Pharmacists can resolve ART adherence problems to achieve HIV viral suppression
According to the US Department of Health and Human services, only 57% of people who receive an HIV diagnosis stay in HIV care.
Patients need to be 95% adherent to antiretroviral therapy (ART) to maintain undetectable HIV RNA vial load and decrease transmission. Pharmacists are medication experts with specialized adherence strategies to help patients with HIV.
A study published in the Journal of Managed Care and Specialty Pharmacy in its February 2018 issue evaluated the clinical and economic effects of a pharmacist-led ART adherence clinic. Primary care providers referred patients for ART initiation or reinitiation, ART failure or high risk of failure, adverse drug reactions, and other adherence or pharmaceutical care issues.
The researchers enrolled 28 participants in the study. The initial adherence visit lasted 1 hour, with 30-minute follow-up visits at 1 to 2 weeks, 6 weeks, 3 months, and 6 months. Pharmacists focused on medication and disease state education, encouraged ART adherence through motivational interviewing and patient recall and repetition (instead of informational handouts), and provided direct patient care in collaboration with other medical professionals.
Researchers noted that pharmacists can resolve adherence problems to achieve HIV viral suppression, provide a societal economic benefit, and prevent HIV transmission.
In the 16 patients who completed the study, viral load decreased from a median of 48,000 copies/mL to undetectable levels (<20 copies/mL). Cost saving was high, with a return of nearly $3 in future medical savings per dollar spent on adherence interventions. The researchers estimated that the intervention prevented about 0.13 secondary HIV infections in sexual partners in the 3 months following the intervention.
The researchers emphasized that the inclusion of pharmacists in multidisciplinary care teams is a must as they increase ART adherence in patients with HIV with documented adherences problems. The study's positive results were a salute to the pharmacists’ quality of care and the time they spent with patients before and after ART initiation.
Dilworth TJ, Klein PW, Mercier R-C, et al. Clinical and economic effects of a pharmacist-administered antiretroviral therapy adherence clinic for patients living with HIV. JManaged Care & Spec Pharm. 2018;24(2):165-172.