Antiretroviral adherence program in HIV patients: a feasibility study in the Swiss HIV Cohort Study

Abstract

The encountered difficulties rely on the implementation, i.e., on the program and the health care system levels rather than on the patient level. Implementation needs to be evaluated further; to be feasible a new adherence program needs to fit into the daily routine of the centre and has to be supported by all trained healthcare providers. However, this study shows that patients' adherence behavior evolved differently in both groups; it decreased more quickly over time in the control than in the intervention group. RCTs are eventually needed to assess the clinical impact of such an adherence program and to verify whether skilled pharmacists can ensure continuity of care for HIV outpatients.

Adherence Profiles and Therapeutic Responses of Treatment-Naive HIV-Infected Patients Starting Boosted Atazanavir-Based Therapy in the ANRS 134-COPHAR 3 Trial

“…The volunteers, who agreed to use the MEMS caps and to undergo more frequent blood sampling to participate in the clinical trial, may be more likely to adhere. In turn, such intensive monitoring may also support and sustain high adherence levels, as shown in a prior intervention study using MEMS (29) and in the qualitative evaluation of the MEMS in our study. The virological success rate reported in this trial (91% of HIV-RNA levels being Ͻ50 copies/ml at W24) outperformed the results of the CASTLE study (70% of HIV-RNA levels being Ͻ50 copies/ml at W24), one of the largest trials to evaluate the use of ATV-RTV and TVD by treatment-naive HIV-infected patients (30).…”

The impact of HIV clinical pharmacists on HIV treatment outcomes: a systematic review

“…The percentage of participants who were Black ranged from 15% to 83% (median = 26%; not stated in 32% of studies); the proportion of White participants ranged from 12% to 71% (median = 52%; not stated in 32% of studies); and the percentage of men who have sex with men (MSM) ranged from 0% to 70% (median = 51%; not stated in 47% of studies). The pharmacist played a central role in the study objectives of 53% of included publications11,14,15,17,20,21,24,25,27,28 and 63% of studies examined the impact of pharmacist interventions (see Methods section for definition) 10–13,15,17,19,20,22–24,26…”

“…The majority of the reviewed studies examined the impact of pharmacists in HIV ambulatory care clinic setting (63%),10–12,15–21,25,28 followed by outpatient community pharmacies (26%) 14,22,24,26,27. The main pharmacist role was the provision of medication adherence counseling and tools for adherence improvement (including pill boxes, refill reminders, beepers, alarms, medication schedules, blister packs, medication diaries, etc).…”

“…Among the 10 publications in which the pharmacist’s role was central,11,14,15,17,20,21,24,25,27,28 adherence was compared between the pharmacist group versus a control group in eight studies;11,14,15,17,21,25,27,28 all of which found an association between assignment to the pharmacist group and improved adherence outcomes. Nine studies examined interventions or clinical care activities where the pharmacist had a peripheral role,10,12,13,16,18,19,22,23,26 among which five reported medication adherence outcomes by comparing the pharmacist group versus a control group 13,16,18,22,26.…”

“…Among 13 studies that compared adherence outcomes of a pharmacist-engaged study arm versus a control arm,11,13–18,21,22,24–26,28 nine reported percent ARV adherence as a continuous outcome in each group at the end of the follow-up period 11,13,16–18,21,24–26. In these studies, adherence in the pharmacist arm was 2%–59% (median = 19%) higher as compared to the control arm.…”