Assessing the Effectiveness of Pharmacy-Based Adherence Interventions on Antiretroviral Adherence in Persons with HIV

Abstract

A key factor to the successful treatment of HIV is good adherence to antiretroviral therapy (ART). We developed a pharmacist-managed adherence clinic and designed a study to assess the impact of the adherence interventions by measuring the proportion of patients with 95% or greater adherence to ART before and after referral to the program. HIV providers referred patients with adherence problems to a pharmacist-managed adherence clinic. Interventions included scheduled clinic visits with the HIV Clinical Pharmacist and monthly refill reminders from pharmacy staff members over a 6-month period. Those aged 18-75, prescribed an ART regimen for a minimum of 3 months, and who filled their medications exclusively at the clinic pharmacy were eligible for study participation. The Proportion of Days Covered (PDC) served as a surrogate marker of overall adherence. A total of 34 patients were referred to the pharmacy clinic for adherence counseling, of whom 28 enrolled in the study. The proportion of participants with 95% or greater adherence to their ART regimen increased from 7% at baseline to 32% postintervention (p = 0.01). A subanalysis of the PDC revealed an overall increase from a baseline adherence mean of 60% to 81% postintervention (p < 0.0001). There was a notable trend toward an increase in the proportion of participants with an undetectable HIV-1 viral load (58-73%, baseline and postintervention, respectively, p = 0.10), but no statistically significant improvement in CD4 cell count. Clinical pharmacy interventions improved overall adherence to ART regimens in these patients with HIV.

A Case Report of 40 Patients With Hiv in São Bernardo Do Campo With Previous Antiviral Drug Resistance, Enfuvirtide Antiretroviral Treatment and Treatment Failure

“…Some patients report uneasiness in self-injecting the medication or lower adherence rates, suggesting that self-injecting may be avoided through the administration of the drug by a relative or in an outpatient service and that patient should have easy access to psychiatric and medical care (Avelino-Silva et al 2011). Adherence problems motivated by factors related to lifestyle, toxicity and/or drug interactions may interfere with the maintenance of adequate levels of antiretroviral drugs in blood and other body compartments (Garvie et al 2011, Henderson et al 2011. The presence of cutaneous signs, and digestive symptoms together with distinct groups of intensity of adverse effect seen in our work are very similar to what is commonly reported (Moyle & Carr 2002).…”

Role of the Pharmacist in Caring for Patients with HIV/AIDS: Clinical Practice Guidelines

“…Pharmacists are recognized as established and integral members of HIV health care teams across Canada and the United States. 3 Pharmacists' involvement in the care of HIVpositive patients has been associated with improved patient outcomes, including enhanced adherence, 4 reduced pill burden and dosing frequency, greater increases in CD4 cell counts, higher rates of viral suppression, 5,6 and decreases in medication errors. 7,8 Guidelines and position statements on the role of the pharmacist in caring for patients with HIV/AIDS have been published by various national and international organizations, [9][10][11] but there have been no updates since combination antiretroviral therapy came into use, about a dozen years ago.…”

The Role of Ambulatory Care Pharmacists in an HIV Multidisciplinary Team within a Free and Bilingual Clinic

“…Ambulatory care pharmacists practicing in HIV clinics have traditionally worked closely with other healthcare professionals to improve medication adherence with ART. 3,4,6,7,9,12 Patients with HIV are often vulnerable to having poor medication adherence, which could be attributed to increased pill burden, adverse effects from ART, lack of disease and medication education, and low threshold between non-adherence and risk of developing resistance to ART.…”

“…E-mail: r.vanmali@usciences.edu working as part of a multidisciplinary team. 4,5,6,7,8,9 March, et al described the impact of pharmacists' interventions on patient outcomes in a federally funded HIV clinic in Los Angeles, CA. At the conclusion of the study, patients being followed by the pharmacists in the clinic had a significant improvement in CD4 count, viral load (VL), and drug-related toxicities.…”