By Gina Shaw
Adding a collaborative practice agreement with pharmacists significantly accelerated initiation of long-acting, injectable pre-exposure prophylaxis (LAI-PrEP) for people at greatest risk for HIV infection, reported investigators with the EquiPrEP study at the ASHP Midyear 2024 Clinical Meeting & Exhibition, in New Orleans (poster 8-056).
EquiPrEP is an equity implementation science study launched in 2023 at Bellevue Hospital, in New York City, focused on increasing LAI-PrEP initiation, particularly among groups that are disproportionately affected by the HIV epidemic. “These populations include Black and Latino men who have sex with men [MSM], transgender and gender non-binary individuals, as well as cisgender women who are often not offered PrEP services in primary care,” said lead author Anthony Gerber, PharmD, a clinical pharmacist. When completed in 2025, the EquiPrEP study is expected to help evaluate the social determinants of health that are affecting patient care and why patients may be unable to access PrEP or are discontinuing treatment.
EquiPrEP launched in February 2023, but Dr. Gerber did not join the team until September 2023. Previously, the team’s medical doctor and patient navigator were responsible for the medication acquisition process. “They found that there was quite a delay from prescribing LAI-PrEP to the patient actually getting it, due to barriers such as insurance coverage and prior authorization [PA] restrictions,” Dr. Gerber said. “Many of our patients are uninsured, so they would have to get enrolled on patient assistance programs. When I joined the team, I worked to ensure that these barriers to care were eliminated, or at least lessened.”
Under a collaborative drug therapy management (CDTM) practice agreement, Dr. Gerber is authorized to prescribe LAI-PrEP.
The analysis included patients enrolled in EquiPrEP between Feb. 10, 2023 and May 20, 2024, and divided them into two groups: those who enrolled in the program before implementation of a CDTM pharmacist (Feb. 10, 2023 to Sept. 21, 2023), and those who enrolled after it (Sept. 22, 2023 to May 20, 2024). A total of 122 patients were included, with 79 (64.8%) patients enrolled before the implementation of CDTM pharmacist services and 43 (35.2%) patients afterward.
The time to PA approval decreased by more than 50% following the addition of a CDTM pharmacist, from five to two days (P=0.015). Additionally, there was a significant decrease in time to PrEP assistance programs with CDTM pharmacist involvement (P=0.021). Of the patients managed by a CDTM pharmacist, 10 were started on LAI-PrEP, with an average of 2.6 visits per patient to ensure proper initiation and follow-up. The time from intake appointment to first injection also decreased, but the difference was not statistically significant (P=0.051).
“I was involved in a total of 68 interventions prior to the initiation of first injection, including 42 prior authorizations, 12 letters of necessity or appeal, and 14 barriers to medication adherence addressed,” Dr. Gerber said. “There is also a significant retention in patient care, with 81% of patients seen in the program returning to care. While the EquiPrEP study is still ongoing, we are definitely seeing that the implementation of a pharmacist on the medical team significantly improved these patient barriers but also made sure that the efficacy of the program was intact.”
Dr. Gerber reported no relevant financial disclosures.
