Pharmacist-Provided HIV Testing in Two Community Pharmacies
Pharmacist-Provided HIV Testing in Two Community Pharmacies
A pharmacist-provided HIV testing model was developed and implemented at two community pharmacies from October 2011 to March 2013. Investigators met with HIV care providers in each community to guide development of the model, including referral plans for confirmatory HIV testing. For Site 1, this included referral to a student health center, physicians group, or health department. For Site 2, the pharmacist planned to contact a health department representative for referral, who agreed to come to the pharmacy within 45 minutes to perform onsite confirmatory HIV testing.
Pharmacists (two at site 1 and three at site 2) received onsite training on HIV test procedures from the manufacturer's representative and on HIV test counseling (based on a course provided by the Midwest AIDS [acquired immunodeficiency syndrome] Training and Education Center) from the study principal investigator, an HIV-specialized clinical pharmacist.
Both study locations were independent pharmacies that were open weekdays, had a private counseling room available, and already offered various clinical services. Site 1, which dispensed approximately 40 prescriptions daily with one full-time pharmacist, was situated on a college campus in a large urban setting with an HIV prevalence rate of 981 cases per 100,000 population (Detroit, MI). Site 2, which dispensed approximately 225 prescriptions daily with two full-time pharmacists, was situated within an academic medical center in a smaller urban community with an HIV prevalence rate of 167 per 100,000 population (Kalamazoo, MI). Each pharmacy maintained a valid Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver on file throughout the study.
Institutional Review Board (IRB) approval was obtained at Wayne State University and Bronson Methodist Hospital. Northwestern University served as the data-coordinating center; the study was exempted from its IRB purview.
Pharmacy consumers were not directly offered HIV testing. Each pharmacy implemented marketing strategies to notify consumers and community residents of the opportunity for HIV testing, including posters readable from outside the pharmacy, postcards distributed with prescriptions or purchases ("bag stuffers"), flyers at nearby businesses, information on the pharmacy websites and Facebook pages, and a news release. A CDC-issued pamphlet (HIV Screening. Standard Care) was also displayed in the pharmacy waiting area.
Interested participants presented to the pharmacy during advertised HIV testing walk-in hours, approximately 10:00 AM to 4:00 PM on 2 days per week, or contacted the pharmacist to schedule an appointment. Eligible participants were at least 18 years old. Participants were excluded if they had a known HIV positive status or were unable to wait for the HIV test result.
After obtaining study informed consent, the pharmacist performed a rapid HIV test, free of charge, using the CLIA-waived Uni-Gold Recombigen HIV-1/2 test on whole blood by fingerstick, which provided results within 10–12 minutes. The pharmacist provided pretest and posttest counseling guided by national and state recommendations. Participants completed a series of deidentified data collection forms during and after testing to facilitate data collection for study outcome measures.
This pilot study evaluated the number of HIV tests performed, time required for HIV testing services; characteristics of the population tested, including demographics, medical history, HIV risk factors, and HIV testing history; pharmacist and participant perceptions of the HIV testing experience; and participant willingness to pay for an HIV test.
Descriptive statistics were used to evaluate study endpoints. Likert-type responses were summarized by frequencies. Data were analyzed using SAS version 9.2 (SAS Institute Inc., Cary, North Carolina).
Methods
Practice Innovation
A pharmacist-provided HIV testing model was developed and implemented at two community pharmacies from October 2011 to March 2013. Investigators met with HIV care providers in each community to guide development of the model, including referral plans for confirmatory HIV testing. For Site 1, this included referral to a student health center, physicians group, or health department. For Site 2, the pharmacist planned to contact a health department representative for referral, who agreed to come to the pharmacy within 45 minutes to perform onsite confirmatory HIV testing.
Pharmacists (two at site 1 and three at site 2) received onsite training on HIV test procedures from the manufacturer's representative and on HIV test counseling (based on a course provided by the Midwest AIDS [acquired immunodeficiency syndrome] Training and Education Center) from the study principal investigator, an HIV-specialized clinical pharmacist.
Study Setting
Both study locations were independent pharmacies that were open weekdays, had a private counseling room available, and already offered various clinical services. Site 1, which dispensed approximately 40 prescriptions daily with one full-time pharmacist, was situated on a college campus in a large urban setting with an HIV prevalence rate of 981 cases per 100,000 population (Detroit, MI). Site 2, which dispensed approximately 225 prescriptions daily with two full-time pharmacists, was situated within an academic medical center in a smaller urban community with an HIV prevalence rate of 167 per 100,000 population (Kalamazoo, MI). Each pharmacy maintained a valid Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver on file throughout the study.
Institutional Review Board (IRB) approval was obtained at Wayne State University and Bronson Methodist Hospital. Northwestern University served as the data-coordinating center; the study was exempted from its IRB purview.
Study Population and Procedures
Pharmacy consumers were not directly offered HIV testing. Each pharmacy implemented marketing strategies to notify consumers and community residents of the opportunity for HIV testing, including posters readable from outside the pharmacy, postcards distributed with prescriptions or purchases ("bag stuffers"), flyers at nearby businesses, information on the pharmacy websites and Facebook pages, and a news release. A CDC-issued pamphlet (HIV Screening. Standard Care) was also displayed in the pharmacy waiting area.
Interested participants presented to the pharmacy during advertised HIV testing walk-in hours, approximately 10:00 AM to 4:00 PM on 2 days per week, or contacted the pharmacist to schedule an appointment. Eligible participants were at least 18 years old. Participants were excluded if they had a known HIV positive status or were unable to wait for the HIV test result.
After obtaining study informed consent, the pharmacist performed a rapid HIV test, free of charge, using the CLIA-waived Uni-Gold Recombigen HIV-1/2 test on whole blood by fingerstick, which provided results within 10–12 minutes. The pharmacist provided pretest and posttest counseling guided by national and state recommendations. Participants completed a series of deidentified data collection forms during and after testing to facilitate data collection for study outcome measures.
Main Outcome Measures
This pilot study evaluated the number of HIV tests performed, time required for HIV testing services; characteristics of the population tested, including demographics, medical history, HIV risk factors, and HIV testing history; pharmacist and participant perceptions of the HIV testing experience; and participant willingness to pay for an HIV test.
Statistical Analysis
Descriptive statistics were used to evaluate study endpoints. Likert-type responses were summarized by frequencies. Data were analyzed using SAS version 9.2 (SAS Institute Inc., Cary, North Carolina).
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