes Representative quotes Perceived convenience and proximity of pharmacies • Shorter waiting times • Easier geographic access • Avoidance of hospital queues “It would be good, because many people fear hospitals because of the long processes and queues. Someone asks themselves, ‘Should I go and line up?’ and ends up not going. Pharmacies, however, are much easier to reach for people who avoid clinics.” — IDI 01, Female, 27 years “You cannot walk two streets without finding a pharmacy, but hospitals are far. If services move closer to people, many more women will be reached.” — IDI 07, Female, 27 years Privacy and reduced stigma in pharmacy settings • Fear of being labelled at hospitals • Discreet encounters • Avoidance of HIV-specific clinics “In government hospitals the HIV section is known. If you go there just for prevention, people already start thinking you are infected. At pharmacies you feel more private and less watched.” — IDI 03, Female, 34 years “Going to hospital makes me afraid that people will think I am taking ARVs, but at the pharmacy it feels normal—you just pick medicine and leave.” — IDI 06, Female, 30 years Affordability and comfort compared with hospitals • Lower perceived costs • Flexible spending • Feeling physically and socially comfortable “Hospitals are expensive because you have to pay to see a doctor, but at pharmacies even with a small amount of money you can still go and buy medicine.” — IDI 04, Female, 23 years “If PrEP comes to shops around us, it becomes easier and increases confidence, because people fear HIV clinics. In pharmacies no one questions you about what the medicine is for.” — IDI 05, Female, 22 years Need for education and sensitization • Training for sex workers • Counselling skills • Awareness campaigns “Education is the biggest issue. You must hold seminars and explain to sex workers clearly, because without understanding people become afraid to use these medicines.” — IDI 01, Female, 27 years “Pharmacies should also have trained people who can explain these drugs properly, just as you explained to me today, so women know what they are taking.” — IDI 06, Female, 30 years Concerns about pharmacy staff competence • Risk of wrong medication • Limited HIV-specific knowledge • Loss of trust “When you talk about pharmacies, they must first be given education. If they are trained well, they will understand these drugs better. Without that training, clients will not trust them to give correct advice.” — IDI 07, Female, 27 years “I once went for ear pain and was given drugs meant for menstrual cramps. Another pharmacy corrected it, but that experience made me fear what damage the first medicines might have caused.” — IDI 03, Female, 34 years Fear and misconceptions about PrEP • Rumors about weakened immunity • Association with HIV infection • Internalized stigma “People fail to use PrEP because taking daily tablets feels like accepting that you are infected. Many have not accepted themselves and fear being judged.” — IDI 07, Female, 27 years “Some people told me that PrEP weakens your immunity, and because of that advice I hesitated to start using it.” — IDI 01, Female, 27 years Key : IDI: Participant who participated in in-depth interview plus the identification number assigned during an interview PrEP: Pre-exposure prophylaxis Barriers and facilitators to community pharmacy delivery of ART and PrEP Across the analysis, nine major themes comprising multiple interrelated sub-themes were identified (Table 7 ). Overall, participants perceived community pharmacies as promising platforms for decentralized ART and PrEP delivery, particularly because of their accessibility and potential to reduce stigma. However, this optimism was consistently balanced by concerns related to operational readiness, especially issues surrounding medicine misuse, incomplete dosing, and the need for strong counselling and monitoring systems. Table 6 Facilitators, barriers, and conditions for implementing ART refills at community pharmacies from in-depth and key informant interviews Theme Sub-themes Representative quotes Perceived convenience of community pharmacies • Reduced travel distance • Avoiding long clinic queues • Flexible opening hours “When we hear about collecting medicines from pharmacies, we feel relieved because it would reduce the long queues at hospitals. Sometimes you arrive at noon, and you are told the fingerprint machine is not working or the network is down, and you end up staying there for hours. Even if you came early, you still leave late. That is why when we hear about pharmacies, we feel happy.” — FGD17 , Female, 33 years “I could even go late at night because some pharmacies operate 24 hours. That would really help me, because I plan my time around my small business. At hospitals, if you arrive late you might be punished by being told to come back the next day, but at pharmacies I feel I could go at a time that suits me.” — FGD13 , Female, 35 years Use of pharmacies for emergencies or travel • Sudden travel • Distance from health facilities “If a funeral suddenly happens and I must travel the same night, and the health facility is far away, I cannot manage to go back to the clinic. I would just go to a pharmacy, get my medicines, and continue with the journey instead of missing my dose.” — FGD08 , Female, 25 years Fear of stigma and breach of confidentiality • Being recognized by neighbors • Gossip • Distrust of pharmacy staff “Honestly, I am afraid. My fear comes from secrecy and stigma. Pharmacies are in the same neighborhood where we live. If you meet a neighbor’s child there, that child might go and tell their mother, and the story spreads from one person to another. Even if nobody says anything directly, you keep worrying that people already know about you.” — FGD14 , Female, 28 years “The pharmacy is different from the hospital because it is surrounded by the community. You might go there and ask for medicine, and people sit watching you. The attendants are young nurses who are still learning, and you fear they might start talking about you. For me, I completely disagree with using pharmacies for this reason.” — FGD18 , Female, 41 years Concern about potential user fees • Pharmacies seen as businesses • Fear ART will no longer be free “Once medicines start being provided in pharmacies it becomes business. You cannot go there without money. Even Panadol is not given for free, so what about these tablets? At hospitals we get them free, but in pharmacies they will start selling them, and that will really affect us.” — FGD15 , Female, 45 years “These drugs are currently free at health facilities, but when you talk about pharmacies it means trade will start. Someone must make profit. That means we who are used to free treatment will face serious challenges.” — FGD12 , Male, 31 years Trust in hospital-based care • Counselling and peer support • Familiar providers • Clinical monitoring “At the hospital there are many services. We get weighed, tested, counselled, and we meet other patients who encourage each other. The nurses there already know us. In pharmacies I would just go, pick the drugs, and leave while feeling afraid, but at hospital I feel free.” — FGD11 , Female, 40 years Concerns about provider competence in pharmacies • HIV-specific training • Ability to manage side-effects • Quality of follow-up “I have changed treatment more than five times because of side-effects. When I went to a doctor who knew my history, he changed my regimen and the problem stopped. Now I worry that if I go to a pharmacy, the person there might not understand these issues the way clinicians at the hospital do.” — FGD13 , Female, 35 years Conditional willingness to use pharmacies • Free ART • Confidentiality safeguards • Trained staff “If the issue of payment was removed and privacy was properly protected, then I could accept going to a pharmacy. But if I still have to pay transport and also buy the medicines, and people can see me there, then it becomes difficult.” — FGD12 , Male, 31 years Suggested safeguards for implementation • Private consultation rooms • Dedicated ART providers • Discreet refill procedures “There should be a separate private room. I enter there and meet a nurse who is trained in this service, we talk privately, I show my card, get my medicines, put them in my bag, and leave. No one else should be able to see or hear what is happening inside.” — FGD16 , Male, 38 years Key : ART: Antiretroviral therapy FGD: Participant who participated in focused group discussion plus the identification number assigned during an interview Table 7 . Facilitators, barriers, and conditions for implementing ART refills at community pharmacies from in-depth and key informant interviews Theme Sub-themes Representative Quotes Accessibility and public-health value of pharmacy-based ART/PrEP • Proximity and timesaving • Reduced congestion at clinics • Demand for PEP/PrEP in communities “Nowadays when many people fall sick, instead of going to hospitals they first look for immediate help… so if ARVs or PrEP services were available in our pharmacies, the first benefit would be accessibility—people would be able to get services easily without wasting time.” — IDI12, Male, 32 years “If these services were available in pharmacies, it would be much easier for anyone… community pharmacies are many compared to health facilities.” — IDI13, Female, 38 years Risk of misuse and need for strong dispensing controls • Diversion to animals • Fabricated exposure stories • Partial dosing “Some people have been using ARVs to feed livestock… a person may come and fabricate a story just to request PrEP… you cannot know how it will be used.” — IDI10, Male, 30 years “Many people do not complete the dose… they keep the remaining pills or give them to someone else without considering the expiry date.” — IDI10, Male, 30 years Regulatory and financing uncertainty • Price regulation vs free provision • Government reimbursement • Sustainability beyond pilots “No businessperson likes someone to enter their shop and take something for free… there has to be a way for them to benefit…” — IDI10, Male, 30 years “A client may come for ARVs or PrEP, but they are also customers… they may come for this service and also get other services there in the pharmacy” — IDI14, Male, 37 years “Government could exempt some of these fees for private pharmacies… so they cover the costs they thought they would use when providing services to HIV clients.” — KII01, Male, 45 years Infrastructure limitations for confidential care • Lack of private rooms • Open counters • Confidentiality risks “If you begin an assessment, you may find that 90% of pharmacies do not even have a private room… the main issue is infrastructure.” — IDI11, Male, 31 years “Most community pharmacies were not designed to have a special room… ARV services require a high level of confidentiality.” — IDI08, Male, 28 years Workforce shortages and workload pressures • Few staff per shift • Time-intensive counselling • Business disruption “During one shift there is usually only one person… there are ordinary customers and those seeking PEP or ART… that other client needs more time.” — IDI13, Female, 30 years “An ARV client may take five or ten minutes… that affects business and customer flow.” — IDI08, Male, 28 years Training and competency requirements • Knowledge gaps • Counselling skills • Documentation “You may find that we hire a young person straight from college who has never provided ARV services… they really need adequate training.” — IDI12, Male, 32 years “Service providers need more training, especially on confidentiality and on giving proper counselling.” — IDI08, Male, 28 years Digital systems and data integration • Harmonized software • National interoperability • Reporting systems “A patient may be served in Dar es Salaam and then later in Mwanza that pharmacy should be able to see what medicines were collected… there must be a nationwide system.” — IDI09, Female, 36 years “The systems used in pharmacies must be interoperable; otherwise, confusion will arise in the records.” — IDI08, Male, 28 years Client selection, referral and supply chains • Stable-patient criteria • Referral mechanisms • Facility-linked supply “There must be a proper mechanism… even if a patient goes to another pharmacy the records should be visible so that patients are properly followed up.” — IDI09, Female, 36 years Stigma reduction through integrated service delivery • Normalizing HIV care • Patient choice • Mixed-service settings “Providing these services in pharmacies would reduce waiting times and queues… and people may feel more comfortable than going to specialized HIV clinics.” — IDI08, Male, 28 years Key : ART: Antiretroviral therapy ARVs: Antiretrovirals IDI: Participant who participated in in-depth interview plus the identification number assigned during an interview KII: Participant who participated in key-informant interview plus the identification number assigned during an interview PEP: Post-exposure prophylaxis PrEP: Pre-exposure prophylaxis Structural and organizational constraints also featured prominently, with recurring sub-themes relating to limited staffing, heavy workloads, and inadequate private spaces for confidential consultations. At the system level, participants repeatedly pointed to regulatory oversight, financing arrangements, and interoperable digital platforms as prerequisites for safe implementation. Collectively, these patterns suggest that while the policy environment is generally supportive, successful scale-up will depend on addressing a small set of foundational challenges related to workforce capacity, infrastructure, financing, and data integration. Discussion This mixed methods study demonstrates substantial but conditional support for decentralizing HIV prevention and treatment services to community pharmacies. Quantitatively, a large proportion of women engaged in transactional sex were willing to obtain PrEP through pharmacies, while a smaller but still notable proportion of people living with HIV were willing to refill ART in these settings. Qualitative findings helped explain these patterns by showing that pharmacies were widely perceived as convenient and accessible because of their proximity, shorter waiting times, and flexible hours, but concerns related to stigma, confidentiality, potential costs, and provider competence strongly shaped acceptability. Participants emphasized that pharmacy-based HIV service delivery would only be acceptable if key safeguards were in place, including trained staff, private consultation spaces, reliable supply systems, and maintenance of free or affordable treatment. Stakeholders further highlighted important implementation challenges, such as infrastructure limitations, workforce capacity constraints, regulatory and financing uncertainties, risks of medication misuse, and the need for interoperable digital health records. Together, these