Abstract:
Background: South Africa continues to experience one of the world's highest HIV incidence rates despite significant progress in HIV prevention. Long-acting injectable Cabotegravir (CAB-LA) has demonstrated superior efficacy compared with daily oral pre-exposure prophylaxis (PrEP), offering a promising alternative for populations experiencing adherence challenges. However, widespread implementation remains constrained by limited service delivery platforms and healthcare workforce capacity. Community pharmacies represent an accessible and underutilized resource that could substantially expand HIV prevention services through differentiated care models.
Methods: This implementation analysis examines the feasibility of integrating CAB-LA delivery into community pharmacy practice using a digitally enabled service model. The proposed model incorporates pharmacist-led patient screening, clinical eligibility assessment through telemedicine-supported prescribing, electronic consent, appointment scheduling, digital clinical documentation, adverse event monitoring, and longitudinal follow-up supported by an integrated digital health platform. The analysis draws on implementation science principles, existing HIV prevention literature, pharmacy practice frameworks, and current South African regulatory considerations to evaluate operational readiness and implementation requirements.
Results: The analysis identified several implementation enablers including high community pharmacy accessibility, established patient trust, existing immunisation and injectable medicine infrastructure, and opportunities for digital integration to improve continuity of care. Telemedicine-enabled prescribing and electronic clinical decision support may reduce physician workload while maintaining clinical governance. Key implementation challenges include regulatory approval for expanded pharmacy services, workforce training, reimbursement mechanisms, cold-chain management, pharmacovigilance, and equitable access in underserved communities. A digitally integrated pharmacy model has the potential to improve appointment adherence, facilitate outcome monitoring, and enhance programme scalability while maintaining quality assurance.
Conclusions: Community pharmacy-based CAB-LA delivery represents a feasible and potentially transformative strategy for expanding HIV prevention services in South Africa. Successful implementation will require coordinated policy development, regulatory support, multidisciplinary collaboration, digital health integration, and sustainable financing models. Pilot implementation studies evaluating clinical outcomes, patient acceptability, cost-effectiveness, and health system impact are recommended to inform national scale-up strategies. Community pharmacy integration could significantly strengthen differentiated HIV prevention services and contribute to achieving national and global HIV elimination targets.
Biography:
Siraaj Adams is a pharmacist, public health practitioner, and Chief Operating Officer of Videomed (Pty) Ltd. His work focuses on digital health innovation, community pharmacy service delivery, telemedicine, HIV prevention, and implementation science. He has led the development of multiple digital healthcare platforms integrating telemedicine, artificial intelligence, electronic prescribing, and community pharmacy workflows across South Africa and internationally. His research interests include pharmacy-based models of care, HIV prevention, digital therapeutics, and health systems strengthening.
