CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

care as these other proven pharmacist-managed protocols. By collaborating with a local HIV primary care clinic, we created an innovative pharmacist-managed HIV PrEP clinic in a community pharmacy setting called One-Step PrEP™. Methods: One-Step PrEP™ was created in March 2015 under physician oversight with a collaborative drug therapy agreement (CDTA). This service is located at Kelley-Ross Pharmacy in Seattle, Washington. One-Step PrEP™ allows for a single patient encounter to provide access to PrEP. Pharmacists meet with patients individually, take a medical and sexual history, make a risk assessment, perform laboratory testing, provide patient education, and prescribe and dispense tenofovir DF/emtricitabine when appropriate. Pharmacists also provide all follow up care as recommended by the practice guidelines. Here we report data on the first year of operating the clinic. Results: FromMarch 2015 through March 2016, 373 individuals sought PrEP services from One-Step PrEP™. Of those, 251 (67%) were evaluated in person, and 57 (23%) reported having a primary care provider. Among those seen in clinic, 245 (98%) initiated PrEP, and 210 (84%) identified as men who have sex with men (MSM). The mean age was 34 years (range 18-64 years). A total of 26 diagnoses of bacterial sexually-transmitted infections were made, and there was one HIV seroconversion. A retention rate of 75%was seen during the first year of operation. A majority of patients (235 or 96%) paid $0 per month for their PrEP medication. Financial viability of the clinic was determined based on the areas of revenue versus clinic costs. Initial startup costs were recouped at 9 months of clinic operations. Conclusion: We have found that a pharmacist-run HIV PrEP clinic in a community pharmacy is logistically feasible and financially viable. We observed a higher-than-expected response fromMSM patients seeking PrEP care in a community pharmacy setting. The high retention rate indicates that patients find value in our service. The One-Step PrEP™ clinic model proves to be financially sustainable by demonstrating a return on investment in less than one year of clinic operation. 962 ASSESSING THE EFFICACY AND FEASIBILITY OF A RETAIL PHARMACY-BASED HIV TESTING PROGRAM Bryan C. Collins , Heather W. Bronson, Elaine G. Martin Virginia Dept of Hlth, Richmond, VA, USA Background: The Virginia Department of Health (VDH) initiated a public/private partnership to launch an HIV testing program in 32 retail pharmacies which also conducted screening for other chronic diseases. We estimated that testing in retail pharmacies would lead to higher service uptake among first-time testers, that clients would reflect the racial/ethnic composition of communities where pharmacies were located, and that the public/private partnership would be more cost-effective than community-based HIV testing. Methods: VDH selected stores in census tracts that were >30% Black/Latino, and where >10% of the population lived in poverty. Clients could request walk-in testing using a one-minute HIV rapid test whenever the pharmacy was open. Clients who tested positive were referred to confirmatory testing at a local nonprofit organization or health department. Results: Between June 1, 2014 and June 30, 2016, Walgreens pharmacists performed 3,221 HIV tests, including 25 positive tests, for a 0.8% positivity rate. Among all clients in the pharmacy testing program, 46% had never been tested or were unsure, versus 31% of clients in community-based HIV testing programs. Among HIV-positive clients in the pharmacy testing program, 64% had never been tested or were unsure, versus 17% of clients in community-based HIV testing programs. Only 39% of tests were performed during business hours, while 61%were provided at night or over the weekend. Statewide, 61% of clients were Black or Latino, more than double the minimum selection criteria. The cost per positive test was $4,300, versus $14,900 in community-based HIV testing programs. Conclusion: Retail pharmacy-based HIV testing effectively facilitates access to HIV testing for clients who will not seek testing from established testing venues, such as Community-Based Organizations (CBO) and Local Health Departments (LHD). Retail pharmacy-based HIV testing is an effective venue for HIV testing, specifically in geographically large or low incidence states, where it can provide services in areas not feasible for CBOs or LHDs. Public/private partnerships present potential cost savings over community-based HIV testing programs. 963 MIDWEST PHARMACISTS’ KNOWLEDGE OF &WILLINGNESS TO PROVIDE PREEXPOSURE PROPHYLAXIS Jordan Broekhuis , Kimberly K. Scarsi, Harlan Sayles, Donald Klepser, Joshua Havens, Susan Swindells, Sara H. Bares Univ of Nebraska, Omaha, NE, USA Background: Pharmacist provision of pre-exposure prophylaxis (PrEP) through collaborative practice agreements with local physicians could expand access for those at risk of HIV infection. We sought to characterize pharmacists’ knowledge about and willingness to provide PrEP services in Nebraska and Iowa. Methods: An 18-question survey was distributed via email to members of the American Society of Health-System Pharmacists in Nebraska and Iowa and to University of Nebraska Medical Center pharmacy preceptors (n=1140). The survey was organized into three parts: demographics, experience, and beliefs. Descriptive analyses were performed for all questions. Pearson chi-square tests identified characteristics based on gender, age, years in practice, and HIV experience. Wilcoxon rank-sumwas used to compare responses to number of HIV-infected patients treated annually. P-values less than 0.05 were considered significant. Results: Of the 140 respondents, 54%were female, 96%were white, 58% practiced in an urban setting, and mean age was 45 years. Less than half of respondents were familiar with the use of PrEP (42%) or the CDC guidelines for its use (25%). Respondents who were older (p=.015) and in practice longer (p=.005) were less likely to be familiar with the use of PrEP. Overall, 54% indicated that they were fairly or very likely to provide PrEP services as part of a collaborative practice agreement and after additional training. While familiarity with PrEP use or guidelines did not affect respondents’ willingness to provide PrEP, respondents were more likely to express an interest in providing PrEP services if they had prior experience counseling HIV-infected patients on antiretroviral therapy (p=0.023) or PrEP (p=0.013), and if they recently completed HIV-related continuing education (p=0.032) [see Table]. Respondents were “moderately concerned” or “very concerned” about the following issues: time burden (61%), inadequate compensation for services (55%), outside skill set (39%), adherence (63%), loss to follow-up (56%), and promotion of drug resistance (51%). Only 13% of respondents identified ethical concerns related to PrEP. Conclusion: Pharmacist respondents in Nebraska and Iowa had limited knowledge and experience with PrEP, but most indicated willingness to provide PrEP through collaborative practice agreements after additional training. Attention to concerns about time burden, workflow disruption and compensation may facilitate development of this innovative model of PrEP delivery.

Poster and Themed Discussion Abstracts

CROI 2017 417