Pharmaceutical Care Improves Outcomes in Patients With HIV
Pharmacist intervention on drug-related problems in HIV outpatients can alleviate adherence issues.
HIV continues to be a global problem, and researchers from Brazil have joined the growing chorus of voices in emphasizing that pharmacist involvement in care for patients with HIV improves outcomes.
In 2014, roughly 16,000 individuals in Brazil presented with new cases of HIV. Brazil has a national incidence rate of approximately 20 cases per hundred thousand individuals. As a comparison, approximately 50,000 Americans contracted HIV in 2014, and the prevalence of new diagnoses ranged from 7.6 cases per hundred thousand in the Midwest to 16.8 per hundred thousand in the South.
The researchers conducted a study that examined the effectiveness of pharmacist intervention on drug-related problems in HIV outpatients. This was a prospective controlled intervention study that appears in the July 2017 issue of Saudi Pharmaceutical Journal.
Although patients with HIV in Brazil receive free treatment, access to pharmaceutical care is a challenge for public health systems, especially in developing countries. As a result, adherence is still a concern. The basis of this work was the hypothesis that pharmacists can educate patients about important factors associated with their drug regimens and increase adherence.
The researchers followed 143 adult patients who were receiving HAART over 3 1/2 years. They excluded patients who were older or obese because of higher rates of toxicities and hyperlipidemia, respectively. Patients received at least 3 structured pharmaceutical care appointments lasting 30-60 minutes. Patients returned to the clinic approximately every 4 months.
Safety issues were most significantly affected. Over the course of the first year, most interventions occurred between pharmacists and patients. Drug-related problems dropped 38%. Common interventions addressed drug-food interactions or drug-drug interactions.
Of note, prescribers accepted 100% of pharmacists’ recommendations.
Patients' CD4 counts increased significantly in both the intervention and control groups. The increase was most profound in the intervention group with a mean CD4 increase of 155 cells/mm3. In the control group, the increase was a mean of 84 cells/mm3. Reduction in viral load (a surrogate marker for adherence) did not demonstrate statistical significance, although decreases were noted in both groups and most especially in the intervention group.
HIV is a global problem and pharmacists from all nations have the education and training to address drug-related problems. This study shows that as few as 3 or 4 meetings with patients lasting 30-60 minutes can improve care.
Molino CGRC, Carnevale RC, Rodrigues AT, et al. HIV pharmaceutical care in primary healthcare: Improvement in CD4 count and reduction in drug-related problems. Saudi Pharm J. 2017;25(5):724-733.