findings suggest that while community pharmacies are viewed as promising complementary platforms for HIV service delivery, successful integration will depend on addressing both individual level acceptability concerns and broader health system readiness factors. Among women at high risk of HIV infection, nearly three-quarters expressed willingness to receive PrEP from community pharmacies, and pharmacies were the most preferred access point for PrEP services. This aligns with qualitative findings in which women consistently emphasized proximity, shorter waiting times, and reduced visibility compared with hospital-based HIV clinics. These features are particularly salient for populations facing stigma and time constraints, suggesting that pharmacy-based models could lower structural barriers to PrEP continuation and refill adherence [ 10 ], [ 28 ].Notably, willingness to receive PrEP at pharmacies did not vary by most sociodemographic or work-related characteristics, indicating broad acceptability across subgroups of sex workers. Education level was the only factor associated with willingness, with higher education linked to greater acceptance, pointing to the potential role of health literacy in shaping confidence in decentralized models. This is reinforced by the high proportion of participants reporting limited confidence in their understanding of PrEP and the near-universal desire for counselling and support services. Together, these findings underscore that pharmacy-based PrEP delivery cannot be limited to drug dispensing alone, but must incorporate structured education, adherence counselling, and possibly peer-support mechanisms [ 28 ]. Despite overall positive acceptability, women engaged in transactional sex reported persistent stigma-related concerns, including fears of recognition, disclosure, and negative attitudes from pharmacy staff, which were also reflected in the quantitative findings. Similar concerns have been reported in studies of pharmacy-based PrEP delivery, which show that while pharmacies reduce structural barriers such as distance and waiting time, they do not automatically eliminate stigma, particularly for populations at elevated risk of acquiring HIV infection [ 14 ], [ 29 ]. Our findings reinforce this evidence by showing that stigma is closely linked to trust in provider competence, confidentiality, and privacy. This suggests that pharmacies may only reduce stigma if services are delivered with trained staff, private consultation spaces, and strong confidentiality safeguards; otherwise, decentralization risks reproducing barriers seen in facility-based HIV care. Despite enthusiasm, women expressed strong fears of being judged, stigma, and discrimination in pharmacy settings concerns echoed almost universally in the quantitative survey. Qualitative narratives further illustrated how misinformation about PrEP, mistrust of pharmacy staff, and previous negative experiences with medication dispensing could undermine uptake. These concerns indicate that pharmacies may only reduce stigma if staff are appropriately trained and services are delivered discreetly, otherwise, they risk reproducing the same barriers encountered in facility-based care [ 29 ]. For ART services, two thirds of PLHIV reported willingness to refill medications at community pharmacies, suggesting moderate but not universal readiness for decentralized refill models. Men and individuals previously aware of pharmacy-based ART services were significantly more willing, highlighting the importance of sensitization and communication in shaping acceptance. Notably, quantitative results showed no association between willingness and access-related factors such as travel time or waiting time, which contrasts with qualitative findings, in which participants strongly emphasized convenience as a key perceived benefit. This difference suggests that while convenience is widely recognized in principle, decisions to use pharmacy-based ART refills may be driven more by concerns about confidentiality, cost, and trust in provider competence than by logistical barriers alone. Similar patterns have been reported in prior studies, which found that although community pharmacy ART models improve access, patient uptake is often constrained by stigma concerns and the perceived need for clinical monitoring and counselling provided in facility-based care [ 10 ], [ 12 ], [ 28 ], [ 30 ]. Qualitative findings revealed more ambivalence toward pharmacy-based ART refills than toward PrEP delivery. While participants appreciated pharmacies for emergencies, travel, and flexible hours, hospitals remained the preferred sites for routine HIV care because of trusted provider relationships, comprehensive counselling, psychosocial support, and ongoing clinical monitoring. Similar concerns have been reported in community pharmacy ART models in Nigeria and South Africa, where patients valued convenience but still perceived facilities as offering more comprehensive and specialised HIV care [ 10 ], [ 12 ], [ 31 ]. Studies have also highlighted confidentiality concerns and uncertainty about pharmacist expertise as barriers to uptake of decentralised ART services [ 28 ], [ 30 ]. However, compared to some implementation studies that demonstrated high retention and patient satisfaction after enrolment into pharmacy ART refill programs [ 12 ], our findings reflect perspectives prior to large-scale implementation. This difference may explain the greater ambivalence observed in our study, as participants were reacting to a hypothetical model rather than drawing on direct experience. In addition, in Tanzania, ART is universally provided free of charge in public facilities, which may heighten concerns about potential commodification in private retail settings. This context-specific financing concern appears to shape acceptance more strongly than in settings where pharmacy-based ART models are already integrated within publicly funded systems. Across stakeholder groups, several cross-cutting implementation challenges were identified, particularly infrastructure limitations, workforce shortages, and gaps in HIV specific training. Similar barriers have been documented in studies of pharmacy-based HIV service delivery in sub-Saharan Africa, where inadequate private space, limited staffing, and insufficient clinical training were found to constrain the quality and confidentiality of HIV care provided in retail settings [ 13 ], [ 31 ]. Evidence from implemented pharmacy ART models suggests that these challenges can be mitigated through targeted strategies, including formal certification and training programs for pharmacists, integration of standardized dispensing and counselling protocols, and establishment of clear referral linkages with health facilities [ 10 ], [ 12 ]. Concerns about medication diversion and inappropriate use also align with prior literature highlighting the need for strong regulatory oversight and monitoring systems when decentralizing ART to private sector outlets [ 23 ],[ 31 ]. Studies further emphasize the importance of interoperable digital health records to support continuity of care, track refills, and prevent duplication or misuse across multiple dispensing sites. Together, these findings suggest that successful scale up of pharmacy-based HIV service delivery will depend less on patient demand alone and more on strengthening regulatory, training, and health system integration mechanisms that ensure safe and accountable implementation. Importantly, both women engaged in transactional sex and people living with HIV, as well as some pharmacists and policymakers, viewed pharmacies as having the potential to normalize HIV prevention and treatment by embedding these services within routine healthcare encounters, as described elsewhere [34], [35]. This “integration effect” was perceived as a possible stigma-reduction mechanism, provided confidentiality is preserved and clients retain the option to choose between facilities and pharmacies. Such findings suggest that community pharmacies may function best as complementary refill points for stable clients rather than full substitutes for facility-based HIV care. Limitations This study has several limitations. Expressed willingness to use pharmacy-based PrEP or ART services may not reflect actual uptake once implemented. Findings relied on self-reported data and may be influenced by social desirability bias, particularly for sensitive topics such as HIV status, sex work, and stigma. The quantitative PrEP sample was relatively small, reducing statistical power and generalizability, while qualitative participants were purposively selected and limited in number, especially policymakers and pharmacists, potentially restricting the diversity of perspectives captured. The study was conducted within an urban context, which may limit transferability to other settings, especially rural and semi-urban areas. Finally, the study did not include economic analyses or objective assessments of pharmacy readiness, infrastructure, or staffing, which are critical for informing large-scale implementation. Conclusions This study demonstrates substantial but differentiated acceptability of community pharmacy–based HIV service delivery. Interest was high for PrEP delivery among women engaged in transactional sex, reflecting the perceived benefits of convenience, accessibility, and reduced structural barriers. In contrast, the acceptability of pharmacy-based ART refills among people living with HIV was more moderate. While pharmacies were recognized as convenient for emergencies and travel, many participants preferred to continue routine ART care in health facilities due to trusted provider relationships, counselling support, and concerns about confidentiality and potential costs. Across both groups, acceptability was highly conditional and depended on assured confidentiality, maintenance of free or affordable medication, trained pharmacy personnel, and private consultation spaces. Stakeholders further identified workforce capacity, infrastructure readiness, regulatory oversight, digital health integration, and sustainable financing as key determinants of feasibility. Taken together, these findings suggest that community pharmacies are most likely to function as complementary platforms, particularly for expanding PrEP access and providing ART refills for stable clients, rather than as full substitutes for comprehensive facility-based HIV care. Further implementation research and pilot evaluations are needed to assess real world uptake, cost effectiveness, and long-term clinical outcomes. Abbreviations ART Antiretroviral therapy CP Community pharmacy FGD Focus group discussion HIV Human Immunodeficiency Virus IDI In-depth interview KII Key informant interview PEP Post-exposure prophylaxis PLHIV People living with HIV PrEP Pre-exposure prophylaxis. Declarations Ethics approval and consent to participate Ethical approval for this study was obtained from the Muhimbili University of Health and Allied Sciences Research Ethics Committee (Ref No. MUHAS-REC-07-2025-3022) and the National Institute for Medical Research through the Dar es Salaam Urban Cohort Study platform (Ref No. NIMR/HQ/Vol.1/3047). Administrative permission to collect data in Dar es Salaam and access the HIV clinics was obtained from the Prime Minister’s Office–Regional Administration and Local Government and the Dar es Salaam Regional Administrative Secretariat. All participants provided written informed consent prior to enrollment. The study was conducted in accordance with the principles of the Declaration of Helsinki. Consent for publication Not applicable Availability of data and materials The data that support the findings of this study are available from the corresponding author, upon reasonable request. Competing interest Authors have no competing interest to declare. Funding Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under Award Number D43 TW0010543. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Authors contribution GMB contributed to the conceptualization and design of the study, data collection, data analysis, and drafting of the manuscript. AI contributed to data analysis. JK and CRS contributed to the conceptualization of the study and critically revised the manuscript for important intellectual content. All authors reviewed and approved the final version of the manuscript. Acknowledgments Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health through Award Number 5D43TW010543-09, the HBNU Fogarty Global Health Training Program, and a sub-award from the University of California, San Francisco under Award Number 3D43TW009343-14S3. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. References Global HIV & AIDS statistics — Fact sheet, “UNAIDS,” 2024. Accessed: Nov. 21, 2025. [Online]. Available: https://www.unaids.org/en/resources/fact-sheet V. Sundareshan, H. M. Swinkels, A. D. Nguyen, R. Mangat, and J. Koirala, Preexposure Prophylaxis for HIV Prevention . 2025. WHO, “Guidelines for HIV post-exposure prophylaxis,” 2024. Accessed: Dec. 31, 2025. [Online]. Available: https://www.who.int/publications/i/item/9789240095137 L. 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Supplementary Files Supplementaryfile1questionnaires.docx Supplementaryfile2.