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JAPhA Practice Innovations
By Francisco Álisson Paula de França.
Multiple health professions, including pharmacists, are authorized to prescribe human immunodeficiency virus postexposure prophylaxis (PEP) in Brazil’s Unified Health System, but the distribution of this task across professions has not been quantified.
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To describe the distribution of PEP dispensations prescribed by physicians, nurses, pharmacists, and dentists, and to identify service and individual characteristics independently associated with prescriber category.
Retrospective cross-sectional analysis was conducted on 324,274 PEP dispensations recorded in the national antiretroviral logistics system and reported through the Ministry of Health’s PEP Dashboard from January 2023 to December 2024. Associations between prescriber category and service or individual characteristics were tested using Pearson chi-square or Fisher exact tests. A multinomial logistic regression model (with physicians as the reference; the model was restricted a priori to prescriber categories with dispensations in more than 1 region, which excluded dentists) was used to estimate adjusted relative risk ratios (aRRRs), with cluster-robust standard errors by state.
Physicians prescribed 65.9% of dispensations (n = 213,714), nurses 30.2% (n = 97,941), pharmacists 3.3% (n = 10,791), and dentists 0.6% (n = 1828). Service setting was the strongest correlate of prescriber category: urgent or emergency care increased the aRRR of prescribing by nurses and pharmacists relative to physicians, whereas testing and counseling centers reduced it. Occupational and sexual violence exposures were more often associated with physician prescribing. Sociodemographic aRRRs were close to 1.0, with all covariates jointly significant (Wald P < 0.001) but with a modest effect size.
Pharmacists and nurses account for a considerable share of PEP prescribing in Brazil, concentrated in urgent-care settings. Task distribution appears to be organized primarily around service structure rather than individual sociodemographic profile, which may be relevant to pharmacist-inclusive models of PEP delivery.
Published in JAPhA Practice Innovations. The abstract is shown as published and remains the work of its authors; read the full article at the source.
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