Clinical outcomes of pharmaceutical care intervention in HIV positive patients with hypertension: A randomized controlled study

Abstract

What is known and objective Pharmaceutical care (PC) has been shown to improve clinical outcomes in hypertensive patients as well as in people living with HIV (PLWHV). The objective of this study was to evaluate the impact of PC on blood pressure (BP) control, viral load and adherence to medications in hypertensive PLWHV. Methods This was a prospective, randomized controlled study conducted in the University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria. Eligible ambulatory patients were randomized equally to two study arms. The control arm (CA) received the traditional care offered at the HIV clinic; the intervention arm (IA) received the traditional care in addition to PC by the research pharmacist, which included structured education/counselling. BP and self‐reported medication adherence were measured at baseline, 6 months and 12 months. Viral load was obtained at baseline and after 12 months. Data were analysed with spss, version 25.0. Results and discussion Of the 206 participants initially randomized, 182 (91 in each study arm) completed the 12‐month follow‐up. No significant differences existed in both arms concerning socio‐demographic/clinical characteristics of participants at baseline (p > 0.05). After 12 months, BP control was significantly higher in the IA (53.4% vs. 25.2%; p < 0.001, adjusted odds ratio, aOR = 3.20 (95% CI 1.59–6.44). Systolic BP reduced by 0.9 mmHg from baseline in the CA (p = 0.668) and by 16.67 mmHg from baseline value in the IA (p < 0.001). Diastolic BP increased by 1.9 mmHg in the CA (p = 0.444), but reduced by 7.0 mmHg in the IA (p < 0.001). No significant differences were observed in the change from baseline in the proportion with undetectable plasma viral load (UPVL) in both groups (p > 0.05). PC led to an increase in mean adherence to antiretroviral drugs (Δ = 0.55; p = 0.015), and an increase in mean adherence to antihypertensive drugs (Δ = 2.32; p < 0.001) in the IA. What is new and conclusion To our knowledge, this is the first prospective randomized controlled study evaluating the impacts of PC on clinical outcomes in hypertensive PLWHV with a 12‐month follow‐up. Our results show that PC significantly improved BP control and adherence to antiretroviral and antihypertensive medications, but had no significant effect on viral load in HIV positive patients with hypertension. Providers of care for PLWHV should leverage the established HIV treatment successes for promoting adherence to treatment for common comorbidities like hypertension in PLWHV in order to improve clinical outcomes.

Effectiveness of integrated chronic care models for cardiometabolic multimorbidity in sub-Saharan Africa: a systematic review and meta-analysis

“…The four cluster-RCTs accounted for clustering effects in their analysis so there was no unit of analysis errors 43 46 49 52. Six studies were appraised as unclear risk due to insufficient information about protection against contamination 44 47 48 50 51 53. One study was rated as unclear risk due to lack of sufficient information about allocation concealment.…”

“…Overall, the certainties of the evidence for SBP, HbA1c, depression, medication adherence and quality of life were downgraded to moderate. This was due to the high risk of bias, imprecision and clinically insignificant effect sizes in the included studies 43–53…”

“…The components of self-delivery included multidisease screening and treatment, task shifting, structured follow-up and collaborative care. Seven studies included self-management support such as home-based self-monitoring, lifestyle counselling, post-clinical patient follow-up and patient support groups 43 44 47 48 51–53. Four studies included decision support components such as supplementary training of healthcare workers and support supervision 43 46 49 50.…”

“…Figure 3 presents the random effects meta-analysis of SBP. The pooled results of six studies44 47–49 52 53 involving 1754 participants show that integrated versus standard care conferred a lower mean SBP (mean difference (MD)=−4.85 mm Hg, 95% CI (−7.37 to −2.34) with a small Hedges’ g effect size (g=−0.25, (−0.39 to −0.11). However, the overall quality of evidence based on GRADE criteria was moderate.…”

“…The characteristics of the included studies are presented in table 1. We included 10 trials from 11 publications [43][44][45][46][47][48][49][50][51][52][53] with a total of 4864 participants. Sample sizes ranged from 55 to 1174 participants.…”