Improving adherence and clinical outcomes through an HIV pharmacist's interventions

Abstract

Human immunodeficiency virus (HIV) positive individuals who adhere to their antiretroviral (ARV) regimens are more likely to achieve suppressed HIV viral load and improved immunologic response; however, for most patients, medication adherence remains a challenge. Prior studies have shown that clinical pharmacists contribute to the management of HIV-infected patients; but due to variability in clinical responsibilities and study limitations, their value has not been fully realized. The objective of this study was to investigate clinical outcomes of an HIV clinical pharmacist's interventions at Kaiser Permanente Medical Care Program, who utilizes medication expertise to provide recommendations for ARV regimen changes. The pharmacist suggests new ARV regimens in order to attain virologic suppression, improve immunologic response, or minimize ARV adverse effects, while aiming to optimize patients' adherence by decreasing pill burden and/or dosing frequency. This retrospective study assessed the effectiveness of the pharmacist's interventions that occurred between 11 September 2006 and 30 September 2008 on pill burden, dosing frequency, and medication adherence. Additionally, CD4+ cell count and HIV viral load pre- and post-intervention were evaluated. Medication adherence was assessed utilizing electronic pharmacy refill records and calculated based on the formula: [(pills dispensed/pills prescribed per day)/days between refills] x 100. From a cohort of 75 patients, mean daily pill quantity and dosing frequency decreased from 7.2 pills/day and 2.0 times/day in the control phase to 5.4 pills/day and 1.5 times/day in the study phase, respectively ( p < 0.001). Medication adherence increased from a mean of 81% in the control phase to 89% in the study phase ( p = 0.003). Clinical outcomes measured by CD4+cell count and CD4% were statistically improved and more individuals achieved undetectable HIV viral loads postintervention ( p < 0.001). In conclusion, HIV clinical pharmacists may play an important role in reducing pill burden and dosing frequency, increasing medication adherence, and improving clinical outcomes.

Retention in Care and Adherence to ART are Critical Elements of HIV Care Interventions

“…'Optimize drug regimens' calls for ''effective, affordable, one pill, once daily potent ARV regimens with minimal toxicities or drug interactions''. This can be expected to have significant positive impact on adherence, as several studies validate the relationship between ease of drug use, such as pill burden, and actual intake [77][78][79][80]. 2.…”

HIV medication therapy management services in community pharmacies

“…17,18 An analysis of more than 10,000 new ART-regimen starts in a large, integrated health care system demonstrated the value of a clinical pharmacist as a member of a multidisciplinary HIV care team, resulting in improvements in ART adherence and CD4+ cell count responses. 19 Developing similar programs adapted for community pharmacists could improve patient adherence to ART and retention in care.…”

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

“…In a recent retrospective study, recommendations on changes to the antiretroviral regimen made by a clinical HIV pharmacist led to significant reductions in daily pill burden and dosing frequency and significant improvements in medication adherence, CD4 response, and viral suppression. 5 Of critical importance is the need to ensure an uninterrupted supply of medication and assistance with financial barriers to adherence. Concerns about privacy and confidentiality should also be addressed, particularly in the community pharmacy setting.…”

“…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.…”