Pharmacies can play a crucial role in access to care by providing harm reduction, sexually transmitted infection (STI), and hepatitis C virus (HCV) services, according to a new study published in the Journal of the American Pharmacists Association.1 The findings show that by offering patient incentives, pharmacies can increase testing and detection of infectious diseases among individuals who might not otherwise seek care.
Together, the epidemics of substance use disorder (SUD), HIV, HCV, and STIs create a syndemic, whereby the presence of one condition increases the risk of acquiring or transmitting another. For instance, individuals with SUD are more likely to engage in risky behaviors such as sharing needles or unprotected sex, which are primary transmission routes for HIV and HCV.2 The alarming surge in drug overdose deaths in the United States, increasing by over 1000% from 2013 to 2019, underscores the syndemic’s threat.3
Put It Into Practice
Incorporate these strategies into your pharmacy practice to improve patient outcomes.
- Offer comprehensive harm reduction services, such as syringe exchange, naloxone distribution, and STI testing and treatment, to address the needs of vulnerable populations.
- Leverage patient incentives to enhance disease testing and detection, especially among individuals who may be reluctant to seek care in traditional health care settings.
- Foster strong collaborations with health care providers to ensure that patients receive timely, effective, and seamless treatment for substance use disorders, STIs, and other health conditions.
However, the risks of the syndemic are not evenly distributed. The rates of morbidity and mortality from the syndemic are far higher in American Indian/Alaska Native (AI/AN) people than in any other race. Although the syndemic requires greater capacity from health systems to respond, the ability to do so is restricted by a lack of human resources, especially in rural areas.
READ MORE: Q&A: Impact of Stigma on Pharmacists with SUD, Importance of Mental Health Care
The Indian Health Service (IHS), a federal agency serving around 2.6 million AI/AN, operates a largely rural health care network with well-documented provider shortages. In many IHS clinics, pharmacy-based services have become essential due to chronic understaffing. To address the need for harm reduction and express STI services among patients with SUD, an IHS hospital in rural Minnesota serving tribal communities integrated these services into its pharmacy.
The hospital identified the need for these services due to a correlation between SUD and syphilis diagnoses, a rise in overdose cases in the emergency department, and the reliance of many patients without primary care providers on the ER for general medical services. Tribal counterparts and internal medical staff advised the design of the program.
Harm reduction and STI services were offered at the pharmacy window without an appointment, referral or intake form. A pharmacist or student pharmacist offered participants a card with an ID number, as well as education and materials relevant to the patient’s situation, in a private counseling room, at no cost to the patient. Education included risks and safe practices when injecting or assistance scheduling a medical appointment; materials included condoms, naloxone, syringes, or a sharps container. The pharmacy later introduced patient incentives.
Harm reduction interactions were not documented in patients’ medical records. Rather, the pharmacy maintained a separate log with identifying numbers to track patient visits. Although there was a daily limit of 50 syringes and 2 doses of naloxone per patient, there were no restrictions on the frequency of visits.
Patients were tested for STIs using standing orders, and after diagnosis, these orders, along with a collaborative practice agreement, authorized the pharmacy to provide STI treatment.
Between October 2022 and November 2023, the program served 101 unique participants with a total of 490 visits. The median age of participants was 36. During this period, the program distributed approximately 23,500 syringes, 1200 condoms, and 730 naloxone nasal spray unit doses.
Although an estimated 37% of all patients at the facility lacked a primary care provider, this figure increased to 71% among those who utilized express STI testing services.
The pharmacy program launched patient incentives in July 2023 in the form of $10 gift cards. In just 5 months, the number of tests ordered increased approximately 12-fold to 101 and the number of unique patients increased approximately 16-fold to 96. Diagnoses surged by over 700%, reaching a total of 44. Of these new diagnoses, 23 were STIs and 21 were HCV.
To this data, investigators wrote, “testing detected an important proportion of diseases that may have been undiagnosed due to lack of symptoms and a lack of use of medical services.”
The integration of these services into the pharmacy setting not only addresses the syndemic of SUD, HIV, HCV, and STIs, but also helps to improve the health outcomes of vulnerable populations. As health care systems and the current syndemic continue to evolve, pharmacies are poised to play a crucial role in improving public health.
READ MORE: Public Health Resource Center
References
1. Dickson W, Meyer J, Leston J, Reilley B. Borne of necessity: Pharmacy-based harm reduction and express sexually transmitted infection services. J Am Pharm Assoc (2003). Published online August 19, 2024. doi:10.1016/j.japh.2024.102213
2. Hartzler B, Dombrowski JC, Crane HM, et al. Prevalence and predictors of substance use disorders among HIV care enrollees in the United States. AIDS Behav. 2017;21(4):1138-1148. doi:10.1007/s10461-016-1584-6
3. Mattson CL, Tanz LJ, Quinn K, Kariisa M, Patel P, Davis NL. Trends and geographic patterns in drug and synthetic opioid overdose deaths - United States, 2013-2019. MMWR Morb Mortal Wkly Rep. 2021;70(6):202-207. doi:10.15585/mmwr.mm7006a4
