Abstract
Background: Sexual health services need to be accessible and acceptable to people seeking testing and prevention services, especially for priority populations and for those who experience stigma and discrimination. Pharmacy-based sexual health service (PbSHS) models are being developed, evaluated, and scaled with the overall goal to improve access to and equity for sexual health care for people living in Canada. We report on participant acceptability of PbSHS with two of these models.
Approach: PbSHS models are developed through ongoing collaboration with researchers, pharmacists and other healthcare providers, public health decision makers, peer associates, and other community partners. In particular, peer associates and community partner team members have been involved since model inception, informing methods and providing meaning to findings from their diverse perspectives.Studies offering pharmacist testing for sexually transmitted and bloodborne infections (STBBIs, the APPROACH 2.0 study) and pharmacist prescribing for preventative therapy for HIV (HIV PrEP, the PrEP-Rx study) were conducted in Alberta (APPROACH), Newfoundland and Labrador (APPROACH), and Nova Scotia (APPROACH and PrEP-Rx).Participants in the APPROACH study chose to receive point-of-care and/or dried bloodspot testing for HIV, hepatitis C and/or syphilis. Pharmacists provided pre- and post-test counselling, and linkage to care for individuals with reactive screening test results. In the PrEP-Rx study, pharmacists assessed participants for eligibility, prescribed PrEP medication, and provided ongoing monitoring for HIV PrEP for a 6-month period. Participants completed voluntary surveys in both studies to provide feedback about their testing experience.Survey items for both studies were based on the Theoretical Framework of Acceptability (TFA) to assess domains of Affective Attitude (AA), Burden (B), Ethicality (E), Intervention Coherence (IC), Opportunity Costs (OC), Perceived Effectiveness (PE), and Self-efficacy (SE). Descriptive statistics were used to analyze, and average ratings for each domain were reported to characterize the level of acceptability. All responses were included in this analysis.
Results: Based on 350 participant records from the APPROACH study and 9 from the PrEP-Rx study, participants reported very high acceptability ratings of the services they received from pharmacists. In APPROACH, high acceptability ratings (90%) were observed in domains AA, E, PE and SE. In PrEP-Rx, high acceptability ratings (90%) were observed for AA, IC, PE and SE. In both studies, OC received the lowest scores, reflecting discordant views on willingness to pay for testing and prevention services at the pharmacy.In both studies, strong positive ratings were expressed around comfort with pharmacist encounters for sexual health services (APPROACH: 97%, PrEP-Rx: 99%), accessibility of pharmacy (APPROACH: 95%, PrEP-Rx: 98%), belief that STBBI testing and HIV PrEP prescribing should always be available in pharmacies (APPROACH: 9%, PrEP-Rx: 99%) and lack of stigma/discrimination faced at the pharmacy (APPROACH: 92%, PrEP-Rx: 96%). Ninety-six percent felt that the pharmacist did a good job administering the test and was qualified to perform and interpret the tests in APPROACH. Ninety-nine percent felt they understood the process of obtaining PrEP from the pharmacist in PrEP-Rx.
Implication: Pharmacy-based, community-informed sexual health services were felt to be highly acceptable among participants. Importantly, services were felt to be accessible, participants did not perceive stigma or discrimination, and they felt comfortable receiving sexual health services through the pharmacy. This evidence can be used to inform scale-up and sustainability of pharmacy-based sexual health services models. Ways to provide these services at no cost to patients may improve equity and access to sexual health care for Canadians.