{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:41:52Z","timestamp":1794325312446,"version":"4.9.0"},"reference-count":47,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2022,2,18]],"date-time":"2022-02-18T00:00:00Z","timestamp":1645142400000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010409","name":"Children's Investment Fund Foundation","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100010409","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,1,28]]},"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Novel mechanisms of service delivery are needed to expand access to pre-exposure prophylaxis (PrEP) for HIV prevention. Providing PrEP directly through pharmacies could offer an additional option for reaching potential users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review of studies examining effectiveness, values and preferences of end users and health workers, and cost of PrEP initiation and continuation through pharmacies (pharmacy access). We searched PubMed, CINAHL, LILACS and EMBASE through 2 December 2020. We also searched clinical trial registries and recent HIV conference abstracts. Standardised methods were used to search, screen and extract data from included studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No studies met the inclusion criteria for the effectiveness review, for either PrEP initiation or continuation. However, six \u2018case studies\u2019 presenting non-comparative data from PrEP pharmacy programmes demonstrated feasibility of this model in the USA. Eleven studies reported values and preferences of end users and health workers. In the USA, Kenya and South Africa, potential PrEP clients generally supported pharmacy access, although some preferred clinics. One study of PrEP pharmacy clients found all would \u2018definitely recommend\u2019 the programme. Six studies found pharmacists were generally supportive of offering PrEP; one study including doctors found more limited favour, while one study of diverse Kenyan stakeholders found broad support. Three studies reported cost data indicating client willingness to pay in the USA and Kenya and initial sustainability of a clinic financial model in the USA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Provision of PrEP through pharmacies has been demonstrated to be feasible in the USA and acceptable to potential end users and stakeholders in multiple settings. Limited evidence on effectiveness and requirements for laboratory testing and assurance of high-quality services may limit enthusiasm for this approach. Further research is needed to determine if pharmacy access is a safe and effective way to help achieve global HIV prevention goals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42021231650.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-054121","type":"journal-article","created":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T12:32:54Z","timestamp":1645446774000},"page":"e054121","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":51,"title":["PrEP distribution in pharmacies: a systematic review"],"prefix":"10.1136","volume":"12","author":[{"given":"Caitlin E","family":"Kennedy","sequence":"first","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7425-0382","authenticated-orcid":false,"given":"Ping Teresa","family":"Yeh","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlyn","family":"Atkins","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Keck School of Medicine, Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Baggaley","sequence":"additional","affiliation":[{"name":"Department of HIV, Viral Hepatitis, and STIs, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjulaa","family":"Narasimhan","sequence":"additional","affiliation":[{"name":"Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,2,21]]},"reference":[{"key":"2025121222490556000_12.2.e054121.1","unstructured":"WHO . Guidelines: updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring. Geneva: World Health Organization, 2021."},{"key":"2025121222490556000_12.2.e054121.2","unstructured":"WHO . Preventing HIV and other STIs among women and girls using contraceptive services in contexts with high HIV incidence: actions for improved clinical and prevention services and choices, 2020. Available: https:\/\/www.who.int\/publications\/i\/item\/actions-for-improved-clinical-and-prevention-services-and-choices-preventing-hiv-and-other-stis-among-women-and-girls-using-contraceptive-services"},{"key":"2025121222490556000_12.2.e054121.3","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1097\/QAI.0000000000001579","article-title":"Evolving models and ongoing challenges for HIV preexposure prophylaxis implementation in the United States","volume":"77","author":"Mayer","year":"2018","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2025121222490556000_12.2.e054121.4","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1111\/phn.12887","article-title":"Community engagement and linkage to care efforts by peer community-health workers to increase PreP uptake among sexual minority men","volume":"38","author":"Farley","year":"2021","journal-title":"Public Health Nurs"},{"key":"2025121222490556000_12.2.e054121.5","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-019-00430-z"},{"key":"2025121222490556000_12.2.e054121.6","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2019.305057"},{"key":"2025121222490556000_12.2.e054121.7","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1016\/j.japh.2020.01.026","article-title":"Community pharmacy delivered PreP to stop HIV transmission: an opportunity not to miss!","volume":"60","author":"Lopez","year":"2020","journal-title":"J Am Pharm Assoc"},{"key":"2025121222490556000_12.2.e054121.8","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1089\/apc.2018.0294","article-title":"The pharmacist's expanding role in HIV