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 15 May, 2026 Reviewers agreed at journal 13 May, 2026 Reviews received at journal 11 May, 2026 Reviews received at journal 08 May, 2026 Reviewers agreed at journal 02 May, 2026 Reviewers agreed at journal 02 May, 2026 Reviewers invited by journal 30 Apr, 2026 Editor assigned by journal 30 Apr, 2026 Editor invited by journal 29 Apr, 2026 Submission checks completed at journal 28 Apr, 2026 First submitted to journal 28 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9530938","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":635350787,"identity":"363a50be-5868-4166-b29c-a15c8ddf0ae5","order_by":0,"name":"George Msema Bwire","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYPCCAwxsDAyMD4AsHj5StDAbgLSwEa0FCNgkwCQhtfLuzcc+fqm4k9gnffhY5dccOxk2BuaHj27g0WJ45ljybJkzzxLb+NLSbstuSwY6jM3YOAeflhk5xsySbYdz23h4zG5LbmMGauFhk8arZf4boJZ/IC3834olt9UT1iIvwWPM+LEBbAsb48dthwlrMeBJS2ZmOPasvo2HzViacdtxHjZmAn6Rbz98mPFHzR1j+R7mhx9/bqu252dvfvgYry0HgFHIA+VAGMx4lINtaQAmlB9QDpwxCkbBKBgFowAZAAAwh0VLCFyNnQAAAABJRU5ErkJggg==","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":true,"prefix":"","firstName":"George","middleName":"Msema","lastName":"Bwire","suffix":""},{"id":635350788,"identity":"452775b3-8fc1-4794-8ba9-5bd54a901cca","order_by":1,"name":"Annabel Itaeli","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Annabel","middleName":"","lastName":"Itaeli","suffix":""},{"id":635350789,"identity":"0e6db141-d820-4329-8a0d-0967357707ea","order_by":2,"name":"Japhet Killewo","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Japhet","middleName":"","lastName":"Killewo","suffix":""},{"id":635350790,"identity":"62c72d67-dbb7-49d2-bbc7-1fb8fb887267","order_by":3,"name":"Christopher R. Sudfeld","email":"","orcid":"","institution":"Harvard T.H. Chan School of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Christopher","middleName":"R.","lastName":"Sudfeld","suffix":""}],"badges":[],"createdAt":"2026-04-26 09:53:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9530938/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9530938/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109085434,"identity":"09d21022-60b1-4679-ae2b-e4415cc9d3ba","added_by":"auto","created_at":"2026-05-12 13:07:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":773147,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9530938/v1/27b8f2fa-824b-43c6-b03a-a6093fbf9650.pdf"},{"id":109082680,"identity":"c8a0932a-01e0-4d55-9421-fc73d815bd5d","added_by":"auto","created_at":"2026-05-12 12:42:29","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":27760,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile1questionnaires.docx","url":"https://assets-eu.researchsquare.com/files/rs-9530938/v1/952e500a4322b834e8b6878a.docx"},{"id":109082821,"identity":"11d37a50-409f-4035-bad8-743e395e10d6","added_by":"auto","created_at":"2026-05-12 12:43:58","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23518,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-9530938/v1/70be5e894d0f049675873d6c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Acceptability and Implementation Considerations for Community Pharmacy–Based Delivery of Pre-Exposure Prophylaxis and Antiretroviral Therapy in Dar es Salaam: A Sequential Explanatory Mixed-Methods Design","fulltext":[{"header":"Background","content":"\u003cp\u003eHIV remains a major global public health challenge, with an estimated 39\u0026nbsp;million people living with HIV worldwide and approximately 1.3\u0026nbsp;million new infections occurring annually despite major advances in treatment and prevention [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although large-scale antiretroviral therapy (ART) programs have reduced AIDS-related mortality by more than 60% since 2004, persistent HIV transmission underscores the need to strengthen biomedical prevention strategies alongside treatment scale-up. Global HIV responses increasingly emphasize antiretroviral-based interventions, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), delivered as part of combination prevention approaches [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Oral PrEP can reduce sexual HIV acquisition by up to 99%, while timely PEP is highly effective following sexual or parenteral exposures [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSub-Saharan Africa continues to experience the greatest burden of HIV, driven by structural barriers such as stigma, limited health system capacity, and inequitable access to services [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In Tanzania, approximately 1.5\u0026nbsp;million adults are living with HIV, with an estimated annual incidence of 0.18%, corresponding to around 60,000 new infections [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. On the other hand, Tanzania has made substantial progress in ART delivery, with 97.9% of diagnosed individuals receiving treatment and 94.3% of those on ART achieving viral suppression [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, service delivery remains concentrated in public-sector facilities, creating challenges related to long waiting times, transportation costs, and stigma for clients [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These same barriers constrain access to PrEP, which is primarily offered through public facilities and targeted programs, leaving many individuals, particularly those in underserved settings, without convenient prevention options [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDifferentiated service delivery models have been promoted to decentralize HIV treatment and prevention and improve client-centered care [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Community pharmacy represents a promising platform for expanding access to PrEP and ART refills because of their wide reach, extended operating hours, and perceived privacy. In Tanzania, these outlets serve nearly 70% of rural and semi-urban populations, and more than 6,000 are registered nationwide [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Expanding pharmacy-based delivery of PrEP and ART services could improve adherence and retention, reduce pressure on overburdened facilities, and strengthen Tanzania\u0026rsquo;s combination prevention strategy through task sharing with pharmacists [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Leveraging community pharmacies for ART and PrEP delivery has the potential to reduce structural and social barriers, expand reach to underserved populations, and strengthen Tanzania\u0026rsquo;s combination prevention strategy. This study assessed the acceptability of community pharmacy-based PrEP delivery and ART refills and explored stakeholder perspectives on the feasibility to inform potential scale-up of decentralized HIV prevention and treatment services.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eThis study employed a sequential explanatory mixed-methods design, in which quantitative surveys were first conducted among women engaged in transactional sex and people living with HIV (PLHIV) to assess acceptability to obtain PrEP or refill ART through community pharmacies in the Dar es Salaam Region of Tanzania beginning in September 2025,, followed by qualitative methods to explore experiences, perceptions, and contextual factors influencing feasibility and implementation. Dar es Salaam was selected as the study setting because it is Tanzania\u0026rsquo;s largest urban center and commercial hub, with rapid urbanization and a high concentration of health service delivery points. According to national census data, the region has a population exceeding five million, representing the largest share of Tanzania\u0026rsquo;s total population of more than 60\u0026nbsp;million [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Tanzania\u0026rsquo;s HIV epidemic is generalized, with an estimated adult HIV prevalence of approximately 4.4%, while Dar es Salaam has a comparable prevalence of about 4.2% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Evidence from Dar es Salaam indicates that HIV prevalence among females engaged in transactional sex is substantially higher than in the general population, with estimates of approximately 15% [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In addition, an estimated 6,000 females engaged in transactional sex reside in the Dar es Salaam Region [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe primary study populations comprised females engaged in transactional sex, defined as the exchange of sexual services for money, goods, or other material benefits, selected to represent individuals at high risk of HIV acquisition, as well as PLHIV. Eligible females engaged in transactional sex were aged 18 years or older, resided in Dar es Salaam, and reported exchanging sex for money, goods, or material support within the past six months; those unable to provide informed consent were excluded. PLHIV were eligible if they were aged 18 years or older, receiving ART at selected HIV clinics in Dar es Salaam, and willing to participate.\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e][\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]Participants engaged in transactional sex were included in both the cross-sectional quantitative survey and qualitative in-depth interviews (IDIs). PLHIV participated in the quantitative component and focus group discussions (FGDs). To complement these perspectives, community pharmacists, pharmacy owners, and institutional stakeholders involved in HIV prevention, pharmaceutical service delivery, and regulation were included through key informant interviews (KIIs).\u003c/p\u003e \u003cp\u003eFor females engaged in transactional sex, given the hidden and stigmatized nature of this population and the lack of a formal sampling frame, respondent-driven sampling was used for both the survey and interviews. Initial participants (\u0026ldquo;seeds\u0026rdquo;) were identified through community networks and recruited peers until the quantitative sample size and qualitative data saturation were reached.\u003c/p\u003e \u003cp\u003ePLHIV were recruited from HIV clinics using a systematic sampling approach. After completion of the quantitative survey, females engaged in transactional sex and PLHIV were subsequently invited to participate in IDIs and FGDs, respectively. For stakeholder perspectives, IDIs were conducted with community pharmacists and pharmacy owners. Purposive sampling was used to recruit these participants, along with other institutional stakeholders involved in HIV prevention, pharmaceutical service delivery, and regulation [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Selection of participants was based on professional roles, experience, and relevance to the implementation of community pharmacy\u0026ndash;based PrEP and ART refill services [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eSample size estimation\u003c/h3\u003e\n\u003cp\u003eQuantitative sample sizes were calculated using the standard cross-sectional formula \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:n={Z}^{2}p(1-p)/{E}^{2}\\)\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. For females engaged in transactional sex, a 95% confidence level (Z\u0026thinsp;=\u0026thinsp;1.96), a margin of error (\u003cem\u003eE\u003c/em\u003e) of 10%, and an estimated population of approximately 6,000 females involved in transactional sex in Dar es Salaam [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], were assumed, yielding a minimum required sample size of 90 participants and a minimum of 340 for PLHIV with a margin of error of 5.5%. For the qualitative component, purposive sampling was used to recruit participants based on their roles, experience, and relevance to community pharmacy\u0026ndash;based HIV service delivery, including women engaged in transactional sex, PLHIV, community pharmacists and pharmacy owners in Dar es Salaam, and national and regional policymakers and regulators. The qualitative sample size was guided by the principle of data saturation, with recruitment continuing until no new themes emerged.\u003c/p\u003e\n\u003ch3\u003eData collection process\u003c/h3\u003e\n\u003cp\u003eThe quantitative questionnaire was developed based on Theoretical Framework of Acceptability, the acceptability\u0026ndash;appropriateness\u0026ndash;feasibility framework acceptability [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and was further informed by constructs adapted from prior research evidence [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. These frameworks and research evidence guided the inclusion of domains assessing perceived acceptability and feasibility to use pharmacy-based ART and PrEP refill services, and the perceived practicality of implementing such services within community pharmacy settings.\u003c/p\u003e \u003cp\u003eSeparate structured questionnaires were administered to females engaged in transactional sex and to PLHIV. The PrEP questionnaire, given to females engaged in transactional sex, included items on PrEP awareness, willingness to obtain PrEP from community pharmacies, preferred service characteristics, perceived benefits, concerns such as stigma and cost, and support needs. The ART questionnaire, administered to PLHIV receiving care at HIV clinics, assessed willingness to refill ART at community pharmacies, prior awareness of pharmacy-based ART services, perceived advantages and barriers, service preferences, and desired additional pharmacy-based services (\u003cb\u003eSupplementary file 1\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eThe qualitative component employed semi-structured interviews to explore experiences and contextual factors influencing the acceptability and feasibility of community pharmacy\u0026ndash;based PrEP refill services. Separate interview guides were developed for females involved in transactional sex, PLHIV and for key stakeholders (including community pharmacists, pharmacy owners, and institutional representatives). Guides for females engaged in transactional sex and PLHIV explored experiences accessing HIV services, perceptions of pharmacy based PrEP and ART delivery, stigma related concerns, and conditions influencing acceptability, while stakeholder guides included additional probes on regulatory, operational, workforce, infrastructure, financing, and data system considerations. For stakeholders, additional probes explored regulatory, operational, and system-level considerations relevant to pharmacy-based ART and PrEP delivery.\u003c/p\u003e \u003cp\u003eThe tools were pre-tested with a small sample of participants from a non-study site to assess clarity, comprehension, and acceptability. Based on feedback, minor revisions were made prior to full deployment, including rewording of selected items to improve clarity, simplifying technical terminology related to ART and PrEP, adjusting the sequence of questions to improve flow, and adding brief explanations to Likert-scale response options to enhance participant understanding. Quantitative data were collected using a structured questionnaire administered through the online KoboToolbox platform (Harvard Humanitarian Initiative, Cambridge, MA, USA). Qualitative data were collected through interviews conducted in Kiswahili, the local language, which were audio-recorded and later transcribed verbatim for analysis.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData collected using the Kobo Toolbox platform (Harvard Humanitarian Initiative, Cambridge, MA, USA) were exported to Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) for data cleaning and management. Descriptive statistics were employed to summarize all study variables using appropriate measures of central tendency and variability, including means (standard deviation), medians (interquartile range: 25% \u0026minus;\u0026thinsp;75%), standard deviations, frequencies, and proportions. Variables summarized included sociodemographic characteristics, HIV related service use characteristics, awareness and preferences regarding pharmacy-based PrEP and ART services, and perceived benefits and concerns. Willingness was measured using a 5-point Likert scale and dichotomized as willing (strongly agree/agree) or not willing (neutral/disagree/strongly disagree) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Chi-square tests were used to assess associations between willingness to obtain PrEP from a community pharmacy and categorical independent variables. These analyses correspond to the assessment of factors associated with willingness presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Quantitative data were analyzed using R statistical software, with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of respondents and willingness to receive PrEP through community pharmacy (N\u0026thinsp;=\u0026thinsp;93).