Medium-risk areas had a population rate of 1% to 5% and low-risk areas had a population rate of <1%. Low incidence of malaria areas were defined as one or less cases previously identified. High-incidence areas had less than buy Panobinostat five cases of malaria during the study period. High-income regions were defined as median household income of >$75,000 (1990 US dollars) and moderate-income regions had a mean household income of less than <$75,000 (1990 dollars). The number of pharmacies within these ZIP codes was identified through query of a ZIP code-based

internet yellow page search engine.9 Pharmacies listed were excluded if they did not provide direct to patient prescription services (ie, distributors or regional offices). High- and moderate-risk regions were compared against low-risk regions using an

unpaired two tailed t-test. Comparator regions to include census-bureau-designated racial and ethnic demographics are detailed in Table 1. A research physician administered the telephonic questionnaire to pharmacy personnel. The questionnaire AZD3965 assessed the availability of the antimalarial medications mefloquine, atovoquone-proguanil, chloroquine, quinine sulfate, primaquine, and sulfadoxine-pyrimethamine. If the medications were not stocked, the pharmacists were then asked about the ability to obtain them and within what time frame. Atovoquone-proguanil and quinine sulfate were considered “first line therapy” for chloroquine resistant Plasmodium falciparum as defined by the Centers for Disease Control and Prevention (CDC) at the time this study was conducted.10 To avoid biasing responses, pharmacists were not initially informed that these questions were part of a research protocol. At conclusion of the study, all participating pharmacies

were sent a “Dear Pharmacist” letter informing them of the study, results, and conclusions. This study was conducted under the supervision and review of the Uniformed Services University very Office of Research and Institutional Review Board. Data from the different risk areas was compared using a single-tail chi-square with Yates’ correction; p < 0.05 was considered a statistically significant difference. Low-risk, low-incidence, moderate-income regions were assumed to set the lower limit of community level availability of these medications. All statistical analyses were performed with open access software (www.graphpad.com). A total of 74 pharmacy listings from 12 ZIP codes were identified for study. After excluding duplicate listings, pharmacies that had closed or moved out of the target ZIP code, and pharmacies not providing direct patient services, 44 pharmacies from 11 ZIP codes were contacted in this study. None of the contacted pharmacies declined to respond. The breakdown of pharmacy location based on stratification of risk, disease incidence, and income is listed in Table 1. Results are summarized in Table 2.