Poster #51 - The Impact of Pharmacist PrEP Prescribing Authority on HIV Prevention and Equity

• In Event: Saturday Poster Luncheon

Abstract

Background: Pre-exposure prophylaxis (PrEP) is a cornerstone of HIV prevention, yet utilization in the United States remains suboptimal and inequitable. While approximately 1.2 million individuals have clinical indications for PrEP, only 18% receive the medication. Traditional delivery models, which rely on specialized infectious disease clinics or primary care physicians, often face significant provider bottlenecks. Long wait times, geographic distance, and the stigma associated with HIV clinics often deter at-risk individuals from seeking care. In response, a growing number of states have turned to task-shifting by granting pharmacists independent prescribing authority. As one of the most accessible healthcare professionals—with 90% of Americans living within five miles of a pharmacy—pharmacists are uniquely positioned to serve as low-barrier entry points for HIV prevention. To address provider bottlenecks, ten states have granted pharmacists independent authority to prescribe PrEP as of 2024. However, evidence remains limited regarding whether these policies effectively reach underserved populations or translate into measurable public health gains, such as reductions in HIV incidence.

Methods: This study utilizes county-level panel data (2016–2024) from AIDSVu and the Area Health Resources Files (AHRF) to evaluate the causal impact of pharmacist independent prescribing authority. To address potential biases in traditional two-way fixed effects (TWFE) models under staggered policy adoption, I employ robust difference-in-differences (DiD) estimators, including the Callaway and Sant’Anna (2020) and Wooldridge (2021) methods. Outcomes include the number of PrEP users, PrEP users per 100,000 residents, the PrEP-to-need ratio (PnR), and new HIV diagnoses, stratified by race, ethnicity, sex, and age.

Results: The analysis reveals that while pharmacist prescribing authority led to a significant overall increase (33 users per 100, population) in PrEP utilization, these gains are not uniform across the population. Specifically:
(1) Demographic Disparities: A significant increase in PrEP uptake was observed among White individuals, males, and younger age groups (specifically those aged <24, 25–34, and 35–44);
(2) Persistent Gaps: No significant increases in utilization were found for female populations, older age groups, or racial and ethnic minority groups (Black and Hispanic/Latino);
(3) Public Health Impact: Despite higher total usage in certain groups, the policy has yet to produce a statistically significant impact on the PrEP-to-need ratio or the number of new HIV diagnoses.

Author

• KUN HUANG, University at Albany
  Presenting Author