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory sample (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eWilling to received PrEP at pharmacy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eYes, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eNo, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge (yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eMean \u0026plusmn; SD: 28.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (12.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u0026ndash;27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (43.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (44.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (46.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge at initiation of transactional sex (yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eMean \u0026plusmn; SD: 25.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u0026ndash;27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (46.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (50.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (29.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDuration in sex work (yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eMedian (IQR): 2 (1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (39.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (39.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (44.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (44.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (16.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (15.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAverage clients per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eMedian (IQR): 3 (2\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (47.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (29.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (52.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (70.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (95.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (94.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHave children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (59.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (40.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (26.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (23.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (73.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (76.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (62.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (24.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (51.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (53.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (45.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDegree or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (18.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ePrimary work location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStreet-based\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (22.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (23.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrothel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBar/club\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (32.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (31.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHotel/lodge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (21.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e**Others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eConsistent condom use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (67.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (65.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (32.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (34.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (25%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExperienced violence / coercion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (54.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (45.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (45.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (54.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOther sources of income apart from sex work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (63.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (54.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (45.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCondom use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (67.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (65.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (32.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (34.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTime since last HIV test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;2 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (90.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61 (88.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23 (95.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEver heard of PrEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (24.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (27.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (75.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (72.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eKey:\u003c/p\u003e \u003cp\u003e*Chi-square test of association computed for willingness to obtain pre-exposure prophylaxis (PrEP) at pharmacy\u003c/p\u003e \u003cp\u003e*Others\u0026nbsp;(e.g., online-based services, private residences, escort agencies, massage parlous or saunas, clients\u0026rsquo; homes, and other informal venues\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor the qualitative component, audio recordings were transcribed verbatim and translated into English before analysis. The qualitative methods were reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Semi structured interview and focus group guides were developed based on the Theoretical Framework of Acceptability and the acceptability, appropriateness, and feasibility framework, as well as findings from the initial quantitative phase. Guides were reviewed by the multidisciplinary research team and piloted at a non study site prior to data collection.\u003c/p\u003e \u003cp\u003eInterviews and focus group discussions were conducted in Kiswahili by trained qualitative researchers with prior experience in HIV research and community based data collection. Field notes were taken during and immediately after each interview or discussion to document non verbal cues, contextual observations, and preliminary analytic reflections. Interviews and discussions were conducted in private settings to ensure confidentiality.\u003c/p\u003e \u003cp\u003eThematic analysis was conducted through systematic coding, categorization, and iterative refinement of themes, with illustrative quotations selected to exemplify key findings [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Transcripts were independently reviewed by at least two members of the research team to enhance analytic rigor. An initial coding framework was developed deductively from the interview guides and relevant implementation frameworks, and further refined inductively as new themes emerged from the data. Coding discrepancies were discussed and resolved through consensus. Data management and coding were conducted using qualitative analysis NVivo software [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Recruitment continued until thematic saturation was reached.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative findings\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003ePrEP refill through community pharmacies\u003c/h2\u003e \u003cp\u003eThe quantitative survey included 93 females engaged in transactional sex. Most participants were aged\u0026thinsp;\u0026ge;\u0026thinsp;28 years (44.1%), and nearly half initiated transactional sex between 23 and 27 years (46.2%). The majority had 2\u0026ndash;5 years of sex work experience (44.1%) and reported\u0026thinsp;\u0026ge;\u0026thinsp;3 clients per day (57.0%). Most were not married (95.7%), 57.0% had children, 51.6% had completed secondary education (21.6% diploma or higher), and 73.1% were not formally employed. In addition, 67.7% reported consistent condom use and 54.8% had experienced violence or coercion. Overall, 74.2% of participants expressed willingness to receive PrEP at a community pharmacy. Willingness did not differ significantly across most sociodemographic or work-related characteristics (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), except for education level, where higher education was associated with greater willingness (p\u0026thinsp;=\u0026thinsp;0.047). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eParticipant preferences and concerns about PrEP services\u003c/h2\u003e \u003cp\u003eMost participants obtained PrEP information from health workers (60.2%). Pharmacies were the preferred PrEP access point for 62.4%, and 80.6% favored refill intervals of two months or longer. Interest in long-acting injectable PrEP was high (77.4%), while most had no preference regarding provider sex (89.2%). Major concerns about pharmacy-based PrEP included fear of being judged (98.9%), cost (58.1%), and stigma or discrimination (49.5%). Convenience was noted by 50.5% of participants, whereas fewer reported worries about medication quality (14.0%) or stockouts (6.5%). Nearly all respondents preferred counselling or support services (98.9%), and 45.2% desired peer support (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant preferences and concerns about PrEP services through community pharmacy (N\u0026thinsp;=\u0026thinsp;93).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePreferred source of pre-exposure prophylaxis (PrEP) information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (60.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e*Others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (39.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eConfidence in understanding PrEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConfident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (32.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (67.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePreferred PrEP facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (62.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-pharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (37.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePreferred provider sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale health worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (10.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo preference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (89.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePreferred refill frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMonthly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (19.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge; 2 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (80.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInterest in long-acting injectable PrEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (77.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (22.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePeer support for PrEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (45.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (54.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePreference for counselling/support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92 (98.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e**What are the concerns about PrEP services through community pharmacy?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore privacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (23.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShorter waiting time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConvenient location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (50.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of being judged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92 (98.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of trust in pharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (25.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedication quality concerns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStockouts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (6.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (58.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of stigma/ discrimination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (49.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eKey:\u003c/p\u003e \u003cp\u003ePrEP: pre-exposure prophylaxis\u003c/p\u003e \u003cp\u003e*Others\u0026nbsp;(including social media platforms, peers/friends, and community outreach worker\u003c/p\u003e \u003cp\u003e**Participant was given an option of tick all apply\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eART refill through community pharmacies\u003c/h2\u003e \u003cp\u003eAmong the 341 PLHIV included in the analysis, 225 (66.0%) reported willingness to refill ART at a community pharmacy. Willingness differed significantly by sex and prior awareness of pharmacy-based ART services: men were more likely than women to report willingness (p\u0026thinsp;=\u0026thinsp;0.1). No other demographic, socioeconomic, clinical, or access-related characteristics, including age, marital status, education, employment status, time since HIV diagnosis or ART initiation, clinic travel time, waiting time, medication support systems, or prior refill challenges were significantly associated with willingness (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant characteristics and the willingness to refill ART at a community pharmacy (N\u0026thinsp;=\u0026thinsp;341).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eWillingness to refill ART at pharmacy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66(29.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18(15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e257 (75.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e159(70.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98(84.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eMedian (IQR): 40 (32\u0026ndash;47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (8.