Preparing for pharmacy-based delivery of long-acting injectable antiretrovirals: a pre-implementation study

Abstract Background: Use of long-acting injectable antiretroviral therapy (LA-ART) for human immunodeficiency virus (HIV) treatment and prevention is increasing, but there are challenges which could limit broad expansion of these important treatments. The goal of this study was to explore attitudes, barriers, and facilitators for implementing LA-ART administration within community pharmacies. Methods: We conducted a mixed-methods study focusing on pre-implementation aspects of community pharmacy-administered LA-ART. Pharmacists, clinic staff members, and persons with HIV completed a baseline survey followed by an individual semi-structured qualitative interview with questions based on the Consolidated Framework for Implementation Research (CFIR). Results: A total of 63 participants (pharmacist n=19, clinic staff n=20, person with HIV n=24) from Alabama, California, Florida, and Texas were included in the study. Most pharmacist participants were employed in retail pharmacies that processed fewer than 500 prescriptions per day (75%) and most had more than 10 years of experience working with people with HIV (53%). Clinic staff participants were also highly experienced in working with people with HIV (55%). People with HIV enrolled in the study were either on oral antiretroviral therapy but interested in LA-ART (59%) or were already on LA-ART (29%). Clinics were the preferred location for LA-ART administration while community pharmacy was the second preferred location. Attitudes regarding pharmacy-based administration of LA-ART were mostly positive, with the primary facilitator being positive experiences or established relationships between clinics and pharmacies or persons with HIV and their pharmacies. Barriers included concerns about pharmacy staffing, training, space, privacy, and pharmacy reimbursement for services. Conclusion: Involving community pharmacies in the administration of LA-ART could expand access to HIV treatment and prevention medications. Outlining best practices that leverage facilitators and overcome barriers can help clinics, pharmacy, and communities expand this novel model of care. ClinicalTrials.Gov Registration: NCT05152953 (posted 12/10/2021)