A pharmacist-delivered pre-exposure prophylaxis (PrEP) program operating within a sexually transmitted infection (STI) clinic in the County of Santa Clara, California, aims to improve access to PrEP by providing an additional community-based option. PrEP pharmacists assess patients for, and prescribe, PrEP with the assistance of PrEP navigators who can provide additional supports. Over the course of the program, there were 2,812 encounters with the PrEP pharmacists, and 545 unique patients initiated PrEP; 69% of these patients also accessed PrEP navigation services. There was a three-fold increase in the number of encounters with the PrEP pharmacists from 2018 (216) to 2023 (608), showing that interest and participation in the program grew over the study period.
Program description
In the pharmacist-delivered PrEP program in the County of Santa Clara, California, pharmacists work with PrEP navigators to provide PrEP services out of an STI clinic. The program prioritizes serving uninsured patients. Most patients are Spanish speaking, Hispanic/Latinx and members of the LGBTQIA+ community. Pharmacists assess patients for, and prescribe, PrEP, and navigators provide support by helping people to enrol in payment assistance programs, by scheduling initial and follow-up PrEP appointments and by providing counselling, referrals and translation services (among other services).
People can be referred to the PrEP STI clinic by a PrEP navigator, through self-referral or through referral from another provider. Once a person is referred, an initial appointment is scheduled with a PrEP pharmacist. The PrEP pharmacist conducts the following steps with the patient at their initial appointment, either face to face or by phone:
- Gather a sexual and social history including assessment of behaviours (e.g., condom use, injection drug use)
- Gather a list of current medications and/or supplements taken by the patient
- Document any allergies or past adverse reactions to medications
- Gather relevant medical history such as renal, liver or bone disorders
- Order needed laboratory tests (e.g., HIV and STI tests, liver and kidney function tests)
- Provide patient education and counselling on HIV, PrEP and safe sex practices
PrEP navigators can facilitate these steps before they link a patient to a PrEP pharmacist, to help streamline the process. For follow-up appointments and ongoing care, the PrEP pharmacist repeats steps 1–3 and 5–6 (usually every three months). Additionally, patients can be offered recommended vaccines (e.g., mpox, hepatitis A and B, human papillomavirus [HPV], influenza) from the pharmacists during any visit.
Results
Between January 2017 and December 2023, a total of 545 patients initiated PrEP at the STI clinic through a PrEP pharmacist; there were a total of 2,812 encounters. Patients identified as Hispanic or Latino (61%), Asian (21%) and another race/ethnicity (18%). Most identified as male (97%) and were between 25 and 44 years old (72%). There was a steady increase in the number of people who used the services of the PrEP pharmacist over the course of the program, ranging from 216 encounters in 2018 to 608 encounters in 2023. This amounts to a three-fold increase in PrEP program use over five years.
Of the 545 patients seen by a PrEP pharmacist, 379 (69%) received PrEP navigation services before connecting with the pharmacist. Patients in this group identified as Hispanic or Latino (65%), Asian (20%) and another race/ethnicity (16%). Most identified as male (97%) and were between 25 and 44 years old (71%).
Of the patients who accessed the program through a PrEP navigator, 60% reported a history of a recent bacterial STI infection (i.e., chlamydia, gonorrhea and/or syphilis); 100% had known behavioural risk factors for HIV (including 51% who reported condomless sex). Patients rated their knowledge of PrEP before PrEP initiation on a 1- to 5-point scale, with 37% reporting knowledge in the lower range (1 or 2 out of 5); 14% reported higher knowledge (4 or 5 out of 5) (15% reported knowledge in the mid range [3 out of 5], and 34% did not have data available).
What does this mean for service providers?
This program shows that use of a PrEP pharmacist alongside a PrEP navigator at an STI clinic can be an effective way to deliver PrEP and improve comfort in seeking PrEP services among priority populations. PrEP care delivered by community-based pharmacists and navigators in STI clinics may be less stigmatizing than in more traditional settings (e.g., primary care settings). Additionally, pharmacists are in a unique position to address any concerns related to PrEP medications because of their roles in educating patients on medication use (e.g., safety, adherence, side effects) and can see patients at regular intervals for follow-up testing and to answer questions.
Related resources
PrEP among homeless-experienced people who use drugs – CATIE evidence brief
Engagement of people who use drugs at needle and syringe programs to increase PrEP uptake – CATIE evidence brief
Same-day HIV Pre-Exposure Prophylaxis in an urban sexually transmitted infection clinic – CATIE evidence brief
Reference
Agroia H, Mousli L. Evaluation of an HIV pre-exposure prophylaxis navigation and pharmacist-delivered clinical services model implemented at a municipal sexually transmitted infections clinic, 2017–2023. Journal of the American Pharmacists Association. 2026;66(3):103064.