Rural Health Care Services Outreach Grant Program - This proposal aims to establish and sustain culturally responsive, pharmacy-based HIV prevention and harm reduction services in rural Southern California, focusing on underserved Black and Latinx communities disproportionately affected by HIV and substance use disorders (SUD). The project will target rural areas within the Inland Empire (IE), which includes Riverside and San Bernardino Counties-two priority jurisdictions for the Ending the HIV Epidemic (EHE) initiative. Between 2020 and 2021, the IE experienced a 13% increase in annual HIV cases, with 79% of diagnoses among non-White individuals and one-third linked to substance use. Expanding PrEP and harm reduction delivery in pharmacies is crucial for increasing uptake among Black and Latinx residents in the IE. Over 90% of IE residents live within 5 miles of a pharmacy. The proximity of pharmacies makes them ideal partners for HIV and SUD prevention services, offering a non-stigmatizing, accessible setting with more convenient hours than traditional clinics. California laws (SB 159 and SB 339) support pharmacist-led PrEP services. Drawing on evidence from successful pharmacist-led HIV prevention programs in Seattle and San Francisco, this intervention leverages the unique role of pharmacists as trusted, readily available healthcare providers. In 2023, Loma Linda University received funding from the National Association of Chain Drug Stores (NACDS) Foundation to develop a pharmacy-based HIV prevention program. This initiative established a network of 15 community pharmacies in partnership with several community organizations. The implemented program allowed pharmacy clients to self-screen for PrEP eligibility on a tablet, receive rapid point-of-care HIV testing, initiate PrEP the same day, receive wraparound services, and access remote support from peer navigators via phone or text. With NACDS funding set to expire in 2025, we seek additional support to sustain and expand this network, engage rural communities, and extend these vital services to remote areas of the IE. This project has five key goals: 1. Expand and sustain a rural pharmacy-based network for HIV and SUD prevention services. 2. Increase client engagement and introduce new services, including long-acting PrEP, doxyPEP, and a buprenorphine program. 3. Enhance point-of-care testing and use client data to improve service delivery and outcomes. 4. Strengthen pharmacy capacity by training technicians, reducing stigma, and incorporating community feedback into care. 5. Increase community awareness of pharmacy-based HIV and SUD prevention services and evaluate the program, incorporating community input to ensure sustainability. Our approach is grounded in evidence-based models shown to increase the uptake of HIV prevention and harm reduction services in underserved communities. Decentralized, pharmacist-led PrEP delivery lowers barriers to care, while community health workers provide critical navigation support. Rapid point-of-care testing for HIV enables early detection and timely intervention. This program is supported by the Loma Linda University expertise in HIV prevention, implementation science, and pharmacy management, alongside partnerships with a clinically integrated pharmacy network (CPESN) and one of the nation's largest health plans (IEHP). This project can significantly improve health outcomes for rural Black and Latinx residents in the Inland Empire by: 1) addressing preventive care gaps through pharmacy-based HIV prevention and harm reduction, 2) focusing on underserved populations with rising HIV rates and substance use challenges, 3) tailoring services to the needs of minoritized communities, 4) reducing stigma and mistrust by providing care in trusted pharmacy settings, and 5) using evidence-based strategies. We are applying under the regular program track and request funding preference for serving a Health Professional Shortage Area (HPSA).
