Public attitudes toward pharmacy-based HIV PrEP in the UK: a national cross-sectional study of 15,000 NHS patients

Background HIV pre-exposure prophylaxis (PrEP) is highly effective, yet uptake in the UK remains suboptimal. Community pharmacies could be accessible venues for PrEP delivery but public acceptability is poorly understood. We examined awareness, attitudes and support for pharmacy-based provision among NHS patients. Methods We conducted a national cross-sectional online survey of 15,071 adults recruited through general practices in England (October 2022-October 2023). The questionnaire captured demographics, PrEP awareness, attitudes and preferences for access. Descriptive statistics, multivariable logistic regression and joint correspondence analysis (JCA) were used to assess predictors of PrEP awareness and support for pharmacy-based delivery. Findings Overall, 37·2% of all respondents had heard of PrEP only 1·8% reported use and 66·9% did not know that PrEP can prevent HIV. Awareness was lower among heterosexual individuals (adjusted odds ratio [aOR] 0·36, 95% CI 0·31, 0·42), women (aOR 0·56, 0·49, 0·65) and older adults (≥ 65 years: aOR 0·41, 0·33, 0·51). Nearly two-thirds (63·5%) expressed interest in learning more about PrEP. Pharmacies were rated the most convenient access point by 51·2% of respondents and 60·8% supported pharmacy-based provision. JCA revealed a polarity between a “traditional” cluster (older, heterosexual, White, partnered men; low awareness and support) and a “diverse” cluster (younger, non-binary, bisexual or pansexual, single individuals; high awareness and support). Interpretation Despite low baseline awareness, there is strong public interest in PrEP and substantial support for pharmacy-based provision. Expanding PrEP through community pharmacies could reduce access barriers and advance equity, particularly for groups underserved by sexual health clinics. These findings support policy reforms enabling pharmacists to deliver PrEP as part of the UK’s HIV elimination strategy.