Trends in Pharmacist‐Prescribed Dispensing Records of HIV Pre‐Exposure (2020–2025) and Post‐Exposure Prophylaxis (2020–2024) in Brazil: A Time Series Analysis

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Abstract
Purpose: Pharmacist prescribing of HIV pre‐exposure (PrEP) and post‐exposure prophylaxis (PEP) is an emerging strategy to expand access to HIV prevention, but real‐world evidence on its implementation remains limited. We assessed national and regional trends in pharmacist‐prescribed dispensing records of PrEP (2020–2025) and PEP (2020–2024) in Brazil. Methods: Nationwide time series analysis using databases from the Ministry of Health. The primary outcome was pharmacist‐prescribed PrEP and PEP dispensing records per 100 000 adults per year. Joinpoint regression was used to estimate average annual percent change (AAPC) and 95% confidence intervals (95% CIs). Results: Pharmacists prescribed 27 126 (2.80%) of 969 536 PrEP records and 13 073 (1.97%) of 664 000 PEP records. The frequency of pharmacist‐prescribed records in relation to all prescribers increased (PrEP: 0.22% to 5.77%; PEP: 0.12% to 4.59%). National pharmacist‐prescribed PrEP dispensing increased from 0.10 to 6.24 per 100 000 adults (AAPC: 120.80; 95% CI 71.96 to 189.84; p < 0.001), while pharmacist‐prescribed PEP dispensing increased from 0.07 to 4.93 per 100 000 adults (AAPC: 166.62; 95% CI 68.66 to 313.26; p < 0.001). The Southeast had the highest absolute rates for both strategies. Significant upward trends were observed in all five regions for PrEP, and in the Southeast, Northeast, and Center‐West for PEP. The national PrEP rate stabilized between 2024 and 2025. Conclusions: Pharmacist prescribing of HIV prophylactic medications significantly increased in Brazil since 2020 and may potentially represent an important mechanism to broaden access to HIV prevention. However, regional differences may underscore the need for targeted policy interventions to address geographic implementation gaps.

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