Evaluating the Effects of an Interdisciplinary Practice Model with Pharmacist Collaboration on HIV Patient Co-Morbidities

HIV patients are likely to have certain medical co-morbidities at a higher prevalence than members of their age group and are more vulnerable to adverse events related to these problems. For this reason, monitoring of patients with this condition is highly utilized through primary care clinics that specialize in the treatment of the infection in association with chronic disease states. The disease states common among HIV patients over the age of 60 include hypertension (45% of people), diabetes (21% of people), and vascular disease (23% of people). Interdisciplinary practice models used in treatment of patients with this condition have been effective in managing these chronic disease states. Because pharmacists play a crucial role in how HIV patients adhere to medications and treatment guidelines, this study focused on determining if there is a benefit to adding pharmacists to this inter professional team.

This study found that pharmacists were able to help in the management of  lipid levels and the cessation of smoking. Along with this, pharmacists were found to significantly decrease the amount of money these patients spend management of their individual chronic co-morbidities (with average savings of $3,000). For this reason, pharmacists involvement in the primary care of patients with HIV should expand past the provision of medications to include counseling and other services.

I think this study is important due to the fact that it represents how the role of a pharmacist within the health system is constantly changing. We are not only trusted sources of information for medications and proper treatment techniques, but we are also crucial in providing adequate counseling to patients. This is something that I believe has been a major focus throughout our studies in pharmacy school over the course of the year, and as a result, a feel I will be well prepared to fill this role in my future profession. This article makes me want to learn specific ways that I can help patients from this population manage their condition.

Cope R, Berkowitz L, Arcebido R, et al. Evaluating the effects of an interdisciplinary practice model with pharmacist collaboration on HIV patient co-morbidities. AIDS Patient Care and STDs. 2015, 29(8): 445-453

Resistance to key HIV drug ‘concerningly common’

HIV has different phases through which the drug’s effectiveness decreases. As a first-line drug, Tenofovir, has been becoming less and less effective in population around the world. This raises concern, as first-line drug is needed to last a longer amount of time in  order to have it’s effectiveness in the treatment regimen. Patients in Africa are unable to afford second-line treatment medications even with the best treatment help from the doctors around with world. This causes patient adherence issues. HIV drugs need to be taken 85-90% of its treatment regimen, and if failed, it can cause drug resistance. Drug resistance in one patient can be a concern to other HIV patients as it is transmissible from one person to another. To avoid this, doctors are trying to reach out to patients and diagnose them at an earlier stage to reduce the cost in Africa and help them understand the importance of adherence.

I believe that this drug has a great ability to treat first phase of HIV in patients. But with drug resistance issues and financial needs in third world country, it makes it harder for this resistance to be constricted in one population. Resistance being able to spread from one person to another causes concerns in a population with less resources and becomes more important for the health care professionals in the that area to address that issue to the population. Physicians or pharmacist, the drug experts, are great resources that can help reduce the problem in this population as they can explain the potential side effects and treatment options to the population better than any other health professional.

Resistance to key HIV drug ‘concerningly common’ (2016, January 28). Retrieved February 11, 2016, from http://www.eurekalert.org/pub_releases/2016-01/ucl-rtk012516.php

http://www.eurekalert.org/pub_releases/2016-01/ucl-rtk012516.php

Cost analysis of a novel HIV testing strategy in community pharmacies and retail clinics

This study was conducted in six pharmacy sites in order to determine the cost of HIV testing in a retail or clinical setting.  The purpose of the study was to provide information to places who are planning on implementing HIV rapid testing so that they may plan and budget accordingly.  The results of the study found that the average cost of a test would be $47.21 per person.  Additionally, it found that the average counseling was two minutes pretest and two minutes posttest if negative or ten minutes posttest if positive. The average cost was comparable to data published in 2006 which stated that clinical testing would costing $28.05 per negative test and $86.84 per positive test. The study found that many factors could impact the actual cost of the tests including the quality of the tests, how many tests were ordered, and how many staff members would complete training for the tests. Additionally, the study was not allowed access to the sites’ overhead costs, including salaries and and utilities, and instead used median wage data so actual costs may be higher.

I was very surprised by the results of the study. I assumed such tests would be much more expensive and was why they were not already available to most pharmacies.  Pharmacies would be a great additional resource for individuals who want or need to be tested for HIV.  Pharmacies can provide the convenience of at-home testing while connecting people who are HIV-positive to the contacts and resources a clinical setting would also provide. With no increase in cost to other settings, pharmacies can become a medical source for patients with HIV to those who have limited access to other types of health care.

Lecher, Shirley Lee, Ram K. Shrestha, Linda W. Botts, Jorge Alvarez, James H. Moore, Vasavi Thomas, and Paul J. Weidle. “Cost Analysis of a Novel HIV Testing Strategy in Community Pharmacies and Retail Clinics.” Journal of the American Pharmacists Association 55.5 (2015): 488-92. Web.

http://www.japha.org/article/S1544-3191(15)30108-4/abstract

Finding a Cheaper Way to Monitor HIV/AIDS

One of the most pressing conditions currently is HIV/AIDS. 36.9 million people live with HIV/AIDS, but 70% of the world’s burden is seen in sub-Saharan Africa. HIV/AIDS is something that should be monitored on a fairly regular basis after an antiretroviral therapy has been initiated. However, the lack of resources, monitoring capabilities, and trained professionals, testing is difficult to do. What this study was attempting to do was determine how effective a new qualitative viral failure assay (VFA) for HIV would be. This would be a lower cost option.

The study conducted included 496 pediatric and adult patients with HIV, and how well of an option the viral failure assay could be was explained in the results. Results of the VFA were compared to results of the standard. The VFA was more sensitive than the standard reference but was not as specific, and it was found that VFA worked better for the adult population in terms of sensitivity, specificity, and accuracy. However, the costs of the VFA would be lower than that of the reference. It is estimated that the cost of the VFA equipment would be about $22,000 in comparison to the $200,000 estimated cost of the standard. Also in terms of cost per run, the VFA would be $683.20 and the standard would be $2,105.80.

What can be seen from the study is that there are up and coming pieces of equipment that could potentially benefit populations with smaller economies. This would provide an option for patients to monitor their HIV/AIDS and to determine how well the therapy is working. Of course, there are issues with the effectiveness of the method, but it is a start to helping patients of all income levels. With this test, patients have the potential to live a more quality life.

Balinda SN, Ondoa P, Obuko EA, et al. Clinical Evaluation of an Affordable Qualitative Viral Failure Assay for HIV Using Dried Blood Spots in Uganda. PLoS One. 2016; 11(1).