title: [Evaluation of a pharmaceutical care program to improve adherence to antiretroviral therapy].
abstract: OBJECTIVE
  To establish the impact of a pharmaceutical care program on the improvement of adherence to antiretroviral therapy, and on patient immunologic and virologic outcome.
  
  
  METHODS
  A multicenter, observational, prospective study in a HIV-infected patient cohort under treatment with antiretrovirals selected by random sampling in 19 Spanish hospitals. The study lasted 12 months, in which the program was applied through a baseline preprocedural visit and 4 quarterly visits. Adherence estimation was based on pill counting. An adherence > or = 90, or > or = 95% was considered adequate (in two time points).
  
  
  RESULTS
  541 patients were included, most of them were males (68.8%) between 20 and 78 years of age. Major risk groups included injecting drug users (43.4%) and heterosexuals (29.4%). Sixty percent had already received treatment for more than 3 years. Mean baseline viral load and CD4 count values were 32,866 copies/ml and 485 cells/mm3, respectively. Throughout the study a slight increase in the percentage of adherent patients was seen; however, statistical significance was not reached (64.3 and 79.2% of patients showed an adherence > 95 and > 90%, respectively, during the fourth quarter, versus 59.8 and 75.5% at baseline). A statistically significant decrease in viral load and increase in CD4 cells was seen following program application. The percentage of patients with a viral load < 200 copies/ml was 72.2, 76.7, and 75.0% at the 2nd, 3rd, and 4th quarters, respectively, versus 64.2% at baseline. CD4 cell counts increased by 50 cells/mm3 on average from the start to the end of follow-up.
  
  
  CONCLUSIONS
  Patients included in the program had a good immunologic and virologic outcome, and a trend towards an increased percentage of patients with good adherence was also seen. These results confirm the need to implement follow-up programs for patients receiving antiretrovirals in order to ensure maximum therapeutic benefits.
authors.affiliation: Servicio de Farmacia, Hospital Clín, 08036 Barcelona. ccodina@clinic.ub.es
authors.forename: C
authors.initials: C
authors.lastname: Codina Jané
authors.forename: M
authors.initials: M
authors.lastname: Tuset Creus
authors.forename: O
authors.initials: O
authors.lastname: Ibarra Barrueta
authors.forename: O
authors.initials: O
authors.lastname: Delgado Sánchez
authors.forename: O
authors.initials: O
authors.lastname: Morancho Echevarría
authors.forename: B
authors.initials: B
authors.lastname: García Díaz
authors.forename: A
authors.initials: A
authors.lastname: Escobar
authors.forename: B
authors.initials: B
authors.lastname: Martínez
authors.forename: T
authors.initials: T
authors.lastname: Butiñá
authors.forename: P
authors.initials: P
authors.lastname: Amador
authors.forename: E
authors.initials: E
authors.lastname: Estaún
authors.forename: A
authors.initials: A
authors.lastname: Sáinz
authors.forename: N
authors.initials: N
authors.lastname: Martínez
authors.forename: S
authors.initials: S
authors.lastname: Cal
authors.forename: M R
authors.initials: MR
authors.lastname: Gómez
authors.forename: R M
authors.initials: RM
authors.lastname: López
authors.forename: A
authors.initials: A
authors.lastname: Carmona
authors.forename: I
authors.initials: I
authors.lastname: Jiménez
authors.forename: C
authors.initials: C
authors.lastname: Moriel
authors.forename: J
authors.initials: J
authors.lastname: León
authors.forename: M D
authors.initials: MD
authors.lastname: Iranzo
authors.forename: L
authors.initials: L
authors.lastname: Caro
authors.forename: I
authors.initials: I
authors.lastname: Castillo
authors.forename: P
authors.initials: P
authors.lastname: Bachiller
authors.forename: B
authors.initials: B
authors.lastname: Irastorza
authors.forename: M
authors.initials: M
authors.lastname: Gine
authors.forename: M L
authors.initials: ML
authors.lastname: Sala
authors.forename: T
authors.initials: T
authors.lastname: Requena
authors.forename: R
authors.initials: R
authors.lastname: Santolaya
authors.forename: A
authors.initials: A
authors.lastname: Lluch
authors.forename: A
authors.initials: A
authors.lastname: Iruin
authors.forename: J
authors.initials: J
authors.lastname: Alfaro
mesh_terms: D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010607:Pharmacy Service, Hospital; D015397:Program Evaluation; D011446:Prospective Studies
chemical_list: D044966:Anti-Retroviral Agents