Exploring workflows for long-acting antiretroviral therapy administration in community pharmacies

Background: Long-acting injectable antiretroviral therapy (LA-ART) can improve adherence and virologic suppression in people with human immunodeficiency virus (HIV). While some clinics have successfully implemented these services, others face staffing and system barriers. Community pharmacies offer an alternative venue for LA-ART administration, but little is known about how workflows might be optimized. Objective: This study aims to outline key considerations in an ideal workflow to implement LA-ART into community pharmacies from the perspective of clinic, pharmacy, and patient stakeholders. Methods: Data were derived from a convergent-parallel mixed-methods parent study. Surveys and semi-structured interviews were conducted to explore perspectives on the feasibility of LA-ART administration in community pharmacies. Using thematic analysis, excerpts specific to ideal pharmacy workflows were extracted, coded, and analyzed. A process map was developed to visualize pharmacy workflow activities. Results: Of the 63 study participants, 59 provided insights on ideal workflows for LA-ART administration in pharmacies. Seven primary themes emerged: (1) communication across stakeholders, (2) staffing and logistical operational structure, (3) patient management and follow-up, (4) insurance and reimbursement barriers, (5) physical space and infrastructure, (6) pharmacist and patient education, and (7) patient choice and flexibility. Effective communication, appointment-based systems, and private spaces were emphasized. Participants identified challenges such as unclear protocols for patient management, insurance and reimbursement complexities, and the need for pharmacists and patient education to ensure successful implementation. Conclusion: Community pharmacies are a promising venue for LA-ART administration. Key workflow issues must be addressed to ensure successful implementation. Understanding stakeholder perspectives provides a foundation for developing scalable models to expand access to HIV treatment and prevention.