After bringing aboard a collaborative drug therapy management (CDTM) pharmacist, the nation's largest public health system saw gains in the efficiency of the EquiPrEP program, a project to provide long-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) to vulnerable patients in the New York City area.
Anthony Gerber, the project’s CDTM pharmacist, said his interventions appeared to reduce the time required to resolve prior authorization requests and to enroll eligible EquiPrEP participants in financial assistance programs.
EquiPrEP, a collaborative implementation science-based project for patients at NYC + Health and the Bellevue Pride Center, ran for 15 months in 2023 and 2024. The project’s study protocol was published in PLOS One in September 2023.
Gerber joined the EquiPrEP team about nine months after the initiative's launch. To evaluate the effects of his interventions, Gerber compared specific PrEP initiation outcomes before and after he began providing CDTM services.
The analysis included 122 patients, about 65% of whom had enrolled in EquiPrEP before the clinical team was expanded to include a CDTM pharmacist. After Gerber began managing prior authorization requests and appeals, the time to LAI-PrEP initiation dropped from 5 days to 2 days, on average.
“That was big; those three days are a big barrier for a lot of patients,” Gerber said.
In addition, the average time between PrEP initiation and enrollment in patient assistance programs decreased from 22 days to 17 days, on average, after patients began receiving CDTM pharmacy services.
“Another thing that did decrease was intake time — the time from when they saw the provider, to their first injection, and when they saw the CDTM pharmacist for that first appointment,” Gerber noted.
Gerber presented his findings during a poster session at the 2024 ASHP Midyear Clinical Meeting & Exhibition in New Orleans, Louisiana. The poster data suggested a potential key role for CDTM pharmacists in LAI-PrEP programs but also emphasized the need for confirmatory studies to assess the scalability and long-term benefits of integrating CDTM pharmacists into HIV prevention initiatives.
EquiPrEP’s main goal was to optimize the use of cabotegravir extended-release injectable suspension — a bimonthly LAI-PrEP formulation that was approved in 2021 — in three target populations: Black and Latine men who have sex with men (MSM), Black and Latine cisgender women, and transgender women and nonbinary people.
When used appropriately, LAI-PrEP is considered broadly effective for preventing HIV infection in sexually active patients, regardless of their risk of infection.
Gerber said that despite the known efficacy of LAI-PrEP, not enough clinicians prescribe it, and too few people who could benefit from the medication are taking it. He said insurance hurdles and educational gaps among clinicians can be barriers to more widespread use of LAI-PrEP, especially among EquiPrEP’s targeted populations.
“Our idea was, how do we promote and adopt some of these new evidence-based prevention practices into our facilities,” said Gerber, who provides HIV prevention and treatment services to patients at Bellevue’s virology and Pride clinics. “So I worked with this for EquiPrEP, and I also worked with it in my gender-affirming hormone therapy patients.”
Gerber said it’s essential for clinicians to help their patients anticipate and manage adverse events, such as injection-site reactions, that can affect PrEP adherence.
“I think pharmacists are really uniquely positioned to do that education component, because they know the drugs, they know exactly how the drugs are administered, they know the pharmacology,” Gerber said. “That goes a long way toward keeping the patients retained in care and keeping them adherent to medications.”
Oral and injectable HIV PrEP products are indicated for use by adolescents and adults who weigh at least 35 kg. The Centers for Disease Control and Prevention (CDC) advises clinicians to prescribe PrEP to any adult or adolescent who asks for it, regardless of their HIV risk factors, and to discuss PrEP with all sexually active patients.
About 32,200 new U.S. HIV infections occurred in people age 13 years or older in 2022, according to CDC’s most recent surveillance data. Although men accounted for 81% of the new infections, the overall infection rate for men fell by 12% from 2018 through 2022. The infection rate was flat for women, suggesting a need to improve HIV prevention in this population.
Federal data also highlight racial disparities in HIV infection. From 2018 through 2022, white people 13 years and older represented 61% of the U.S. population and accounted for 24% of new HIV infections. Black, Hispanic, and Latino people collectively represented 30% of the U.S. population and 70% of new HIV infections.
Gerber indicated that although EquiPrEP’s outreach appeared effective for several high-risk, underrepresented populations, the project did not fully meet its total enrollment goal of 210 patients.
“The majority of our patients were Black and Latine and MSM,” he said. “The cisgender women was a hard group to target. And we’re looking into why that is.”
He said the biggest takeaway from EquiPrEP is that many vulnerable patients still don’t get the care they need to reduce their risk of infection and help turn the tide of the national HIV epidemic.
“I think we, as pharmacists or healthcare providers, really need to spend a little more time focusing on vulnerable populations,” he said. “Because those are the ones that are going to affect all our patients in the long run.”
