Translating Evidence into Action: Novel modeling approaches to understand the efficacy of pharmacy-based PrEP

The underutilization of Pre-Exposure Prophylaxis (PrEP)1–5 in the US stems from a perfect storm of social, health, political, and economic factors contributing to low uptake and retention.6–14 A variety of pharmacist-led PrEP models have demonstrated feasibility and success.15–22 However, most states limit the pharmacists’ scope of practice.23 This project will prove a theory-based, multi-level, longitudinal analysis of expanding the scope of practice of pharmacists implemented to promote PrEP uptake with attention to their longer-term impacts on retention to care and their economic impact. This complex dynamic will be examined through a multi-source, national analysis of datasets. The project’s cutting-edge methods include causal inference techniques of staggered difference-in-differences24,25 and agent-based modeling26, to gauge the evolution of PrEP use vis-à-vis pharmacists’ scope of practice laws. The project proposes three aims: Aim 1 will integrate existing policy, census, survey, and medical claims data to assess the longitudinal impacts of the scope of practice laws on PrEP initiation, abandonment, retention, and new HIV diagnoses among the US population. Aim 2 will assess the economic impact of expanding the scope of practice of pharmacists as well as under what conditions (e.g., training requirements, limits on quantities of PrEP supply, or reimbursement rules) they might become most economic. Aim 3 will produce modeling innovations and an automated decision support system that will enable health departments and public health professionals involved in changing policies to analyze how expanding the scope of practice of pharmacists might promote PrEP access and outcomes. The project will gather existing, dispersed, often untapped sources of data from individuals, communities, and states (e.g., policies), thus producing new synergies and maximizing the use of research resources. This innovative application responds to RFA-MH-25-185 (Advancing HIV service delivery through pharmacies and pharmacists) and will leverage ongoing efforts by an outstanding interdisciplinary, multi-regional team of scholars with expertise in economics, computational methods, pharmaceutical sciences, psychology, communication, public health, law, and public policy in a world-class institutional environment. A policy network with representatives from 9 states across the nation (AZ, CO, IL, MN, NY, PA, TX, VA, and UT) will inform the project and use the recommendation tools. If successful, the project could inform future policy decisions to improve public health outcomes related to HIV prevention.