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (8.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (21.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27(23.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110 (32.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71 (31.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39(33.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57 (25.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25(21.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (12%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eTime since HIV diagnosis (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eMedian (IQR): 6 (4\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129 (37.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39(33.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e194 (56.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e123(54.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71(61.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26(22.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e179 (52.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121(53.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58(50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced/Separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19(16.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(11.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHave children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e293 (85.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e197(87.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96(82.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20(17.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19(16.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (19.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28(24.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e195 (57.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e126 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69(59.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eHighest education level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e186 (54.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121(53.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65(56%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121 (35.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39(33.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDegree or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCurrent ARV refill location\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e164 (48.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102(45.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62(53.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177 (51.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e123(54.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54(46.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eTime to reach clinic (minutes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eMedian (IQR): 45 (30\u0026ndash;60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28(12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229 (67.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e157(69.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40(17.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eTime spent at clinic (minutes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eMedian (IQR): 30 (20\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e306 (89.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e201(89.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105(90.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(10.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11(9.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eMedication reminder/support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e266 (78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e175(77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91(78.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePartner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (8.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11(9.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(10.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10(8.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeer/Support group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eEver missed ART refill due to clinic challenges\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e334 (97.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e219 (97.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e115 (99.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eKey:\u003c/p\u003e \u003cp\u003eART: Antiretroviral therapy\u003c/p\u003e \u003cp\u003eIQR: Interquartile range\u003c/p\u003e \u003cp\u003e*: Chi-square test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eAwareness, perceived benefits, and concerns regarding pharmacy-based ART services\u003c/h2\u003e \u003cp\u003eA total of 341 PLHIV completed questions on awareness, perceived benefits, concerns, and preferences regarding community pharmacy\u0026ndash;based ART services. Only 14.7% had previously heard of pharmacy-based ART services, and none had ever received ART from a private pharmacy. Nevertheless, respondents frequently identified practical advantages, including shorter waiting times (63.6%), reduced transportation costs (62.8%), and proximity to home (52.8%). Concerns were common, particularly fear of stigma (74.8%) and confidentiality (61.3%), while approximately one-quarter cited high cost or worries about medication quality. Apprehension about pharmacist expertise (7.0%) and record-keeping (1.2%) were uncommon. Acceptance of long-acting injectable ART was high (91.8%). Interest in additional pharmacy-based services was also substantial, especially general health screening (60.7%) and adherence counseling (57.8%) Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAwareness, experience, perceived benefits, concerns, and preferences regarding community pharmacy\u0026ndash;based ART services (N\u0026thinsp;=\u0026thinsp;341).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory / response\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAwareness and experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeard of pharmacy-based ART services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (14.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEver received ART from a private pharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e*Perceived benefits of receiving ART from a community pharmacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreater privacy/confidentiality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClose to home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e180 (52.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShorter waiting time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e217 (63.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLonger/flexible opening hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (24.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced transportation costs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e214 (62.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConvenience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriendly staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e*Concerns and barriers regarding pharmacy-based ART\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of stigma or being identified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e255 (74.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh cost of services or medicines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (22.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug stock-outs / unreliable supply\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (12.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcerns about drug quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (23.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacist lacks HIV expertise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (7.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfidentiality not assured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e209 (61.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor record-keeping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWould accept long-acting injectable ART (every six month)?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e313 (91.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e*Other services desired at the pharmacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV testing and counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment adherence counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197 (57.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual and reproductive health services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112 (32.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexually transmitted infection testing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122 (35.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral health screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e207 (60.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*Participant was requested to tick all apply\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eQualitative findings\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003eOverview of qualitative participants\u003c/h2\u003e \u003cp\u003eIn total 27 participants were interviewed, the qualitative dataset comprised 7 IDIs with women engaged in transactional sex, 6 IDIs with pharmacists and pharmacy owners, 2 KIIs with policymakers and regulators, and 3 FGDs with PLHIV. Women engaged in transactional sex were interviewed to assess the acceptability of pharmacy-based PrEP delivery; PLHIV participated in FGDs to explore perceptions of ART refills in community pharmacies; pharmacists and pharmacy owners were interviewed to identify operational and infrastructural requirements for implementation; and policymakers were interviewed to examine the regulatory and policy context governing community-based HIV service delivery.\u003c/p\u003e \u003cp\u003eAcross all qualitative participants, ages ranged from 22 to 52 years, with an overall median age of 32 years (IQR: 27\u0026ndash;38). Among women engaged in transactional sex (n\u0026thinsp;=\u0026thinsp;7), the mean age was 26.7 years (SD 4.2); all were female, the median number of children was one (range 0\u0026ndash;1), and three reported current PrEP use while four had never used PrEP. People living with HIV who participated in FGDs (n\u0026thinsp;=\u0026thinsp;12) had a mean age of 36.1 years (SD 8.4); ten were female and two males, with a median time on ART of five years (IQR: 3\u0026ndash;8). Five reported community pharmacies as their first point of contact for care, while seven primarily used health facilities or hospitals. Pharmacists and health-system stakeholders interviewed through IDIs (n\u0026thinsp;=\u0026thinsp;7) had a mean age of 32.0 years (SD 3.3); five were male and two females, and the median duration of professional experience was six years (IQR: 5\u0026ndash;9), with two reporting direct involvement in HIV service delivery. Key informants and policymakers (n\u0026thinsp;=\u0026thinsp;2) had a mean age of 44 years; one was male and one female, and their median professional experience was seven years (\u003cb\u003eSupplementary file 2)\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eAcceptability of PrEP refills at community pharmacies\u003c/h2\u003e \u003cp\u003eAnalysis of interviews with women engaged in transactional sex identified six major themes and eighteen sub-themes related to the acceptability of PrEP delivery through community pharmacies. Overall, participants largely viewed community pharmacies as an acceptable and often preferable setting for PrEP provision compared with hospitals. Pharmacies were valued for their accessibility, shorter waiting times, discretion, and lower perceived costs, which were seen as reducing fears of stigma and unwanted disclosure.\u003c/p\u003e \u003cp\u003eHowever, acceptability was highly conditional on several safeguards. Participants highlighted the need for improved training of pharmacy staff, availability of private counselling spaces, clear and targeted health education for sex workers, and deliberate efforts to dispel misconceptions surrounding PrEP. In the absence of these measures, mistrust in providers, fear of judgment, and persistent misinformation were perceived as likely to undermine uptake and limit the effectiveness of pharmacy-based PrEP delivery models (\u003cb\u003eTable\u0026nbsp;5\u003c/b\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eAcceptability of ART refills at community pharmacies\u003c/h2\u003e \u003cp\u003eAnalysis of the focus-group discussions with PLHIV identified eight major themes and twenty-two sub-themes regarding the acceptability of ART refills at community pharmacies among people living with HIV. Participants highlighted potential advantages such as reduced travel distance, shorter waiting times, flexible pharmacy opening hours, and access during emergencies. However, strong concerns emerged around stigma, breaches of confidentiality, possible user fees, and the perceived lack of HIV-specific expertise among pharmacy staff. Hospitals were widely trusted for providing counselling, psychosocial support, and clinical monitoring.\u003c/p\u003e \u003cp\u003eOverall, willingness to use community pharmacies was mixed. Participants emphasized that acceptability would depend on ART remaining free of charge, the availability of private and discreet dispensing areas, and the presence of specially trained personnel capable of maintaining confidentiality and providing appropriate clinical support. Without these safeguards, most participants preferred to continue obtaining ART through hospital-based services (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerceived acceptability of community pharmacy\u0026ndash;based ART refills among people living with HIV\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRepresentative quotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceived convenience and proximity of pharmacies\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Shorter waiting times\u003c/p\u003e \u003cp\u003e\u0026bull; Easier geographic access\u003c/p\u003e \u003cp\u003e\u0026bull; Avoidance of hospital queues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It would be good, because many people fear hospitals because of the long processes and queues. Someone asks themselves, \u0026lsquo;Should I go and line up?\u0026rsquo; and ends up not going. Pharmacies, however, are much easier to reach for people who avoid clinics.