How Pharmacist-Led ART Protocol Improves HIV Medication Outcomes

At Howard University Hospital, a pharmacist-led antiretroviral therapy (ART) formulary protocol cut the time to restart HIV therapy for hospitalized patients from around 67 hours to about 32. By introducing the new protocol, medication errors fell from 60 in 72 patients to 29 among 63.

Nicholas Rebold, PharmD, MPH, BCIDP, AAHIVP, assistant professor of infectious diseases in the Department of Clinical & Administrative Pharmacy Sciences at the Howard University College of Pharmacy, joins Drug Topics®to discuss the necessary protocols that drive ART adherence and safety among the patients living with HIV that he and his team encounter on a regular basis.

Howard University Hospital serves an underserved patient population with a high prevalence of individuals living with HIV, many of whom present to the hospital undiagnosed, off therapy, or taking complex resistance-based regimens.

The pharmacist-led formulary initiative condenses specialized HIV pharmacy knowledge into an accessible protocol, empowering staff pharmacists to transition patients between complex regimens and adjust for changing renal function. Prior to implementation, care teams often deferred ART until formal infectious disease consultations could occur.

READ MORE: Injectable HIV Treatment Beats Daily Pills in Adolescent Trial

By establishing protocolized lists of baseline home therapies, the initiative eliminated unnecessary treatment gaps, preventing viral load rebound and reducing the risk of opportunistic infections.

Antiretroviral stewardship addresses systemic vulnerabilities across academic medical centers, where admission-related medication discrepancies frequently occur. Automated patient identification within electronic medical record systems enables clinical pharmacists to review active antiretroviral orders and address potential drug interactions rapidly.^1,2

Standardized inpatient protocols have been shown to reduce antiretroviral-related error rates from 17% of hospital days to just 2%, significantly improving continuity of care for aging and medically complex patients. Dedicated pharmacist oversight ensures that dosing adjustments account for acute renal changes while preventing inappropriate regimen modifications upon discharge.

Inpatient Stewardship and Error Reduction Strategies

Beyond hospital walls, HIV-specialized pharmacists play a vital role in tailoring outpatient regimens, evaluating viral resistance profiles, and addressing social determinants of health.¹

Pharmacists routinely navigate insurance coverage, prior authorizations, and patient assistance programs to ensure uninterrupted therapy for vulnerable populations. During disaster events that cause patient displacement, official guidance emphasizes that treatment interruptions must be minimized and home regimens resumed promptly.^1,3

When exact formulations are temporarily unavailable, pharmacists utilize evidence-based substitution strategies to maintain viral suppression and prevent resistance. Pharmacists also manage complex transitions for patients receiving long-acting injectable therapies, ensuring dosing schedules remain on track during disruptions.

Long-Term Economic Impact and Clinical Effectiveness

Long-term economic microsimulations reinforce the clinical and monetary value of maintaining optimal ART over less effective multi-tablet options. Initiating single-tablet regimens also extends patient life expectancy by more than 1 year compared with generic multi-tablet regimens.⁴

Although single-tablet options carry higher initial drug costs, these expenses are substantially offset by a $12,035 reduction in inpatient hospitalization costs due to improved treatment adherence and viral suppression.

Pharmacists across health systems, ambulatory clinics, and community pharmacies remain essential leaders in expanding antiretroviral stewardship, optimizing health outcomes, and safeguarding patient safety across the continuum of care.^1,4

Stay tuned for more from our conversation with Rebold, who dives deeper into the Howard University ART protocol and the ways in which pharmacists everywhere can get involved.

READ MORE: HIV Resource Center

REFERENCES

1. Mackowiak A, Januszka J. The art of ART: the pharmacist’s role in HIV care. Pharmacy Times. January 3, 2024. Accessed November 5, 2026. https://www.pharmacytimes.com/view/the-art-of-art-the-pharmacist-s-role-in-hiv-care

2. Bylsma T, Grossman K, Vindenes T. 1565. Antiretroviral stewardship: protocol development and implementation at an Academic Medical Center. Open Forum Infect Dis. 2023;10(Suppl 2):ofad500.1400. 2023 Nov 27. doi:10.1093/ofid/ofad500.1400

3. Guidance for non-HIV-specialized providers caring for people with hiv who have been displaced by disasters (such as a hurricane). Clinicalinfo.HIV.gov. October 11, 2024. Accessed November 5, 2026. https://clinicalinfo.hiv.gov/en/guidelines/guidance-hiv-disasters/non-specialized-providers

4. Sweet DE, Altice FL, Cohen CJ, et al. Cost-effectiveness of single- versus generic multiple-tablet regimens for treatment of HIV-1 infection in the United States. PLoS One. 2016;11(1):e0147821. 2016 Jan 25. doi:10.1371/journal.pone.0147821