SUAC0203 | Feasibility and Acceptability of Pharmacy-Based Collection of PrEP Refills for Female Sex Workers: A Process Evaluation of a Randomised Pilot

Nancy Ruhode¹, Constancia Watadzaushe¹, Sharon Munhenzva¹, Fadzai Masiyambiri¹, Marisa Fujimoto², Oppah Kuguyo¹, Laura Packel³, Frances Cowan⁴, Sandra Mccoy², Euphemia Sibanda^1|4 | ¹Ceshhar Zimbabwe, Harare, Zimbabwe; ²University of California Berkeley, San Francisco, USA; ³University of California San Francisco, San Francisco, USA; ⁴Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK

Oral PrEP continuation among sex workers (SW) is suboptimal. We piloted pharmacy-based collection of PrEP refills for female SW (FSW), the Together Optimizing PrEP Access in Zimbabwe (TOPAZ) intervention. We report results of the pilot process evaluation. TOPAZ was embedded in the nationally scaled Key Populations (KP) program providing HIV and sexual and reproductive health services to SW. In four KP program outreach areas in Harare, SW initiating PrEP could collect refills at program clinics or nearby pharmacies. SW collecting from pharmacies received gift vouchers of $5, $6, and $7 at 1, 3 and 6 months, respectively. Trained pharmacists conducted HIV tests and dispensed PrEP. Pharmacists received US$1 dispensing fee/refill and $50 after the pilot. We explored intervention feasibility, acceptability, and implementation fidelity using 20 observations and in-depth interviews (IDIs) with pharmacists/pharmacy staff (13, 7 female), FSW (12), and KP program staff. We held 3-monthly meetings with SW and pharmacist advisory boards, who gave additional inputs/insights. Data were analyzed thematically. TOPAZ was implemented from Mar 2024 to May 2025. Observations, IDIs, and advisory board meetings revealed that the intervention was mostly implemented as intended, with reported high acceptability among SW and pharmacists. Main drivers for SW acceptability were convenience, long opening hours, and quick, friendly service. All pharmacists wanted TOPAZ scaled up, describing HIV testing and PrEP as capacity strengthening. Most pharmacists believed the payments offered were fair, although they suggested increasing the dispensing fee to match the ‘long process.' Gift vouchers were appreciated by SW and pharmacists alike, although advisory boards and IDIs said most benefits emanated from the established pharmacist/SW relationship and pharmacy patronage going beyond PrEP. This was reinforced by program data showing high PrEP continuation after incentive discontinuation - 43% continuation in TOPAZ at 12 months versus 0% in standard-of-care from 3 months. Most challenges reported by SW and pharmacy staff related to having only one trained person per pharmacy who could conduct TOPAZ procedures. Conclusions and recommendations: We demonstrated that pharmacy-based PrEP refills are feasible and acceptable for supporting PrEP continuation among FSW. Addressing identified barriers will optimize this intervention that has promise beyond oral PrEP.