Exploring Community Pharmacy Based Antiretroviral Therapy Refill for Stable HIV Patients in Tanzania

Abstract Background HIV/AIDS remains a major public health challenge in Tanzania, where approximately 1.7 million people live with HIV. Despite progress in antiretroviral therapy (ART) access, retention and adherence remain critical challenges. Decentralising ART refills through community pharmacies offers a potential approach to improve access, reduce facility burden, and strengthen continuity of care. Methods A qualitative implementation study was conducted in Dar es Salaam and Pwani, Tanzania. Data were collected through key informant interviews (KIIs) with policymakers and regulators, in-depth interviews (IDIs) with pharmacy clients and healthcare providers, and focus group discussions (FGDs). Interviews were audio-recorded, transcribed verbatim, and analysed thematically using QDA Miner Lite. Results Four KIIs, eight IDIs, and two FGDs were conducted among pharmacy clients, healthcare providers, pharmacists, regulators, and policymakers (N = 20). Findings were organised into three implementation outcome domains: acceptability, appropriateness, and feasibility. Acceptability findings highlighted benefits related to accessibility, convenience, and reduced waiting time, alongside concerns about confidentiality, stigma, and limited clinical support. Appropriateness findings emphasised integrating pharmacy refill services within existing healthcare and regulatory systems, with clear patient eligibility and tracking mechanisms. Feasibility findings identified operational, financial, and monitoring challenges related to workforce capacity, infrastructure, sustainability, and system oversight. Across all domains, participants stressed the need for coordination, regulatory guidance, and confidentiality safeguards. Conclusion Community pharmacy based ARV refill is promising but requires strong integration, regulatory oversight, and system capacity to ensure confidentiality, continuity of care, and sustainable implementation.