A qualitative exploration of pharmacists and customers barriers and facilitators to community pharmacy PrEP delivery using the COM-B model of behaviour change
Authors: Harrison China , Family Hannah , Kesten Joanna , Denford Sarah , Scott Jennifer , Sabin Caroline A , Copping Joanne , Harryman Lindsey , Cochrane Sarah , Saunders John , Hamilton-Shaw Ross , Horwood Jeremy 
Published: July 2024

Objectives

Expanding delivery of oral Pre-exposure Prophylaxis (PrEP) to community pharmacies could improve access, aligning well with government goals for England to eliminate new HIV acquisitions by 2030. Using the Capability, Opportunity, Motivation, Behaviour (COM-B) model for behaviour change, the aim of this research was to explore the barriers and facilitators of community pharmacy PrEP delivery, for pharmacists and community members.

Methods

Community members at elevated risk of acquiring HIV and community pharmacists were recruited to participate in semi-structured interviews. Interviews were recorded, transcribed, and thematically analysed within the framework of the COM-B model.

Results

17 interviews with pharmacists (pharmacy owners n=7; employed pharmacists n=6; locums n=4) and 24 with community members (Black African women n=6; other women n=2; young adults aged 18-25 years n=6; transgender people n=6; female sex workers n=4) were carried out. Capability barriers included sub-optimal awareness and knowledge of PrEP, pharmacy facilities, and pharmacist roles in delivering public health services. Opportunity barriers included lack of staff capacity, privacy and pharmacy screening and monitoring facilities. Motivational barriers included a concern that increased access could increase sexually transmitted infections and involve a financial cost. Capability facilitators included awareness raising, HIV and PrEP training and education. Opportunity facilitators included PrEP appointments and the accessibility of pharmacies. Motivational facilitators included a preference for pharmacy delivery over other models (e.g., sexual health, GP), and a belief that it would be discrete and less stigmatising.

Conclusion

Pharmacy PrEP delivery is acceptable but for it to be feasible, results point to the need for the development of a behaviour change intervention focusing on education, training and awareness raising, targeting pharmacists and community members to stimulate patient activation and de-stigmatise HIV. This intervention would need to be facilitated by system and environmental changes (e.g., commissioning service).

Key messages

What is already known on this topic

Location, sigma of sexual health clinics and lack of PrEP awareness limits PrEP access for key groups among whom new HIV acquisitions remain high. Previous research and the UK government suggests PrEP provision via community pharmacies as a potential way of improving PrEP access and health equity.

What this study adds

This is the first research study to explore the barriers to and facilitators of pharmacy PrEP delivery for pharmacists and community members in the UK. To increase capabilities and motivation, training and awareness raising is needed. To increase opportunities and motivation, environmental and system level changes are needed.

How this study might affect research, practice or policy

Results point to the acceptability of pharmacy PrEP delivery, but for it to be feasible behaviour change interventions supported by system and environmental changes are needed.