Developed Protocol Can Identify, Describe Impact of Expanding PrEP Access

The formulation of a protocol depicting and identifying the potential effect of expanding access to pre-exposure prophylaxis (PrEP) and other HIV prevention services across pharmacies revealed that there are more available pharmacies in the US than there are facilities that prescribe PrEP, indicating a potential gap in services that can be used to expand access to PrEP.¹

HIV in the US continues to spread each year, with 31,800 new cases in 2022.² Although the spread is slower than it used to be, eliminating HIV in the country can only be achieved through accessible means of obtaining HIV prevention methods, such as PrEP, which has 99% efficacy in preventing the spread of HIV. Despite its efficacy, uptake of PrEP is low across the US, especially in those who are most at risk. Improving the ability of pharmacies to stock and distribute PrEP could help address this low uptake. This study aimed to assess the potential reach of pharmacies in the US, identifying gaps in access to PrEP and the impact of expanding PrEP access to pharmacies.

The researchers of this study created maps to visualize the gaps in coverage for PrEP and pharmacy locations. The National Council for Prescription Drug Programs was used to collect locations of pharmacies across the US. The National Prevention Information Network was used to collect the locations of facilities that prescribed PrEP. Both of these databases included street addresses for each pharmacy or facility. The Google application programming interfaces were used to map street addresses to latitude and longitude coordinates to geocode all pharmacies and facilities. Cases of HIV were counted using the AIDSVu database.

The maps the researchers created spanned all 50 states, with 1 US territory and 54 cities. The researchers found that there was more accessibility to pharmacies across the country compared with facilities that prescribed PrEP. Areas of high caseloads of HIV also had more accessibility to pharmacies compared with facilities that prescribed PrEP across state, county, and zip code levels.

The mean PrEP facility-to-need ratio (PfnR) for pharmacies was 0.04 in Mississippi, the lowest among the 50 states, whereas Alaska had the highest ratio at 1.3. However, these ratios were higher than the mean PfnRs for PrEP facilities, which ranged from 0.0004 in Puerto Rico to 0.19 in Alaska. Fold increases were greatest in states in the Midwestern and Southern regions of the US.

There were some limitations to this study. Some states lacked data on HIV cases per 100,000 at the county or zip code level, which could have affected the results. Comparisons across different spatial scales could not be done due to the differences in spatial granularity across regions. Variations in state regulations regarding the ability of pharmacies to deliver PrEP were not accounted for in the estimates, making implementation less feasible.

“By providing a data-driven framework to visualize PrEP access gaps and estimate the potential of pharmacy-based delivery, this protocol offers a practical tool for public health agencies, policymakers, and health systems to guide resource allocation,” the authors concluded.

References

1. Harrington KRV, Hamilton C, Alohan DI, Hudson A, Young HN, Crawford ND. The PrEP pharmacy reach study: protocol for the creation of maps to visualize the impact of expanding access to prevention services through pharmacies. JMIR Public Health Surveill. 2025:11:e75077. doi:10.2196/75077

2. The HIV/AIDS epidemic in the United States: the basics. KFF. Updated October 9, 2024. Accessed October 28, 2025. https://www.kff.org/hiv-aids/the-hiv-aids-epidemic-in-the-united-states-the-basics/