{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:09:18Z","timestamp":1788890958161,"version":"build-2803163510"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","award":["WHO registration: 2023\/1363112-0"],"award-info":[{"award-number":["WHO registration: 2023\/1363112-0"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43 TW-011324"],"award-info":[{"award-number":["D43 TW-011324"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In 2024, only 3,451 individuals accessed free oral HIV pre-exposure prophylaxis (PrEP) at government clinics in Malaysia, despite an estimated 354,000 key population members who could benefit from PrEP. To inform pre-implementation refinement of a pharmacy-led PrEP service delivery model, we explored stakeholder perspectives on implementing the model within private community pharmacies in Malaysia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A one-day stakeholder consultation was conducted in April 2023 in Kuala Lumpur with 28 stakeholders representing community pharmacies, professional societies, telemedicine providers, non-governmental organizations (NGOs), and HIV implementation science researchers. The meeting began with a review of preliminary findings from formative qualitative research involving key populations, community pharmacists, and PrEP prescribers. Through facilitated discussions, stakeholders identified short- and long-term solutions to implementation barriers. Stakeholder inputs from discussions and structured worksheets were synthesized descriptively to identify recurring implementation considerations that informed refinement of the pilot model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Key implementation considerations included enhancing awareness and demand generation, ensuring privacy, confidentiality, and affordability, integrating HIV self-testing, using digital checklist-based assessments, simplifying laboratory testing requirements, developing practical workflows supported by a reference guide, strengthening pharmacist training, and fostering cross-sector collaboration. Identified training needs included PrEP fundamentals, eligibility assessment for initiation and continuation, referral procedures, and scenario-based learning. Key competencies included knowledge of HIV and sexually transmitted infections, risk assessment, professional conduct, and person-centered communication. Six study sites were selected, with preparation requirements including HIV self-test kits, PrEP medications, informational materials, trained pharmacists, telemedicine subscriptions, and nearby referral clinics. The consultation informed refinements to the implementation plan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This stakeholder consultation informed refinement of a pharmacy-led PrEP service delivery model for pilot implementation in Malaysia and identified practical implementation considerations related to privacy, affordability, HIV self-testing, physician-pharmacist coordination, training, and referral systems. The findings may inform future implementation planning for similar urban, private-sector PrEP delivery models.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0357920","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T17:41:39Z","timestamp":1788889299000},"page":"e0357920","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stakeholder-informed pre-implementation refinement of a pharmacy-led pre-exposure prophylaxis (PrEP) service delivery model in Malaysia"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5558-243X","authenticated-orcid":true,"given":"Yan Nee","family":"Gan","sequence":"first","affiliation":[{"name":"Universiti Malaya","place":["Kuala Lumpur, Malaysia"],"department":["Department of Social and Preventive Medicine, Faculty of Medicine"]},{"name":"Ministry of Health","place":["Putrajaya, Malaysia"],"department":["Malaysian Health Technology Assessment Section (MaHTAS)"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sin How","family":"Lim","sequence":"additional","affiliation":[{"name":"Universiti Malaya","place":["Kuala Lumpur, Malaysia"],"department":["Department of Social and Preventive Medicine, Faculty of Medicine"]},{"name":"Centre of Excellence for Research in Infectious Diseases and AIDS (CERiA), Universiti Malaya","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7860-693X","authenticated-orcid":true,"given":"Frederick L.","family":"Altice","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Research in Infectious Diseases and AIDS (CERiA), Universiti Malaya","place":["Kuala Lumpur, Malaysia"]},{"name":"Yale School of Medicine","place":["New Haven, Connecticut, United States of America"],"department":["Section of Infectious Disease, Department of Internal Medicine"]},{"name":"Yale School of Public Health","place":["New Haven, Connecticut, United States of America"],"department":["Division of Epidemiology of Microbial Diseases"]},{"name":"Center for Interdisciplinary Research on AIDS (CIRA), Yale University","place":["New Haven, Connecticut, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharifah Khadijah","family":"Syed Razif","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Research in Infectious Diseases and AIDS (CERiA), Universiti Malaya","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9528-5624","authenticated-orcid":true,"given":"Mariani","family":"Ahmad Nizaruddin","sequence":"additional","affiliation":[{"name":"University of Cyberjaya","place":["Cyberjaya, Selangor, Malaysia"],"department":["Department of Community and Pharmacy Practice, Faculty of 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Accessed 2024 January 15. https:\/\/www.doc2us.com\/"},{"key":"pone.0357920.ref036","unstructured":"Alpro Pharmacy. About us: corporate profile. 2002. 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