Pharmacist-Led Program Expands Access to PrEP in Indian Health Service

PrEP medications are safe and effective and can help prevent one from getting HIV. More than one million people in the U.S. could benefit from taking PrEP medicines, but only a tiny fraction of those actually get a prescription. In addition, many people do not know about PrEP medication and how it can help them, and many can’t afford to pay for the medicine. PrEP is available with no out-of-pocket costs at IHS and most tribal health clinics.

The Albuquerque Indian Health Center started PrEP services with one patient about 2½ years ago, with just myself and another pharmacist. With time, we expanded the role of pharmacy, and we now have more than 12 patients on PrEP, with six pharmacists directly involved. Providing PrEP through pharmacy clinic services allows patients to get services the same day or within a week after provider referral.

Our role is to improve access to HIV prevention services and quality of care. A crucial part of this is taking burdens off the providers’ schedule due to the frequent follow-up visits – every three months – that PrEP requires. At these PrEP visits, pharmacists have the prescriptive authority to order PrEP medication and laboratory tests and interpret laboratory data for PrEP.

With access to order laboratories, our PrEP clinic has detected multiple episodes of STIs. We have provided access to timely treatment and prevented the spread of these communicable diseases. In addition, in our PrEP clinic we also conduct a comprehensive sexual health history, provide risk-reduction counseling to prevent HIV and STI infection, and optimize patients’ commitment to adherence to PrEP therapy.  

In our protocol, patients see their primary care physician at least once yearly, and the providers refer PrEP candidates to our service. This type of internal referral also is possible from urgent care and emergency medicine settings, especially for patients without a primary care physician or who don’t regularly seek care.

For some of our PrEP patients, we ask if they have friends or family who also would benefit from the service. A few transgender female patients are also spreading the word that this service is accessible. We also gave training to our providers to help them identify patients best suited for referral to us. We are thinking of actively reaching out to our patients with repeat STI diagnoses to come in and see if PrEP is a fit for them.

PrEP is vital for any IHS, tribal, or urban Indian healthcare facility. Generic PrEP medications are available, so the impact on the pharmacy budget is minimal. In addition, most insurance plans and state Medicaid programs cover PrEP. And the HHS-administered Ready, Set, PrEP program makes PrEP medication available at no cost to those without prescription drug coverage. The pharmacist plays a critical role in stopping the spread of HIV and STIs in our communities. Pharmacists can consider this as an addition to the clinics we already manage. Our experience in Albuquerque demonstrates that it’s doable for any site, big or small.

PrEP may be unfamiliar to some pharmacists as it might have been covered only in training for fairly new clinicians. I know some might be very nervous at first, but there are many resources they can access. Just be confident; there is more help on clinical decisions for PrEP than there was a few years ago. I welcome any pharmacists thinking about it to reach out to me.

Pharmacists and other healthcare providers can also consult CDC’s 2021 updated PrEP Clinical Practice Guideline and the National Clinician Consultation Center’s PrEP warmline for healthcare providersExit Disclaimer. See also this HIV.gov blog post, Pharmacists: Crucial Partners in the Response to HIV, and an accompanying letter to pharmacists.

The National HIV/AIDS Strategy specifically spotlights pharmacists’ roles in both HIV prevention and care and calls us to action. Among the important contributions we can make to ending the HIV epidemic in Indian Country and across the U.S. is expanding access to effective HIV prevention interventions like PrEP.