Analysis of pharmaceutical practice in HIV pre-exposureprophylaxis: contributions to access and equity in Brazil
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Keywords
access to health, pharmaceutical care, HIV, pre-exposure prophylaxis, vulnerability
Abstract
Despite the expansion of pre-exposure prophylaxis (oral PrEP) in Brazil, the comparative impact of pharmacists on access, continuity, and equity of care among vulnerable populations remains poorly understood. This study aimed to investigate the role of pharmacists in prescribing and monitoring oral PrEP for HIV in Brazil, comparing their performance with other health professionals across different healthcare contexts and analyzing their influence on continuity and equitable access. A cross-sectional analysis was conducted using data from the Medicines Logistics Control System (Siclom) from 2018 to 2023. Variables included users’ sociodemographic profiles, type of healthcare service (public or private), and the professional category responsible for PrEP follow-up. Associations were assessed using Pearson’s chi-squared test. By December 2023, 57,625 individuals met the inclusion criteria. Pharmacists were responsible for 1.7% of follow-ups, with 99.3% of these users linked to public services. In Testing and Counseling Centers, pharmacists monitored 49.4% of users, compared to 27.9% by other professionals. In Specialized Services, follow-up rates were 46.4% for pharmacists and 61.2% for other healthcare providers. Among users who received PrEP in the past 12 months, 76.3% remained in active follow-up with a pharmacist, while only 54.1% remained active under other professionals. The proportion of pharmacist-led follow-ups was higher among Black individuals (15.5%) and among gay and other cisgender men who have sex with men (MSM), reaching 84.2%. Regionally, 80.4% of users monitored by pharmacists lived in the Southeast, compared to 59.9% of those assisted by other professionals. Among users still on PrEP in 2023, 80.6% were managed by pharmacists and 78.4% by others. These findings reinforce the essential role of pharmacists in expanding access to PrEP and promoting equity, especially among populations most vulnerable to HIV. As the first national study to compare pharmacists to other professionals in a large cohort, the results highlight the need for policies and training to strengthen pharmaceutical practice in Brazil’s HIV prevention efforts.
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