Investigating the Potential Accessibility to HIV Pre-Exposure Prophylaxis viaCommunity Pharmacies and Sexual Health Clinics: A Scoping Review of Two Integrated Care Systems in London

Background HIV prevalence in North West London (NWL & NCL) & North Central London is either high or very high for England across the eight boroughs. Despite advancements in HIV prevention, barriers and disparities in accessing Pre-exposure Prophylaxis (PrEP) from specialist services persist. Community pharmacies, with their extensive reach in London, offer an opportunity to reduce these disparities and help end new HIV infections Objective This study aims to investigate the accessibility of HIV PrEP through community pharmacies and sexual health clinics (SHCs) across two London Integrated Care Systems (ICS) and assess the potential for community pharmacies to enhance access to PrEP and to address existing gaps in PrEP provision to gauge the potential for community pharmacies to facilitate easier access to PrEP. Methods We mapped the distribution of pharmacies, PrEP clinics, and SHCs across 11 local authority areas in London, covering NWL ICS and three catchment areas from NCL ICS using publicly available data, including postcode data. Our selection process for sources of evidence was guided by a set of predefined criteria aimed at identifying community pharmacies and SHCs within the targeted ICSs for their relevance to HIV PrEP accessibility. Two reviewers systematically charted data from each included source. Information extracted included the name of the pharmacy or clinic, address, contact details and operating hours. Results Our data collection, spanning from April to July 2022, included 692 community pharmacies. The study revealed that 78.4% of these pharmacies offered sexual health services, with a significant proportion categorised at Tier 2 according to the Umbrella Sexual Health Model, indicating they are well-positioned to offer PrEP services. The mapping showed an uneven distribution of PrEP and sexual health clinics, with community pharmacies widely accessible and offering longer service hours. Conclusion The findings highlight the critical role community pharmacies could play in providing PrEP, addressing gaps in accessibility, and reducing HIV transmission risks, thus potentially facilitating easier access to PrEP. This study supports the need for policy adjustments to enable community pharmacies to dispense PrEP, aligning with public health goals for broader access to HIV preventative measures.