pre-exposure prophylaxis","volume":"33","author":"Farmer","year":"2019","journal-title":"AIDS Patient Care STDS"},{"key":"2025121222490556000_12.2.e054121.9","unstructured":"WHO . WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights. Geneva, Switzerland: World Health Organization, 2019. https:\/\/www.who.int\/reproductivehealth\/publications\/self-care-interventions\/en\/"},{"key":"2025121222490556000_12.2.e054121.10","unstructured":"WHO . WHO Academy, 2021. Available: https:\/\/www.who.int\/about\/who-academy"},{"key":"2025121222490556000_12.2.e054121.11","unstructured":"WHO . Maintaining essential health services: operational guidance for the COVID-19 context interim guidance. Geneva, Switzerland: World Health Organization, 2020. https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-essential-health-services-2020.1"},{"key":"2025121222490556000_12.2.e054121.12","unstructured":"WHO . Maintaining essential health services: operational guidance for the COVID-19 context interim guidance, 2020. Available: https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-essential-health-services-2020.1"},{"key":"2025121222490556000_12.2.e054121.13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"2025121222490556000_12.2.e054121.14","doi-asserted-by":"crossref","unstructured":"Higgins JPT , Thomas J , Chandler J . Cochrane Handbook for systematic reviews of interventions, 2019.","DOI":"10.1002\/9781119536604"},{"key":"2025121222490556000_12.2.e054121.15","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-018-0925-0"},{"key":"2025121222490556000_12.2.e054121.16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/apc.2019.0235","article-title":"A pharmacist-led, same-day, HIV pre-exposure prophylaxis initiation program to increase PreP uptake and decrease time to PreP initiation","volume":"34","author":"Khosropour","year":"2020","journal-title":"AIDS Patient Care STDS"},{"key":"2025121222490556000_12.2.e054121.17","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.japh.2019.06.021","article-title":"Implementation of pre-exposure prophylaxis at a community pharmacy through a collaborative practice agreement with San Francisco department of public health","volume":"60","author":"Lopez","year":"2020","journal-title":"J Am Pharm Assoc"},{"key":"2025121222490556000_12.2.e054121.18","article-title":"Development of a pharmacist-led human immunodeficiency virus pre-exposure prophylaxis clinic at an urban community clinic","volume":"56","author":"Sawkin","year":"2016","journal-title":"Journal of the American Pharmacists Association"},{"key":"2025121222490556000_12.2.e054121.19","article-title":"Feasibility of a pharmacist-run HIV PreP clinic in a community pharmacy setting","volume":"25","author":"Tung","year":"2017","journal-title":"Topics in Antiviral Medicine"},{"key":"2025121222490556000_12.2.e054121.20","doi-asserted-by":"publisher","DOI":"10.1071\/SH18084"},{"key":"2025121222490556000_12.2.e054121.21","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofz365","article-title":"Acceptability and feasibility of a pharmacist-led HIV pre-exposure prophylaxis (PreP) program in the midwestern United States","volume":"6","author":"Havens","year":"2019","journal-title":"Open Forum Infect Dis"},{"key":"2025121222490556000_12.2.e054121.22","doi-asserted-by":"crossref","first-page":"S395","DOI":"10.1093\/ofid\/ofy210.1126","article-title":"1293. the next step in PreP: evaluating outcomes of a Pharmacist-Run HIV pre-exposure prophylaxis (PreP) clinic","volume":"5","author":"Ryan","year":"2018","journal-title":"Open Forum Infect Dis"},{"key":"2025121222490556000_12.2.e054121.23","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1093\/ajhp\/zxz059","article-title":"Treatment of patients with HIV or hepatitis C by pharmacist clinicians in a patient-centered medical home","volume":"76","author":"Ryan","year":"2019","journal-title":"Am J Health Syst Pharm"},{"key":"2025121222490556000_12.2.e054121.24","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1177\/0956462420912141","article-title":"High pre-exposure prophylaxis awareness and willingness to pay for pre-exposure prophylaxis among young adults in Western Kenya: results from a population-based survey","volume":"31","author":"Begnel","year":"2020","journal-title":"Int J STD AIDS"},{"key":"2025121222490556000_12.2.e054121.25","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1177\/0897190020904590","article-title":"Willingness to discuss and screen for pre-exposure prophylaxis in pharmacies among men who have sex with men","volume":"34","author":"Crawford","year":"2021","journal-title":"J Pharm Pract"},{"key":"2025121222490556000_12.2.e054121.26","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/j.japh.2019.12.003","article-title":"Pharmacy-based pre-exposure prophylaxis support among pharmacists and men who have sex with men","volume":"60","author":"Crawford","year":"2020","journal-title":"J Am Pharm Assoc"},{"key":"2025121222490556000_12.2.e054121.27","doi-asserted-by":"crossref","first-page":"e75-e79","DOI":"10.1016\/j.japh.2020.09.020","article-title":"Patient perspectives of pharmacists prescribing HIV pre-exposure prophylaxis: a survey of patients receiving antiretroviral therapy","volume":"61","author":"Lutz","year":"2021","journal-title":"J Am Pharm Assoc"},{"key":"2025121222490556000_12.2.e054121.28","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25528","article-title":"Preferences for long\u2010acting Pre\u2010Exposure prophylaxis (PreP) for HIV prevention among South African youth: results of a discrete choice experiment","volume":"23","author":"Minnis","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"2025121222490556000_12.2.e054121.29","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.japh.2020.03.013","article-title":"Patient perception of community pharmacists prescribing pre-exposure prophylaxis for HIV