title: Assessing the effectiveness of pharmacy-based adherence interventions on antiretroviral adherence in persons with HIV.
abstract: A key factor to the successful treatment of HIV is good adherence to antiretroviral therapy (ART). We developed a pharmacist-managed adherence clinic and designed a study to assess the impact of the adherence interventions by measuring the proportion of patients with 95% or greater adherence to ART before and after referral to the program. HIV providers referred patients with adherence problems to a pharmacist-managed adherence clinic. Interventions included scheduled clinic visits with the HIV Clinical Pharmacist and monthly refill reminders from pharmacy staff members over a 6-month period. Those aged 18-75, prescribed an ART regimen for a minimum of 3 months, and who filled their medications exclusively at the clinic pharmacy were eligible for study participation. The Proportion of Days Covered (PDC) served as a surrogate marker of overall adherence. A total of 34 patients were referred to the pharmacy clinic for adherence counseling, of whom 28 enrolled in the study. The proportion of participants with 95% or greater adherence to their ART regimen increased from 7% at baseline to 32% postintervention (p = 0.01). A subanalysis of the PDC revealed an overall increase from a baseline adherence mean of 60% to 81% postintervention (p < 0.0001). There was a notable trend toward an increase in the proportion of participants with an undetectable HIV-1 viral load (58-73%, baseline and postintervention, respectively, p = 0.10), but no statistically significant improvement in CD4 cell count. Clinical pharmacy interventions improved overall adherence to ART regimens in these patients with HIV.
authors.affiliation: 1 University of Colorado Denver School of Pharmacy , Aurora, Colorado, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Henderson
authors.forename: Jason
authors.initials: J
authors.lastname: Hindman
authors.forename: Steven C
authors.initials: SC
authors.lastname: Johnson
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Valuck
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Kiser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016903:Drug Monitoring; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010607:Pharmacy Service, Hospital; D011446:Prospective Studies; D012017:Referral and Consultation; D017678:Sex Distribution; D055815:Young Adult