Stakeholder-informed pre-implementation refinement of a pharmacy-led pre-exposure prophylaxis (PrEP) service delivery model in Malaysia.

INTRODUCTION: In 2024, only 3,451 individuals accessed free oral HIV pre-exposure prophylaxis (PrEP) at government clinics in Malaysia, despite an estimated 354,000 key population members who could benefit from PrEP. To inform pre-implementation refinement of a pharmacy-led PrEP service delivery model, we explored stakeholder perspectives on implementing the model within private community pharmacies in Malaysia. MATERIALS AND METHODS: A one-day stakeholder consultation was conducted in April 2023 in Kuala Lumpur with 28 stakeholders representing community pharmacies, professional societies, telemedicine providers, non-governmental organizations (NGOs), and HIV implementation science researchers. The meeting began with a review of preliminary findings from formative qualitative research involving key populations, community pharmacists, and PrEP prescribers. Through facilitated discussions, stakeholders identified short- and long-term solutions to implementation barriers. Stakeholder inputs from discussions and structured worksheets were synthesized descriptively to identify recurring implementation considerations that informed refinement of the pilot model. RESULTS: Key implementation considerations included enhancing awareness and demand generation, ensuring privacy, confidentiality, and affordability, integrating HIV self-testing, using digital checklist-based assessments, simplifying laboratory testing requirements, developing practical workflows supported by a reference guide, strengthening pharmacist training, and fostering cross-sector collaboration. Identified training needs included PrEP fundamentals, eligibility assessment for initiation and continuation, referral procedures, and scenario-based learning. Key competencies included knowledge of HIV and sexually transmitted infections, risk assessment, professional conduct, and person-centered communication. Six study sites were selected, with preparation requirements including HIV self-test kits, PrEP medications, informational materials, trained pharmacists, telemedicine subscriptions, and nearby referral clinics. The consultation informed refinements to the implementation plan. CONCLUSIONS: This stakeholder consultation informed refinement of a pharmacy-led PrEP service delivery model for pilot implementation in Malaysia and identified practical implementation considerations related to privacy, affordability, HIV self-testing, physician-pharmacist coordination, training, and referral systems. The findings may inform future implementation planning for similar urban, private-sector PrEP delivery models.