HIV prevention efforts should support PrEP delivery though community pharmacies

PrEP (pre-exposure prophylaxis), is medicine that prevents acquiring HIV through sex or injecting drugs. In England, PrEP is provided free via NHS sexual health clinics, but these can feel stigmatising, hard to access and limited in capacity. Community pharmacies, could offer a more accessible, and discreet alternative, supporting the UK Government’s goal of ending new HIV transmissions by 2030.

The Accessing PrEP through Pharmacies to Improve HIV Prevention study, the first of its kind in the UK, examined community pharmacy-based PrEP awareness raising and delivery through three components:

1. Review of international evidence on pharmacy PrEP delivery 

We reviewed 56 studies to identify the barriers and facilitators of community pharmacy PrEP delivery, mostly from the USA. 

2. Interviews with UK pharmacists and underserved community members 

We examined the feasibility of community pharmacy PrEP delivery in the UK through interviews with community pharmacists and community members at increased risk of acquiring HIV.

3. Design and implementation of a community pharmacy PrEP delivery pilot 

Between October 2024 and April 2025, five community pharmacies across Bristol North  Somerset South Gloucestershire (BNSSG) piloted oral PrEP awareness raising and initiation (i.e., delivery). NHS policy restrictions prevented on-site dispensing, requiring referral pathways with a local sexual health clinic (see fig 1). 

Figure 1: Pathway for community pharmacy PrEP delivery pilot

Policy recommendations

  • Embed community pharmacies in national HIV prevention strategies and stigma reduction efforts, with inclusion in sexual health training & commissioning guidance.
  • Expand UK pharmacy PrEP pilots to assess scalability, cost-effectiveness, and equity impact.
  • Invest in pharmacy infrastructure, staffing, and on-site screening capacity to support effective service delivery.
  • Introduce streamlined reimbursement for PrEP consultation to incentivise pharmacy participation and ensure sustainability.
  • Develop a national pharmacist PrEP training programme to build confidence and capability.
  • Co-produce public awareness campaigns with underserved communities to help build trust and uptake.
  • Support walk in consultations for PrEP delivery and integrate awareness raising and delivery into existing pharmacy public health services to reach underserved groups, especially those not accessing sexual health clinics or unaware of PrEP.
  • Amend NHS policy to enable pharmacies to stock and dispense PrEP, supported by integrated care models, to enable autonomous supply by trained pharmacists and reduce access delays.
  • Plan for community pharmacy delivery of long-acting injectable PrEP to maximise access, support continued use, and reduce demand on sexual health clinics.

Key findings

  • Awareness of HIV and PrEP was low among pharmacists and community members, including who can benefit and where to access PrEP.
  • Community pharmacies are well-positioned to raise awareness and improve access to PrEP. Pharmacies were valued for their accessibility, extended opening hours, walk-in availability and perceived as less stigmatising than sexual health clinics.
  • Pharmacy teams were keen to deliver PrEP, but needed training, infrastructure, reimbursement and PrEP supply mechanisms. 
  • Pharmacists reported a lack of facilities and capacity to delivery STI and HIV screening required for PrEP initiation and a concern about the potential cost and added workload.
  • Walk-in pharmacy PrEP availability and integration with existing pharmacy public health services can improve convenience, reduce HIV stigma and normalise PrEP delivery.
  • Training increased pharmacists’ PrEP knowledge, confidence in initiating PrEP consultations, and readiness to provide oral PrEP.
  • Pharmacy-based PrEP delivery required integrated care models with sexual health services for training, screening, monitoring, and access to NHS-funded PrEP.
  • Current NHS policy prevented community pharmacies stocking and dispensing NHS-funded PrEP directly, requiring referrals to sexual health clinics to prescribe PrEP, which could cause delays in access.

Conclusions

The study found low PrEP awareness among pharmacists and community members, but strong support for pharmacy delivery as an accessible, trusted, and less stigmatising option. Pharmacy PrEP delivery was shown to be feasible, with training boosting pharmacists’ confidence. With the right policy support, such as enabling pharmacies to stock and dispense NHS PrEP, establishing clear reimbursement mechanisms, integrating care pathways and co-producing public awareness campaigns, this model could significantly reduce PrEP awareness and access inequalities. The introduction of long-acting injectable PrEP offers an additional opportunity to expand pharmacy-based delivery and ease pressure on sexual health clinics.  Acting now will ensure these benefits are realised quickly, helping to end new HIV transmissions in the UK.   

Further information 

Accessing PrEP through pharmacies to improve HIV prevention project page

  1. Harrison, C. R., et al. (2024) Facilitators and barriers to community pharmacy PrEP delivery: A scoping review. Journal of the International AIDS Society.
  2. Harrison, C. R., et al (2024) A qualitative exploration of the barriers and facilitators to community pharmacy PrEP delivery for UK pharmacists and underserved community members using the COM-B model of behaviour change. Sexually Transmitted Infections.
  3. Harrison, C. R., et al (2025). Development and implementation of pharmacy PrEP awareness raising and initiation: acceptability and feasibility of a UK pilot. medRxiv Pre-print.

This research was funded by Gilead Sciences, Inc, and supported by the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) and the NIHR  Health  Protection Research Unit (HPRU) in Evaluation and Behavioural Science at the University of Bristol, and NIHR HPRU in Blood Borne and Sexually Transmitted Infections at UCL. HPRU’s are partnerships with UK Health Security Agency  UKHSA.

The views expressed are those of the authors and not necessarily those of Gilead Sciences, the NIHR, UKHSA or the Department of Health and Social Care. 

Authors

Dr China Harrison

Professor Jeremy Horwood