UCSF has been leading the global response to HIV for four decades, from the earliest clinical observations to today’s efforts to understand post-intervention control and long-term remission. While scientists pursue a cure, clinicians in the UCSF School of Pharmacy have sustained the work that makes these breakthroughs possible.

Spanning the epidemic, clinical pharmacy professors Betty Dong, PharmD, and Jennifer Cocohoba, PharmD, represent the role pharmacists have played in UCSF’s dedication to evidence-based, patient-centered innovation.  

Pharmacotherapy and HIV evolution

Dong found herself on the front lines of HIV care before HIV had a name. As the only pharmacist providing clinical consults on the first Family Medicine inpatient service at Zuckerberg San Francisco General Hospital and Trauma Center in the early 1980s, she cared for patients with a mysterious pneumonia later identified as an opportunistic infection.

“We didn’t know what we were dealing with, only that people were very sick,” Dong said. “But everyone worked together — the physicians, nurses, and social workers. You learned quickly because you had to.”

Since those early days of devastation, pharmacists have led efforts to optimize drug regimens, prevent interactions, and support adherence. Dong spent decades improving the use of and expanding access to antiretrovial therapy (ART), and what was once a fatal diagnosis has become a manageable chronic condition.

The era of HIV prevention

Both Dong and Cocohoba, who built on Dong’s work, describe the rapid ascent of long-acting HIV therapies as one of the most exciting shifts in the field.

“We’re in the era of HIV prevention, with so many new and exciting tools,” said Cocohoba. “Now there is an injection given once every two months, or injections once every six months to prevent HIV. This is going to be a gamechanger, as long as people have adequate access.”

Today’s therapeutic options lessen the daily burden of taking pills and, for many, represent the first viable path to consistent prevention or treatment. But their promise also brings practical challenges: high drug costs, the need for injection visits, and inconsistent reimbursement models that can make pharmacy-based care difficult to sustain.

Access as the next frontier

California laws such as SB 159 and AB 339 authorize pharmacists to initiate Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP), critical tools for HIV prevention. Yet implementation remains uneven, often creating financial strain for pharmacies trying to offer services that are time-sensitive and sometimes considered specialty medicine.

Dong, who is leading a statewide study designed to expand access to injectable PrEP, sees this gap firsthand. “We have the laws that allow pharmacists to start PrEP and PEP, but not the reimbursement that makes it financially sustainable,” she said. “That’s a real barrier to equity.”

Pharmacists increasingly serve as navigators of fragmented systems, helping patients with prior authorizations, insurer restrictions, and inconsistent assistance programs.

“The pharmacist stands at the center of these systems that really boil down to whether a patient gets their HIV treatment or prevention medicines,” Cocohoba said. “Pharmacists understand the process of medication acquisition — what’s going on at the payer level, and what’s happening for the patient.”

Interdisciplinary clinics — access and adherence

Both pharmacists highlight UCSF’s interdisciplinary clinical model, where medical, behavioral, and social disciplines come together to meet the full spectrum of patient needs.

Cocohoba points to her work with the UCSF Women’s HIV Program, where patients receive primary care, women’s health services, pregnancy care, chronic disease management, and social support in one coordinated setting.

“You’re not just treating a condition. You’re addressing the full set of life circumstances that influence a person’s health, like housing, food insecurity, and mental health. It’s all part of access and adherence. You can’t alleviate one without attempting to alleviate the other.”

Pharmacists as indispensable infrastructure

Dong and Cocohoba both see community pharmacies as essential to sustaining the next era of HIV prevention and treatment, especially as long-acting therapies shift how patients access care.  

Dong’s study is testing whether four community pharmacies, with proper training and reimbursement, can safely deliver injectable PrEP, PEP, and STI-prevention tools like Doxy-PEP to people who might never set foot in a traditional clinic.

Cocohoba’s recent research examines the infrastructure needed to make that possible at scale, from staffing and injection training to workflow and patient outreach. “Pharmacies could do so much more,” she said, “but the systems around them have to support that role.”

At the same time, people with HIV are living longer, adding new layers of chronic disease management into routine care. “We’re now seeing people age with HIV, where HIV may not be their primary health concern,” Cocohoba said. “Chronic diseases such as diabetes, high blood pressure, and high cholesterol in the context of HIV are treated in similar ways as for the general population, but there are also important differences.”

Pharmacists remain indispensable in treating such complexities, Dong said, emphasizing that her passion for pharmacotherapy continues as she looks toward future possibilities.

“It’s very rewarding work, and there's still so much to do, in terms of studying drug interactions and side effects,” she said. “Now there's a lot of emphasis on cure treatments, and it does seem like it's possible to cure HIV, like with stem cell transplants. We just have to find the right formula.”