\u0026rdquo;\u0026nbsp;\u0026mdash;\u0026nbsp; IDI 01, Female, 27 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;You cannot walk two streets without finding a pharmacy, but hospitals are far. If services move closer to people, many more women will be reached.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash;\u0026nbsp;\u003cem\u003eIDI 07, Female, 27 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrivacy and reduced stigma in pharmacy settings\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Fear of being labelled at hospitals\u003c/p\u003e \u003cp\u003e\u0026bull; Discreet encounters\u003c/p\u003e \u003cp\u003e\u0026bull; Avoidance of HIV-specific clinics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;In government hospitals the HIV section is known. If you go there just for prevention, people already start thinking you are infected. At pharmacies you feel more private and less watched.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash;\u0026nbsp;\u003cem\u003eIDI 03, Female, 34 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Going to hospital makes me afraid that people will think I am taking ARVs, but at the pharmacy it feels normal\u0026mdash;you just pick medicine and leave.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash;\u0026nbsp;\u003cem\u003eIDI 06, Female, 30 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAffordability and comfort compared with hospitals\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Lower perceived costs \u0026bull; Flexible spending\u003c/p\u003e \u003cp\u003e\u0026bull; Feeling physically and socially comfortable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Hospitals are expensive because you have to pay to see a doctor, but at pharmacies even with a small amount of money you can still go and buy medicine.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash;\u0026nbsp;\u003cem\u003eIDI 04, Female, 23 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;If PrEP comes to shops around us, it becomes easier and increases confidence, because people fear HIV clinics. In pharmacies no one questions you about what the medicine is for.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash;\u0026nbsp;\u003cem\u003eIDI 05, Female, 22 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeed for education and sensitization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Training for sex workers\u003c/p\u003e \u003cp\u003e\u0026bull; Counselling skills\u003c/p\u003e \u003cp\u003e\u0026bull; Awareness campaigns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Education is the biggest issue. You must hold seminars and explain to sex workers clearly, because without understanding people become afraid to use these medicines.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash;\u0026nbsp;\u003cem\u003eIDI 01, Female, 27 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Pharmacies should also have trained people who can explain these drugs properly, just as you explained to me today, so women know what they are taking.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash;\u0026nbsp;\u003cem\u003eIDI 06, Female, 30 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConcerns about pharmacy staff competence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Risk of wrong medication\u003c/p\u003e \u003cp\u003e\u0026bull; Limited HIV-specific knowledge\u003c/p\u003e \u003cp\u003e\u0026bull; Loss of trust\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;When you talk about pharmacies, they must first be given education. If they are trained well, they will understand these drugs better. Without that training, clients will not trust them to give correct advice.\u0026rdquo;\u0026nbsp;\u0026mdash;\u0026nbsp;IDI 07, Female, 27 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I once went for ear pain and was given drugs meant for menstrual cramps. Another pharmacy corrected it, but that experience made me fear what damage the first medicines might have caused.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash;\u0026nbsp;\u003cem\u003eIDI 03, Female, 34 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFear and misconceptions about PrEP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Rumors about weakened immunity\u003c/p\u003e \u003cp\u003e\u0026bull; Association with HIV infection\u003c/p\u003e \u003cp\u003e\u0026bull; Internalized stigma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;People fail to use PrEP because taking daily tablets feels like accepting that you are infected. Many have not accepted themselves and fear being judged.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash;\u0026nbsp;\u003cem\u003eIDI 07, Female, 27 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Some people told me that PrEP weakens your immunity, and because of that advice I hesitated to start using it.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash;\u0026nbsp;\u003cem\u003eIDI 01, Female, 27 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKey\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e\u003cb\u003eIDI: Participant who participated in in-depth interview plus the identification number assigned during an interview\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ePrEP: Pre-exposure prophylaxis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eBarriers and facilitators to community pharmacy delivery of ART and PrEP\u003c/h2\u003e \u003cp\u003eAcross the analysis, nine major themes comprising multiple interrelated sub-themes were identified (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e7\u003c/span\u003e). Overall, participants perceived community pharmacies as promising platforms for decentralized ART and PrEP delivery, particularly because of their accessibility and potential to reduce stigma. However, this optimism was consistently balanced by concerns related to operational readiness, especially issues surrounding medicine misuse, incomplete dosing, and the need for strong counselling and monitoring systems.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFacilitators, barriers, and conditions for implementing ART refills at community pharmacies from in-depth and key informant interviews\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRepresentative quotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerceived convenience of community pharmacies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Reduced travel distance\u003c/p\u003e \u003cp\u003e\u0026bull; Avoiding long clinic queues\u003c/p\u003e \u003cp\u003e\u0026bull; Flexible opening hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;When we hear about collecting medicines from pharmacies, we feel relieved because it would reduce the long queues at hospitals. Sometimes you arrive at noon, and you are told the fingerprint machine is not working or the network is down, and you end up staying there for hours. Even if you came early, you still leave late. That is why when we hear about pharmacies, we feel happy.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash; \u003cem\u003eFGD17\u003c/em\u003e, \u003cem\u003eFemale, 33 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I could even go late at night because some pharmacies operate 24 hours. That would really help me, because I plan my time around my small business. At hospitals, if you arrive late you might be punished by being told to come back the next day, but at pharmacies I feel I could go at a time that suits me.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash; \u003cem\u003eFGD13\u003c/em\u003e, \u003cem\u003eFemale, 35 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of pharmacies for emergencies or travel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Sudden travel\u003c/p\u003e \u003cp\u003e\u0026bull; Distance from health facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;If a funeral suddenly happens and I must travel the same night, and the health facility is far away, I cannot manage to go back to the clinic. I would just go to a pharmacy, get my medicines, and continue with the journey instead of missing my dose.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash; \u003cem\u003eFGD08\u003c/em\u003e, \u003cem\u003eFemale, 25 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of stigma and breach of confidentiality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Being recognized by neighbors\u003c/p\u003e \u003cp\u003e\u0026bull; Gossip\u003c/p\u003e \u003cp\u003e\u0026bull; Distrust of pharmacy staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Honestly, I am afraid. My fear comes from secrecy and stigma. Pharmacies are in the same neighborhood where we live. If you meet a neighbor\u0026rsquo;s child there, that child might go and tell their mother, and the story spreads from one person to another. Even if nobody says anything directly, you keep worrying that people already know about you.\u0026rdquo;\u003c/em\u003e\u0026mdash; \u003cem\u003eFGD14\u003c/em\u003e, \u003cem\u003eFemale, 28 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The pharmacy is different from the hospital because it is surrounded by the community. You might go there and ask for medicine, and people sit watching you. The attendants are young nurses who are still learning, and you fear they might start talking about you. For me, I completely disagree with using pharmacies for this reason.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash; \u003cem\u003eFGD18\u003c/em\u003e, \u003cem\u003eFemale, 41 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcern about potential user fees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Pharmacies seen as businesses\u003c/p\u003e \u003cp\u003e\u0026bull; Fear ART will no longer be free\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Once medicines start being provided in pharmacies it becomes business. You cannot go there without money. Even Panadol is not given for free, so what about these tablets? At hospitals we get them free, but in pharmacies they will start selling them, and that will really affect us.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash; \u003cem\u003eFGD15\u003c/em\u003e, \u003cem\u003eFemale, 45 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;These drugs are currently free at health facilities, but when you talk about pharmacies it means trade will start. Someone must make profit. That means we who are used to free treatment will face serious challenges.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash; \u003cem\u003eFGD12\u003c/em\u003e, \u003cem\u003eMale, 31 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrust in hospital-based care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Counselling and peer support\u003c/p\u003e \u003cp\u003e\u0026bull; Familiar providers \u0026bull; Clinical monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;At the hospital there are many services. We get weighed, tested, counselled, and we meet other patients who encourage each other. The nurses there already know us. In pharmacies I would just go, pick the drugs, and leave while feeling afraid, but at hospital I feel free.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash; \u003cem\u003eFGD11\u003c/em\u003e, \u003cem\u003eFemale, 40 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcerns about provider competence in pharmacies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; HIV-specific training\u003c/p\u003e \u003cp\u003e\u0026bull; Ability to manage side-effects\u003c/p\u003e \u003cp\u003e\u0026bull; Quality of follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I have changed treatment more than five times because of side-effects. When I went to a doctor who knew my history, he changed my regimen and the problem stopped. Now I worry that if I go to a pharmacy, the person there might not understand these issues the way clinicians at the hospital do.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash; \u003cem\u003eFGD13\u003c/em\u003e, \u003cem\u003eFemale, 35 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConditional willingness to use pharmacies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Free ART\u003c/p\u003e \u003cp\u003e\u0026bull; Confidentiality safeguards\u003c/p\u003e \u003cp\u003e\u0026bull; Trained staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;If the issue of payment was removed and privacy was properly protected, then I could accept going to a pharmacy. But if I still have to pay transport and also buy the medicines, and people can see me there, then it becomes difficult.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash; \u003cem\u003eFGD12\u003c/em\u003e, \u003cem\u003eMale, 31 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuggested safeguards for implementation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Private consultation rooms\u003c/p\u003e \u003cp\u003e\u0026bull; Dedicated ART providers\u003c/p\u003e \u003cp\u003e\u0026bull; Discreet refill procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;There should be a separate private room. I enter there and meet a nurse who is trained in this service, we talk privately, I show my card, get my medicines, put them in my bag, and leave. No one else should be able to see or hear what is happening inside.\u0026rdquo;\u003c/em\u003e\u0026nbsp;\u0026mdash; \u003cem\u003eFGD16\u003c/em\u003e, \u003cem\u003eMale, 38 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKey\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e\u003cb\u003eART: Antiretroviral therapy\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eFGD: Participant who participated in focused group discussion plus the identification number assigned during an interview\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 7\u003c/strong\u003e. Facilitators, barriers, and conditions for \u0026nbsp;implementing ART refills at community pharmacies from in-depth and key informant interviews\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRepresentative Quotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAccessibility and public-health value of pharmacy-based ART/PrEP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Proximity and timesaving\u003c/p\u003e \u003cp\u003e\u0026bull; Reduced congestion at clinics\u003c/p\u003e \u003cp\u003e\u0026bull; Demand for PEP/PrEP in communities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Nowadays when many people fall sick, instead of going to hospitals they first look for immediate help\u0026hellip; so if ARVs or PrEP services were available in our pharmacies, the first benefit would be accessibility\u0026mdash;people would be able to get services easily without wasting time.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI12, Male, 32 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;If these services were available in pharmacies, it would be much easier for anyone\u0026hellip; community pharmacies are many compared to health facilities.