The pharmacist role in STI screening

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Pharmacists are in a good position to provide STI screening services – but confidentiality is just one barrier to be overcome

Helen Wood and Sajni Gudka from the School of Allied Health at the University of Western Australia have written an article in Integrated Pharmacy Research and Practice in which they explore the evidence and barriers for pharmacist-led STI screening.

Community pharmacies could be an appropriate setting for some STI screening, they say, as “their convenient location and opening hours improve accessibility, and pharmacists are seen as trusted health professionals in a highly regulated Industry”.

“In addition, pharmacists can offer private consultations in a health care setting that is already involved in sexual health through sales of condoms and the provision of emergency hormonal contraceptive (EHC) and oral contraceptives.”

The two collated evidence about the current and potential role pharmacists could have, and found that while pharmacists are well-positioned to provide STI screening services, further investigations are necessary “to overcome financial, safety, and confidentiality barriers”.

They searched the EMBASE, Medline and Global Health databases for relevant articles up to August 31, 2017, selecting 15 and adding another three from the authors’ own reference libraries.

“There is sufficient evidence for pharmacy-based chlamydia screening, with many consumers and pharmacists finding it an acceptable and highly valued service,” the pair write.

“Some evidence was found for pharmacy-based gonorrhea, hepatitis B virus (HBV), and human immunodeficiency virus (HIV) screening.”

However, appropriate sample collection for gonorrhea screening needs to be further examined in a pharmacy setting, the authors say.

“HBV screening presented an increased risk of personal injury to pharmacists through the collection of whole blood specimens, which could be reduced through consumer self-sampling.

“Pharmacist-collected specimens for HIV is less risky as an oral swab can be used, nullifying the risk of transmission; but pre- and post-screen consultations can be time-intensive; hence, pharmacists would require remuneration to provide an ongoing HIV screening service.”

The authors found that there was insufficient evidence to support syphilis screening through community pharmacies and that more studies are required that consider sampling methods other than pharmacist-collected whole blood specimens.

“There is no evidence to date for pharmacist-led trichomoniasis or HSV screening.”

The authors conclude that avenues for safe, accurate STI screening need to be identified and supported, and that pharmacist-led screening has many benefits.

These include that “sample collection is either non or minimally invasive, some samples can be self-collected in the privacy of the consumer’s home, and is more convenient than clinician-led testing.”

However for it to be effective, pharmacist-led screening must also have demonstrated high sensitivity and specificity and must be acceptable to consumers.

“The role of pharmacists in providing sexual health screening can be as simple as providing an over-the-counter screening kit, or they can bear more responsibility with tasks such as recommending STI screening to at-risk consumers, collecting samples, educating consumers, referring to appropriate health services, and managing medications,” the authors conclude.

“Although some STIs have no or some evidence that pharmacists are well-placed to provide screening services, there is sufficient evidence that pharmacists can assume a more prominent role in screening for STIs such as chlamydia.

“However, further investigations are needed—particularly with respect to remuneration, infrastructure, screening accuracy, and pharmacist safety—before global recommendations can be made.”

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