prevention","volume":"60","author":"Zhu","year":"2020","journal-title":"J Am Pharm Assoc"},{"key":"2025121222490556000_12.2.e054121.30","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0207372","article-title":"Midwest pharmacists' familiarity, experience, and willingness to provide pre-exposure prophylaxis (PreP) for HIV","volume":"13","author":"Broekhuis","year":"2018","journal-title":"PLoS One"},{"key":"2025121222490556000_12.2.e054121.31","doi-asserted-by":"crossref","first-page":"115-120","DOI":"10.1016\/j.japh.2020.10.005","article-title":"Support and perceived barriers to implementing pre-exposure prophylaxis screening and dispensing in pharmacies: examining concordance between pharmacy technicians and pharmacists","volume":"61","author":"Hopkins","year":"2021","journal-title":"J Am Pharm Assoc"},{"key":"2025121222490556000_12.2.e054121.32","doi-asserted-by":"crossref","first-page":"e179","DOI":"10.1016\/j.japh.2020.06.005","article-title":"Attitudes about community pharmacy access to HIV prevention medications in California","volume":"60","author":"Koester","year":"2020","journal-title":"J Am Pharm Assoc"},{"key":"2025121222490556000_12.2.e054121.33","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-020-05898-9","article-title":"Design of a care pathway for pharmacy-based PreP delivery in Kenya: results from a collaborative stakeholder consultation","volume":"20","author":"Ortblad","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"2025121222490556000_12.2.e054121.34","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25306","article-title":"Understanding user perspectives of and preferences for oral PreP for HIV prevention in the context of intervention scale-up: a synthesis of evidence from sub-Saharan Africa","volume":"22 Suppl 4","author":"Eakle","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"2025121222490556000_12.2.e054121.35","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1007\/s10461-016-1627-z","article-title":"Values and preferences on the use of oral pre-exposure prophylaxis (PreP) for HIV prevention among multiple populations: a systematic review of the literature","volume":"21","author":"Koechlin","year":"2017","journal-title":"AIDS Behav"},{"key":"2025121222490556000_12.2.e054121.36","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/QAI.0000000000001945","article-title":"Young women's stated preferences for biomedical HIV prevention: results of a discrete choice experiment in Kenya and South Africa","volume":"80","author":"Minnis","year":"2019","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2025121222490556000_12.2.e054121.37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/09540121.2020.1778628","article-title":"Experienced barriers to adherence to pre-exposure prophylaxis for HIV prevention among MSM: a systematic review and meta-ethnography of qualitative studies","volume":"33","author":"Edeza","year":"2021","journal-title":"AIDS Care"},{"key":"2025121222490556000_12.2.e054121.38","unstructured":"WHO . Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva, Switzerland: World Health Organization, 2015. https:\/\/www.who.int\/hiv\/pub\/guidelines\/earlyrelease-arv\/en\/"},{"key":"2025121222490556000_12.2.e054121.39","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000511"},{"key":"2025121222490556000_12.2.e054121.40","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-0872-x"},{"key":"2025121222490556000_12.2.e054121.41","unstructured":"South Africa National Department of Health . Guidelines for the provision of pre-exposure prophylaxis (PreP) to persons at substantial risk of HIV infection 2020."},{"key":"2025121222490556000_12.2.e054121.42","unstructured":"National AIDS & STI Control Program . Framework for the implementation of pre-exposure prophylaxis of HIV in Kenya. Kenya Ministry of health, 2017. Available: https:\/\/prep.nascop.org\/policies-and-guidelines\/"},{"key":"2025121222490556000_12.2.e054121.43","unstructured":"Zimbabwe Ministry of Health and Child Care . Implementation plan for HIV pre-exposure prophylaxis in Zimbabwe, 2017. Available: http:\/\/www.mohcc.gov.zw\/index.php?option=com_content&view=article&id=189&Itemid=732"},{"key":"2025121222490556000_12.2.e054121.44","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25296","article-title":"The role of costing in the introduction and scale\u2010up of HIV pre\u2010exposure prophylaxis: evidence from integrating PreP into routine maternal and child health and family planning clinics in Western Kenya","volume":"22","author":"Roberts","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"2025121222490556000_12.2.e054121.45","unstructured":"WHO . Updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring. WHO, 2021."},{"key":"2025121222490556000_12.2.e054121.46","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0000000000000597"},{"key":"2025121222490556000_12.2.e054121.47","doi-asserted-by":"crossref","first-page":"3871","DOI":"10.1007\/s10461-021-03229-5","article-title":"Acceptability and feasibility of Pharmacy-Based delivery of pre-exposure prophylaxis in Kenya: a qualitative study of client and provider perspectives","volume":"25","author":"Roche","year":"2021","journal-title":"AIDS Behav"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-054121","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T06:49:16Z","timestamp":1765608556000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-054121"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2]]},"references-count":47,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,21]]},"published-print":{"date-parts":[[2022,2]]}},"alternative-id":["10.1136\/bmjopen-2021-054121"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-054121","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2021-054121.supp1","asserted-by":"subject"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2]]}}}