Rapid HIV testing in community pharmacies: Perspectives of retail pharmacists

Background: The role of the community pharmacists has shifted from being a dispenser of medications to an active health care team member involved in public health. Practice changes (immunizations, Medication Therapy Management (MTM) services, counseling, and health education) have become part of the duties of community pharmacists. HIV disease is a major U.S. public health issue. About 20% of infected people are unaware of their status and 40% of people testing HIV-positive do so very late in the disease process. Early diagnosis and access to treatment of HIV could substantially reduce transmission. Rapid CLIA-waivered HIV tests are available and used extensively by health departments and community organizations. Community pharmacies could be a non-stigmatizing and accessible venue for rapid HIV testing; however, very little is known about the attitudes of community pharmacists towards this idea. Methods: Key informant interviewing was chosen to explore complex issues associated with HIV testing in pharmacies. Licensed community pharmacists in Indiana were recruited through personal networks, pharmacy school faculty contacts, and state pharmacy organizations. Interviews lasting 20-60 minutes were conducted with 17 participants between May and September, 2012. Results: In general, participants felt that the idea of pharmacy-based HIV testing was acceptable, due to the accessibility and convenience of community pharmacies. Participants recognized the public health benefit of pharmacy based HIV testing. The pharmacist-patient relationship figured prominently when participants discussed advantages to testing. Staffing issues, unfamiliarity or discomfort with delivering results to patients, lack of existing training, and issues of reimbursement were named as barriers. Participants discussed feasibility of pharmacy based HIV testing in terms of professional adjustment to providing testing and ways testing might be operationalized in pharmacies. The shift to pharmacy-based immunizations served as a reference point for practice adjustment. Participants felt that it would be feasible to offer testing in settings with private consultation rooms where confidentiality could be assured. Readiness to implement HIV testing was discussed in terms of whether pharmacies had experience providing augmented services. Most participants felt that, with sufficient training and support, they could offer testing services; occasionally they expressed doubts about the readiness of their pharmacist-peers. Conclusion: Although there are challenges to offering rapid HIV testing in community pharmacy settings, Indiana community pharmacists felt that, with changes in pharmacy infrastructure and management support, testing was acceptable and feasible. Pharmacists require training before testing could be implemented.