Seven Dimensions Are Not Enough: Actively Disseminating Applied Behavior Analysis.

The United States South, as defined by the US Census Bureau, accounts for 53% of human immunodeficiency virus (HIV) diagnoses in the US, despite only accounting for 38% of the country’s population. Additionally, the South is home to only 38% of the country’s pre-exposure prophylaxis (PrEP) users and has the lowest PrEP-to-Need Ratio in the country, at 12 PrEP users for every new HIV diagnosis. With such low PrEP uptake, interventions for HIV prevention are desperately needed. Ending the HIV Epidemic (EHE) priority jurisdictions are defined by the U.S. Department of Health and Human Services as 50 counties/regions where more than 50% of HIV diagnoses occur, as well as 7 states with disproportionately high rates of HIV in rural regions. Nearly 50% of these counties and 6 of the 7 states are located in the South. Previous work has shown that the implementation of PrEP services in community pharmacies could increase PrEP uptake by 80-fold in the U.S. South. Accessing a PrEP provider is often challenging in the U.S. South, especially in rural areas where healthcare providers in general can be few and far between. Despite the high HIV prevalence, this region only has 25.7% of the country’s PrEP prescribing clinics. However, pharmacies are much more evenly dispersed, with nearly 90% of Americans living within 5 miles of a pharmacy; this makes them well-positioned to provide preventative HIV care services. Aside from just their physical accessibility, pharmacies are also open beyond standard business hours, and the staff often have strong rapport with community members, making them a convenient and accessible option for expanded healthcare. Through a collaborative practice agreement (CPA), a pharmacist can establish a formal relationship with a physician that allows them to autonomously perform patient care functions as specified in the agreement. These functions can include drug therapy initiation, modification, and management, along with services like physical assessments and ordering labs. Over the years, they have been successfully implemented in pharmacies in nearly every state throughout the United States, with many of them being initiated for purposes like hormonal contraception initiation, opioid use disorder management, smoking cessation, and management of chronic diseases such as hypertension and diabetes. CPAs hold the potential to bridge the gap in health care access, especially in rural areas, because they leverage the accessibility and medication expertise of pharmacists. However, they can be difficult to implement, as requirements and laws surrounding them vary widely by state and are affected by ever-changing legislation.