A nurse- and pharmacist-led treatment advice clinic for patients attending an HIV outpatient clinic.
OBJECTIVE
This paper is a report of a study to map care pathways, examine the approach of different treatment advisors and explore the acceptability of a nurse- and pharmacist-led treatment advice clinic in order to aid decision-making for the future development and evaluation of the clinic.


BACKGROUND
High levels of adherence to antiretroviral drugs are a prerequisite for a successful and durable virological and immunological response to HIV. Treatment guidelines acknowledge that adherence is a process, not a single event, and that adherence support must be integrated into clinical follow-up for all patients receiving these drugs.


METHODS
Data were collected between September 2004 and January 2005 through 17 consultation observations and 10 patient interviews in a specialist treatment advice clinic located within a central London HIV outpatient clinic providing care for over 2200 patients, of whom more than 1300 are taking highly active antiretroviral therapy.


RESULTS
The nurses and pharmacist had similar consultation approaches, although follow-up care varied in extent. Benefits of the clinic approach included permitting patients to observe real tablets, tailoring regimens to lifestyles and telephone follow-up. These factors, particularly telephone support, were perceived by patients to assist with adherence.


CONCLUSIONS
The role of telephone support, perceived to assist with initial adherence, requires further investigation. Future work is also needed to explore the health economics of this approach and to determine the actual impact of the clinic on clinical and adherence outcomes.
Griffiths
C
C
Centre for Sexual Health and HIV Research, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK. cgriffiths@gum.ucl.ac.uk
Miles
K
K
Aldam
D
D
Cornforth
D
D
Minton
J
J
Edwards
S
S
Williams
I
I
D000553:Ambulatory Care / Q000458:organization & administration*; D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000592:standards; D023241:Antiretroviral Therapy, Highly Active / Q000451:nursing*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000451:nursing*; D006801:Humans; D008131:London; D008297:Male; D010349:Patient Compliance / Q000523:psychology*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*