Integrated HIV and Overdose Prevention in Pharmacies: Assessing Availability and Implementation Strategies in Different Policy Environments (HIP-Pharm)

Wake Forest University Health Sciences, Winston-Salem NC

Investigators

Abstract

: Overdose and HIV are among the greatest threats to people who inject drugs (PWID) in the United States (US). Although pre-exposure prophylaxis (PrEP) was approved in 2012, its adoption has been slow, creating obstacles to the US Ending the HIV Epidemic (EHE) goals—an initiative launched in 2019 to reduce new HIV infections by 90% by 2030. Currently, less than 1% of people who use drugs use PrEP. Overdose death rates are rising at alarming rates among people at risk for or living with HIV. People living with HIV are more likely to die from overdose than HIV-related conditions. Pharmacies offer over-the-counter overdose prevention tools, such as naloxone and fentanyl test strips, but ensuring broad access remains a challenge, particularly in rural areas. Pharmacies remain an underutilized healthcare setting for HIV and overdose prevention. State and federal policies have advanced efforts to increase the availability of these services through pharmacies, but implementation has varied widely. North Carolina (NC) and Illinois (IL), both part of the EHE initiative, offer a valuable case study due to their differing approaches: In IL, pharmacists are authorized to initiate PrEP under standing orders from physicians or medical directors, whereas in NC, pharmacists may only dispense but not initiate PrEP. Understanding the real-world accessibility of these services is essential for informing future policy development and public health initiatives. We propose three aims: 1) assess the changes in the availability of HIV and overdose prevention services at all community and retail pharmacies in IL and NC using mystery shopper calls; 2) examine regional (i.e., rural vs. urban) differences associated with integrated HIV and overdose prevention services at community retail pharmacies in IL and NC; 3) conduct a 3-phase mixed- methods assessment, using qualitative interviews and an e-Delphi approach, to develop strategies with pharmacies and end-users address implementation gaps integrated HIV and overdose prevention services. By evaluating the pharmacy-based landscape for HIV and overdose prevention services, this research will generate actionable insights to support ongoing federal and state efforts to expand healthcare access and improve public health infrastructure. The study aligns with national priorities to improve healthcare delivery, increase service availability, and remove challenges to essential prevention. This work contributes to broader efforts to enhance pharmacy-based access to prevention options, ensuring that healthcare services are more widely available to all individuals, regardless of location.