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI13, Female, 38 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRisk of misuse and need for strong dispensing controls\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Diversion to animals\u003c/p\u003e \u003cp\u003e\u0026bull; Fabricated exposure stories\u003c/p\u003e \u003cp\u003e\u0026bull; Partial dosing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Some people have been using ARVs to feed livestock\u0026hellip; a person may come and fabricate a story just to request PrEP\u0026hellip; you cannot know how it will be used.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI10, Male, 30 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Many people do not complete the dose\u0026hellip; they keep the remaining pills or give them to someone else without considering the expiry date.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI10, Male, 30 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegulatory and financing uncertainty\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Price regulation vs free provision\u003c/p\u003e \u003cp\u003e\u0026bull; Government reimbursement\u003c/p\u003e \u003cp\u003e\u0026bull; Sustainability beyond pilots\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;No businessperson likes someone to enter their shop and take something for free\u0026hellip; there has to be a way for them to benefit\u0026hellip;\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI10, Male, 30 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;A client may come for ARVs or PrEP, but they are also customers\u0026hellip; they may come for this service and also get other services there in the pharmacy\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI14, Male, 37 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Government could exempt some of these fees for private pharmacies\u0026hellip; so they cover the costs they thought they would use when providing services to HIV clients.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eKII01, Male, 45 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfrastructure limitations for confidential care\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Lack of private rooms\u003c/p\u003e \u003cp\u003e\u0026bull; Open counters\u003c/p\u003e \u003cp\u003e\u0026bull; Confidentiality risks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;If you begin an assessment, you may find that 90% of pharmacies do not even have a private room\u0026hellip; the main issue is infrastructure.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI11, Male, 31 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Most community pharmacies were not designed to have a special room\u0026hellip; ARV services require a high level of confidentiality.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI08, Male, 28 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorkforce shortages and workload pressures\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Few staff per shift\u003c/p\u003e \u003cp\u003e\u0026bull; Time-intensive counselling\u003c/p\u003e \u003cp\u003e\u0026bull; Business disruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;During one shift there is usually only one person\u0026hellip; there are ordinary customers and those seeking PEP or ART\u0026hellip; that other client needs more time.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI13, Female, 30 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;An ARV client may take five or ten minutes\u0026hellip; that affects business and customer flow.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI08, Male, 28 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTraining and competency requirements\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Knowledge gaps\u003c/p\u003e \u003cp\u003e\u0026bull; Counselling skills\u003c/p\u003e \u003cp\u003e\u0026bull; Documentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;You may find that we hire a young person straight from college who has never provided ARV services\u0026hellip; they really need adequate training.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI12, Male, 32 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Service providers need more training, especially on confidentiality and on giving proper counselling.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI08, Male, 28 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDigital systems and data integration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Harmonized software\u003c/p\u003e \u003cp\u003e\u0026bull; National interoperability\u003c/p\u003e \u003cp\u003e\u0026bull; Reporting systems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;A patient may be served in Dar es Salaam and then later in Mwanza that pharmacy should be able to see what medicines were collected\u0026hellip; there must be a nationwide system.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI09, Female, 36 years\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The systems used in pharmacies must be interoperable; otherwise, confusion will arise in the records.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI08, Male, 28 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClient selection, referral and supply chains\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Stable-patient criteria\u003c/p\u003e \u003cp\u003e\u0026bull; Referral mechanisms\u003c/p\u003e \u003cp\u003e\u0026bull; Facility-linked supply\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;There must be a proper mechanism\u0026hellip; even if a patient goes to another pharmacy the records should be visible so that patients are properly followed up.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI09, Female, 36 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStigma reduction through integrated service delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Normalizing HIV care\u003c/p\u003e \u003cp\u003e\u0026bull; Patient choice\u003c/p\u003e \u003cp\u003e\u0026bull; Mixed-service settings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Providing these services in pharmacies would reduce waiting times and queues\u0026hellip; and people may feel more comfortable than going to specialized HIV clinics.\u0026rdquo;\u003c/em\u003e \u0026mdash; \u003cem\u003eIDI08, Male, 28 years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKey\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e\u003cb\u003eART: Antiretroviral therapy\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eARVs: Antiretrovirals\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eIDI: Participant who participated in in-depth interview plus the identification number assigned during an interview\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eKII: Participant who participated in key-informant interview plus the identification number assigned during an interview\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ePEP: Post-exposure prophylaxis\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ePrEP: Pre-exposure prophylaxis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eStructural and organizational constraints also featured prominently, with recurring sub-themes relating to limited staffing, heavy workloads, and inadequate private spaces for confidential consultations. At the system level, participants repeatedly pointed to regulatory oversight, financing arrangements, and interoperable digital platforms as prerequisites for safe implementation. Collectively, these patterns suggest that while the policy environment is generally supportive, successful scale-up will depend on addressing a small set of foundational challenges related to workforce capacity, infrastructure, financing, and data integration.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis mixed methods study demonstrates substantial but conditional support for decentralizing HIV prevention and treatment services to community pharmacies. Quantitatively, a large proportion of women engaged in transactional sex were willing to obtain PrEP through pharmacies, while a smaller but still notable proportion of people living with HIV were willing to refill ART in these settings. Qualitative findings helped explain these patterns by showing that pharmacies were widely perceived as convenient and accessible because of their proximity, shorter waiting times, and flexible hours, but concerns related to stigma, confidentiality, potential costs, and provider competence strongly shaped acceptability.\u003c/p\u003e \u003cp\u003eParticipants emphasized that pharmacy-based HIV service delivery would only be acceptable if key safeguards were in place, including trained staff, private consultation spaces, reliable supply systems, and maintenance of free or affordable treatment. Stakeholders further highlighted important implementation challenges, such as infrastructure limitations, workforce capacity constraints, regulatory and financing uncertainties, risks of medication misuse, and the need for interoperable digital health records. Together, these findings suggest that while community pharmacies are viewed as promising complementary platforms for HIV service delivery, successful integration will depend on addressing both individual level acceptability concerns and broader health system readiness factors.\u003c/p\u003e \u003cp\u003eAmong women at high risk of HIV infection, nearly three-quarters expressed willingness to receive PrEP from community pharmacies, and pharmacies were the most preferred access point for PrEP services. This aligns with qualitative findings in which women consistently emphasized proximity, shorter waiting times, and reduced visibility compared with hospital-based HIV clinics. These features are particularly salient for populations facing stigma and time constraints, suggesting that pharmacy-based models could lower structural barriers to PrEP continuation and refill adherence [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].Notably, willingness to receive PrEP at pharmacies did not vary by most sociodemographic or work-related characteristics, indicating broad acceptability across subgroups of sex workers. Education level was the only factor associated with willingness, with higher education linked to greater acceptance, pointing to the potential role of health literacy in shaping confidence in decentralized models. This is reinforced by the high proportion of participants reporting limited confidence in their understanding of PrEP and the near-universal desire for counselling and support services. Together, these findings underscore that pharmacy-based PrEP delivery cannot be limited to drug dispensing alone, but must incorporate structured education, adherence counselling, and possibly peer-support mechanisms [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite overall positive acceptability, women engaged in transactional sex reported persistent stigma-related concerns, including fears of recognition, disclosure, and negative attitudes from pharmacy staff, which were also reflected in the quantitative findings. Similar concerns have been reported in studies of pharmacy-based PrEP delivery, which show that while pharmacies reduce structural barriers such as distance and waiting time, they do not automatically eliminate stigma, particularly for populations at elevated risk of acquiring HIV infection [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Our findings reinforce this evidence by showing that stigma is closely linked to trust in provider competence, confidentiality, and privacy. This suggests that pharmacies may only reduce stigma if services are delivered with trained staff, private consultation spaces, and strong confidentiality safeguards; otherwise, decentralization risks reproducing barriers seen in facility-based HIV care.\u003c/p\u003e \u003cp\u003eDespite enthusiasm, women expressed strong fears of being judged, stigma, and discrimination in pharmacy settings concerns echoed almost universally in the quantitative survey. Qualitative narratives further illustrated how misinformation about PrEP, mistrust of pharmacy staff, and previous negative experiences with medication dispensing could undermine uptake. These concerns indicate that pharmacies may only reduce stigma if staff are appropriately trained and services are delivered discreetly, otherwise, they risk reproducing the same barriers encountered in facility-based care [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor ART services, two thirds of PLHIV reported willingness to refill medications at community pharmacies, suggesting moderate but not universal readiness for decentralized refill models. Men and individuals previously aware of pharmacy-based ART services were significantly more willing, highlighting the importance of sensitization and communication in shaping acceptance. Notably, quantitative results showed no association between willingness and access-related factors such as travel time or waiting time, which contrasts with qualitative findings, in which participants strongly emphasized convenience as a key perceived benefit. This difference suggests that while convenience is widely recognized in principle, decisions to use pharmacy-based ART refills may be driven more by concerns about confidentiality, cost, and trust in provider competence than by logistical barriers alone. Similar patterns have been reported in prior studies, which found that although community pharmacy ART models improve access, patient uptake is often constrained by stigma concerns and the perceived need for clinical monitoring and counselling provided in facility-based care [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eQualitative findings revealed more ambivalence toward pharmacy-based ART refills than toward PrEP delivery. While participants appreciated pharmacies for emergencies, travel, and flexible hours, hospitals remained the preferred sites for routine HIV care because of trusted provider relationships, comprehensive counselling, psychosocial support, and ongoing clinical monitoring. Similar concerns have been reported in community pharmacy ART models in Nigeria and South Africa, where patients valued convenience but still perceived facilities as offering more comprehensive and specialised HIV care [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Studies have also highlighted confidentiality concerns and uncertainty about pharmacist expertise as barriers to uptake of decentralised ART services [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, compared to some implementation studies that demonstrated high retention and patient satisfaction after enrolment into pharmacy ART refill programs [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], our findings reflect perspectives prior to large-scale implementation. This difference may explain the greater ambivalence observed in our study, as participants were reacting to a hypothetical model rather than drawing on direct experience. In addition, in Tanzania, ART is universally provided free of charge in public facilities, which may heighten concerns about potential commodification in private retail settings. This context-specific financing concern appears to shape acceptance more strongly than in settings where pharmacy-based ART models are already integrated within publicly funded systems.