Since the beginning of the HIV epidemic, approximately 33 million people have died from HIV/AIDS and 76 million people have been infected with the virus, according to a virtual session at the National Association of Specialty Pharmacy (NASP) Annual Meeting & Expo 2020.

During the session on the state of HIV care in 2020, Brandon Patchett, PharmD AAHIVP, senior director of pharmacy—clinical services at the AIDS Healthcare Foundation, said that in the late 1980s and the 1990s, the virus was thought to affect only men who have sex with men. However, by the 2000s, the prevalence of the virus among minority communities was evident, according to Patchett.

During the 2000s, an expansion of treatment options occurred, allowing for a simplification of regimens that continued into the 2010s, during which time treatment as prevention of the virus became the standard approach. In this period, single tablet regiments became the standard of care, more tolerable antiretroviral treatments (ART) with decreased toxicity were approved, and patients began to successfully grow older while living with HIV.

In 2019, there were 1.1 million people living with HIV in the United States, with 15,280 deaths related to HIV complications, which is a significant decrease in the annual mortality rate from the virus since the start of the epidemic.

“In general, the numbers are slowly declining, but HIV remains a significant epidemic that we still need to keep our focus on,” Patchett said.

Following the global impact of coronavirus disease 2019 (COVID-19) on the health care system in 2020, Patchett said there have been some clear changes in HIV care in the United States. The US Department of Health and Human Services released a guidance at the beginning of the pandemic clarifying guidelines regarding best practices in HIV care.

“Telephone, virtual visits, routine and nonurgent care, and adherence counseling really should be done over the phone versus a face-to-face encounter requirement. Persons for whom a regimen switch is planned, we can consider delaying the switch until close follow-up and monitoring are possible. For patients who are ill, we can consider telehealth options, including phone calls, or we can triage to a provider who may be able to manage the patient in person more effectively in some cases,” Patchett explained.

This switch to telehealth due to the COVID-19 pandemic has necessitated that providers become more comfortable connecting with patients in new ways, Patchett said. Methods of communication such as videoconferencing, patient portals, secure email contact, streaming media, electronic medical record systems, and wireless communication have become the norm in order to continue to deliver care for patients with HIV.

Patchett noted that a recent Houston Clinic study surveyed the acceptance of the switch to telehealth by patients with HIV. The results showed that 57% of respondents were more likely to use telehealth over in-person care if available. Additionally, 37% indicated that they would use telehealth frequently or always as an alternative to clinic visits.

The reasons cited for preferring telehealth for HIV care included that telehealth was a better fit for patient schedules, allowed for a decrease in travel time, and provided more privacy. However, patients did note that they had concerns regarding the efficacy of a telehealth visit in being able to meet all of their needs, as well as the issue of the security of their personal health information online.

Patchett said that there are also ongoing cost considerations for ART, which is the primary treatment for HIV. In 2018, ART was among the top 5 therapeutic classes in non-discounted spending on medicine. Additionally, the overall cost of first-line ART regimens has increased more than 30% since 2012.

“Overall, cost to the health care system, to insurers, and to society are significant, especially considering the increasing number of people who require lifelong antiretroviral therapy and experience rising drug costs,” Patchett said. “In general, out-of-pocket costs for patients can be a barrier to the initiation and continuation of therapy. Us as pharmacists play such a critical role when it comes to navigating through these potential barriers and cost considerations for patients.”

REFERENCE
Patchett B. State of Care 2020: HIV. Presented at: NASP Annual Meeting & Expo 2020; September 15, 2020; virtual. nasp.6connex.com/event/VirtualExperience/en-us#!/Lobby. Accessed September 15, 2020.