The Virginia Department of Health (VDH) initiated a public/private partnership to launch an HIV testing program in 32 retail pharmacies which also conducted screening for other chronic diseases. We estimated that testing in retail pharmacies would lead to higher service uptake among first-time testers, that clients would reflect the racial/ethnic composition of communities where pharmacies were located, and that the public/private partnership would be more cost-effective than community-based HIV testing.
VDH selected stores in census tracts that were >30% Black/Latino, and where >10% of the population lived in poverty. Clients could request walk-in testing using a one-minute HIV rapid test whenever the pharmacy was open. Clients who tested positive were referred to confirmatory testing at a local nonprofit organization or health department.
Between June 1, 2014 and June 30, 2016, Walgreens pharmacists performed 3,221 HIV tests, including 25 positive tests, for a 0.8% positivity rate. Among all clients in the pharmacy testing program, 46% had never been tested or were unsure, versus 31% of clients in community-based HIV testing programs. Among HIV-positive clients in the pharmacy testing program, 64% had never been tested or were unsure, versus 17% of clients in community-based HIV testing programs. Only 39% of tests were performed during business hours, while 61% were provided at night or over the weekend. Statewide, 61% of clients were Black or Latino, more than double the minimum selection criteria. The cost per positive test was $4,300, versus $14,900 in community-based HIV testing programs.
Retail pharmacy-based HIV testing effectively facilitates access to HIV testing for clients who will not seek testing from established testing venues, such as Community-Based Organizations (CBO) and Local Health Departments (LHD). Retail pharmacy-based HIV testing is an effective venue for HIV testing, specifically in geographically large or low incidence states, where it can provide services in areas not feasible for CBOs or LHDs. Public/private partnerships present potential cost savings over community-based HIV testing programs.