\u003c/p\u003e \u003cp\u003eAcross stakeholder groups, several cross-cutting implementation challenges were identified, particularly infrastructure limitations, workforce shortages, and gaps in HIV specific training. Similar barriers have been documented in studies of pharmacy-based HIV service delivery in sub-Saharan Africa, where inadequate private space, limited staffing, and insufficient clinical training were found to constrain the quality and confidentiality of HIV care provided in retail settings [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Evidence from implemented pharmacy ART models suggests that these challenges can be mitigated through targeted strategies, including formal certification and training programs for pharmacists, integration of standardized dispensing and counselling protocols, and establishment of clear referral linkages with health facilities [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Concerns about medication diversion and inappropriate use also align with prior literature highlighting the need for strong regulatory oversight and monitoring systems when decentralizing ART to private sector outlets [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e],[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Studies further emphasize the importance of interoperable digital health records to support continuity of care, track refills, and prevent duplication or misuse across multiple dispensing sites. Together, these findings suggest that successful scale up of pharmacy-based HIV service delivery will depend less on patient demand alone and more on strengthening regulatory, training, and health system integration mechanisms that ensure safe and accountable implementation.\u003c/p\u003e \u003cp\u003eImportantly, both women engaged in transactional sex and people living with HIV, as well as some pharmacists and policymakers, viewed pharmacies as having the potential to normalize HIV prevention and treatment by embedding these services within routine healthcare encounters, as described elsewhere [34], [35]. This \u0026ldquo;integration effect\u0026rdquo; was perceived as a possible stigma-reduction mechanism, provided confidentiality is preserved and clients retain the option to choose between facilities and pharmacies. Such findings suggest that community pharmacies may function best as complementary refill points for stable clients rather than full substitutes for facility-based HIV care.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. Expressed willingness to use pharmacy-based PrEP or ART services may not reflect actual uptake once implemented. Findings relied on self-reported data and may be influenced by social desirability bias, particularly for sensitive topics such as HIV status, sex work, and stigma. The quantitative PrEP sample was relatively small, reducing statistical power and generalizability, while qualitative participants were purposively selected and limited in number, especially policymakers and pharmacists, potentially restricting the diversity of perspectives captured. The study was conducted within an urban context, which may limit transferability to other settings, especially rural and semi-urban areas. Finally, the study did not include economic analyses or objective assessments of pharmacy readiness, infrastructure, or staffing, which are critical for informing large-scale implementation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study demonstrates substantial but differentiated acceptability of community pharmacy\u0026ndash;based HIV service delivery. Interest was high for PrEP delivery among women engaged in transactional sex, reflecting the perceived benefits of convenience, accessibility, and reduced structural barriers. In contrast, the acceptability of pharmacy-based ART refills among people living with HIV was more moderate. While pharmacies were recognized as convenient for emergencies and travel, many participants preferred to continue routine ART care in health facilities due to trusted provider relationships, counselling support, and concerns about confidentiality and potential costs. Across both groups, acceptability was highly conditional and depended on assured confidentiality, maintenance of free or affordable medication, trained pharmacy personnel, and private consultation spaces. Stakeholders further identified workforce capacity, infrastructure readiness, regulatory oversight, digital health integration, and sustainable financing as key determinants of feasibility. Taken together, these findings suggest that community pharmacies are most likely to function as complementary platforms, particularly for expanding PrEP access and providing ART refills for stable clients, rather than as full substitutes for comprehensive facility-based HIV care. Further implementation research and pilot evaluations are needed to assess real world uptake, cost effectiveness, and long-term clinical outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eART\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAntiretroviral therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity pharmacy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFGD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFocus group discussion\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHIV\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIDI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIn-depth interview\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eKII\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKey informant interview\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePEP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePost-exposure prophylaxis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePLHIV\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePeople living with HIV\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePrEP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePre-exposure prophylaxis.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Muhimbili University of Health and Allied Sciences Research Ethics Committee (Ref No.\u0026nbsp;MUHAS-REC-07-2025-3022) and the National Institute for Medical Research through the Dar es Salaam Urban Cohort Study platform (Ref No.\u0026nbsp;NIMR/HQ/Vol.1/3047). Administrative permission to collect data in Dar es Salaam and access the HIV clinics was obtained from the Prime Minister’s Office–Regional Administration and Local Government and the Dar es Salaam Regional Administrative Secretariat. All participants provided written informed consent prior to enrollment. The study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author, upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors have no competing interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under Award Number D43 TW0010543. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGMB contributed to the conceptualization and design of the study, data collection, data analysis, and drafting of the manuscript. AI contributed to data analysis. JK and CRS contributed to the conceptualization of the study and critically revised the manuscript for important intellectual content. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch reported in this publication was supported by the Fogarty International Center of the National Institutes of Health through Award Number\u0026nbsp;5D43TW010543-09, the\u0026nbsp;HBNU Fogarty Global Health Training Program, and a sub-award from the\u0026nbsp;University of California, San Francisco\u0026nbsp;under Award Number\u0026nbsp;3D43TW009343-14S3. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGlobal HIV \u0026amp; AIDS statistics \u0026mdash; Fact sheet, \u0026ldquo;UNAIDS,\u0026rdquo; 2024. Accessed: Nov. 21, 2025. [Online]. Available: https://www.unaids.org/en/resources/fact-sheet\u003c/li\u003e\n\u003cli\u003eV. 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Johnson, \u0026ldquo;A Qualitative Study Examining HIV Antiretroviral Adherence Counseling and Support in Community Pharmacies,\u0026rdquo; \u003cem\u003eJournal of Managed Care Pharmacy\u003c/em\u003e, vol. 19, no. 6, pp. 454\u0026ndash;460, Jul. 2013, doi: 10.18553/jmcp.2013.19.6.454.\u003c/li\u003e\n\u003cli\u003eA. Tembo \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;Leveraging community pharmacies for HIV services in South Africa: Opportunities and constraints,\u0026rdquo; \u003cem\u003eSouth. Afr. J. HIV Med.\u003c/em\u003e, Oct. 2025, doi: 10.4102/SAJHIVMED.v26i1.1739.\u003c/li\u003e\n\u003cli\u003eT. Nyamuzihwa, K. E. Oladimeji, A. Nyatela, L. Makola, S. T. Lalla-Edward, and A. Tembo, \u0026ldquo;Setting up a pharmacy HIV pre-exposure prophylaxis delivery model: Lessons and recommendations for implementation,\u0026rdquo; \u003cem\u003eSouth. Afr. J. HIV Med.\u003c/em\u003e, vol. 26, no. 1, Mar. 2025, doi: 10.4102/sajhivmed.v26i1.1683.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Community pharmacies, HIV service delivery, pre-exposure prophylaxis, Antiretroviral therapy, Tanzania","lastPublishedDoi":"10.21203/rs.3.rs-9530938/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9530938/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCommunity pharmacies (CPs) may provide a decentralized platform for refills of pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART). However, evidence on their acceptability and implementation requirements remains limited. This study assessed the acceptability of using CP for PrEP and ART refills and explored stakeholder perspectives on feasibility to inform potential scale-up in urban Tanzania.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA sequential explanatory mixed-methods design study of community pharmacies was conducted in Dar es Salaam, Tanzania. Quantitative surveys were first conducted among women engaged in transactional sex and people living with HIV (PLHIV) to assess the acceptability and feasibility of obtaining PrEP or refilling ART through CPs. These findings then informed qualitative data collection, which included in-depth interviews with women engaged in transactional sex (TS), pharmacists, pharmacy owners, and key informants such as policymakers, as well as focus-group discussions with PLHIV. Qualitative data were analyzed thematically to contextualize and explain the quantitative results.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eNearly 74.2% of the 93 women engaged in TS expressed willingness to receive PrEP from CPs. Among PLHIV, 66.0% of the 341 participants reported willingness to refill ART at community pharmacies. Across both groups, major concerns included stigma related to HIV status or perceived sexual behavior and potential user fees. Qualitative findings (N\u0026thinsp;=\u0026thinsp;27) highlighted perceived advantages of pharmacies such as proximity, shorter waiting times, flexible opening hours, and the ability to obtain services discreetly within routine care settings. However, participants emphasized that acceptability would depend on assured confidentiality, free or affordable treatment, private consultation spaces, and specialized HIV training for pharmacy staff. Stakeholders further identified regulatory and financing uncertainties, infrastructure constraints, workforce shortages, medication misuse risks, and the need for digital health record systems as implementation challenges.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCPs were perceived as promising complementary platforms for PrEP delivery, particularly to improve prevention access among high-risk populations, and for ART refills mainly among stable clients. However, successful integration into national HIV programs will require robust regulatory frameworks, sustainable financing, provider training, and systems to safeguard confidentiality and continuity of care. Implementation research is needed to evaluate feasibility, impact, and safety.\u003c/p\u003e","manuscriptTitle":"Acceptability and Implementation Considerations for Community Pharmacy–Based Delivery of Pre-Exposure Prophylaxis and Antiretroviral Therapy in Dar es Salaam: A Sequential Explanatory Mixed-Methods Design","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-12 11:29:10","doi":"10.21203/rs.3.rs-9530938/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-15T13:38:08+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"300639526596878651875274125605840713490","date":"2026-05-13T06:18:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T12:53:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T14:42:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133275361695121842868406383964673825898","date":"2026-05-02T16:35:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166382600998906344239101902967182244727","date":"2026-05-02T15:34:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-30T09:16:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-30T07:26:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-29T07:05:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-28T17:00:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-04-28T14:51:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f2e78112-9670-43f8-86f9-b003b13fb5ab","owner":[],"postedDate":"May 12th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-15T13:38:08+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"300639526596878651875274125605840713490","date":"2026-05-13T06:18:25+00:00","index":37,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T12:53:38+00:00","index":34,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T14:42:31+00:00","index":33,"fulltext":""},{"type":"reviewerAgreed","content":"133275361695121842868406383964673825898","date":"2026-05-02T16:35:30+00:00","index":29,"fulltext":""},{"type":"reviewerAgreed","content":"166382600998906344239101902967182244727","date":"2026-05-02T15:34:36+00:00","index":28,"fulltext":""},{"type":"reviewersInvited","content":"9","date":"2026-04-30T09:16:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-30T07:26:14+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T13:53:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-12 11:29:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9530938","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9530938","identity":"rs-9530938","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}