Dal Solutions: Dalhousie study helps give Nova Scotia pharmacists the power to directly prescribe HIV prevention drug

The Dal Solutions series offers an in-depth look at how Dalhousie researchers are collaborating across disciplines to make significant contributions to lives locally, nationally, and around the globe.

The Snapshot

Canadians have access to a drug that prevents HIV infection, but it's not getting into the hands of those who need it most. Dalhousie’s Dr. Kyle Wilby is tackling the issue by collaborating with policymakers to make Nova Scotian pharmacists among the first in the country with the ability to prescribe the lifesaving medication.

The Challenge

Dale Lemieux lives in Nova Scotia and knows very well a frustration shared by many in Canada's 2SLGBTQI+ community: trying to access to Pre-exposure Prophylaxis (PrEP), a drug that could make them nearly impervious to HIV.

Dale Lemieux

“Over the years, I talked to people at the clinics about wanting to get on PrEP, and they said — okay, but these are the million steps,” says Lemieux. “You have to talk to a doctor, you have to get this blood work, then you have to come here, and then you have to do this, and then you'll have to do that again. And then we can't guarantee the time that you’ll get in. It was just all very daunting.”

That's why he, like others often do, gave up pursuing PrEP before even getting started.  

And while antiretroviral therapies have significantly diminished the dangers of HIV, the virus is still very much with us. Statistics Canada counted 1,833 new diagnoses in 2022, a 25 per cent increase over 2021. The pathogen leads to a greater risk of infections, cancers, and cardiovascular and liver disease. The emotional burden of managing and disclosing HIV can seriously impact mental health. And Canadians continue to die of the virus — 133 in 2021. 

For those in the health field, PrEP offers an obvious answer. But the path to get there is complicated. Barriers to access make adoption difficult.

Dalhousie health researcher Dr. Kyle Wilby explains that until earlier this month, Nova Scotians who wanted PrEP needed to get a prescription from oversubscribed primary physicians or nurse practitioners. Sexual Health Nova Scotia clinics are also an option, but months-long appointment waits make regular check-ins and blood testing for refills difficult to manage.

“I know there's definitely people out in the community who haven’t been able to follow through with getting PrEP,” says Lemieux. “We’re at risk, and that's not something that we should have to deal with when there is something preventative that we should be able to access in an easier way.”

The Solution

As a gay man and pharmacist who worked in Ghana and Qatar earlier in his career, Dr. Wilby says he was confronted firsthand with how a person’s sexual identity can limit access to health care. It’s a lesson that informs the work of this newly appointed director of Dalhousie’s College of Pharmacy, including his efforts to increase access to PrEP in Nova Scotia.

Dr. Kyle Wilby, Professor and Director of Dalhousie's College of Pharmacy

Dr. Wilby started taking PrEP years ago while working in New Zealand. When he moved to Nova Scotia without a family doctor, he quickly found his access to the drug changed for the worse.

“I was going to walk-in clinics to get my prescription and physicians weren't aware of it or they didn't know about the monitoring. The use of PrEP is still not very common, so they can’t be blamed. But the result was disjointed care for a drug that requires regular monitoring and testing for STIs,” says Dr. Wilby.

He saw a solution at the pharmacist’s counter. Embedded in every neighborhood, he says pharmacies provide ready access to health professionals who specialize in the proper use of medication.

He says giving pharmacists the power to prescribe PrEP is a natural fit with the greater role they’ve begun to play in relieving pressure on taxed health care systems. Their function as a release valve became evident during the COVID pandemic when pharmacists stepped up to deliver vaccines. But it can also be seen in their expanded authority to prescribe and refill drugs and manage chronic ailments like diabetes.

The Work

“Our objective was to explore the feasibility and acceptability of PrEP prescribing by pharmacists in Nova Scotia as part of their scope of practice,” says Dr. Wilby.

In a six-month pilot study supported by Shoppers Drug Mart, Dr. Wilby followed 50 patients at 10 pharmacies, tracking the experience from both sides of the counter. The results were positive, with pharmacists keen to provide the service and patients eager to pursue it in the future.

A pill container with PrEP.

On July 1, after reviewing the study’s findings and a proposal from Dr. Wilby, the Nova Scotia College of Pharmacists, which regulates the practice of pharmacy in Nova Scotia, authorized pharmacists to prescribe  for PrEP. This makes Nova Scotia pharmacists the first in the country to prescribe PrEP.

Bev Zwicker, CEO and registrar of the Nova Scotia College of Pharmacists, says the research completed by Dr. Wilby provided the insight to land on the decision.

“This is about determining when somebody would benefit from a medication for prevention,” says Zwicker. “So, when Dr. Wilby came to us, it was clear that this would be a role that pharmacists could play in protecting people from HIV. Then it was just a matter of developing the necessary safeguards to ensure that it happens safely.”

Now that pharmacists have this prescribing authority, planning is taking place so pharmacists can fully implement this scope so the public can benefit. The expectation is that the first prescriptions will be written in early fall. 

The Impact

As one of the study’s participants, Dale Lemieux says the experience was transformative.

“We have been working with the pharmacists and it has been life-changing in the way that we are on top of everything," he says. "I feel safer now. It was what I needed in my life. I think it's needed in a lot of queer peoples’ lives to have this kind of access.”

Lemieux, right, at the pharmacy

Dartmouth-based pharmacist Yasmine Abdalla, who also participated in the study, says she’s happy to see the research led to her profession’s ability to add further capacity to Nova Scotia’s health-care system.

“Extending the scope of our practice is really important,” she says. “A recent report showed Primary Care Clinics have contributed to a 10 per cent decrease in visits to the ER for non-essential emergencies. That's an achievement. Even if I play a small role in that, I'm happy.”

Dr. Wilby echoes the sentiment, noting that a key goal of his work is focused on reducing burdens on the healthcare system. But his primarily concerned is improving health outcomes. He says connections between pharmacists and people seeking PrEP will open new doors to care, highlighting that testing conducted for the study already revealed numerous other health issues, including hepatitis B and cases of asymptomatic chlamydia and gonorrhea that were then treated.

“People might come in for PrEP, but pharmacists might determine they also need support for mental or cardiovascular health, and refer them onward,” he says. “It offers that first contact with the health-care system that can start that person to on their health journey, hopefully in a more inclusive and accessible way.”