Pharmacist-Led Transitions of Care Could Be Crucial in HIV Treatment

After a pharmacist-led antiretroviral therapy (ART) formulary protocol took effect, 30-day hospital readmissions among patients with HIV fell from about 1 in 3 to under 1 in 4. 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, says adding transitions-of-care services could push those metrics within the protocol even lower.

“I'm sure that could be impacted even more strongly with direct transitions-of-care services on that inpatient discharge, maybe a transitions of care pharmacist,” Rebold told Drug Topics®. “We're still a little bit limited in our hospital, but [a] meds-to-beds program would be an ideal way to make sure that patients living with HIV have those medications in hand, rather than just prescribed.”

In part 3 of our interview discussion, Rebold concludes by exploring the hospital-to-home transition of care and how pharmacists can play an active role in ensuring the utmost adherence to prescription drug regimens for patients living with HIV.

Learn about Rebold and his team’s efforts, from lowering readmission rates to the sheer value behind pharmacists as clinical counselors on HIV medications.

READ MORE: How Pharmacist-Led ART Protocol Improves HIV Medication Outcomes

Addressing Systemic Readmission Risks in HIV Care

Hospital readmissions remain a major challenge in HIV management because adults living with HIV face significantly elevated risks compared with the general patient population. A multi-state study analyzing millions of hospitalizations revealed an unadjusted 30-day readmission rate of 19.7% among adults living with HIV, compared with just 11.2% for HIV-uninfected individuals.¹

Even after accounting for age, race, diagnostic category, and coverage under Medicare or Medicaid, patients living with HIV maintained 1.5 times higher odds of being readmitted within 30 days of discharge. Researchers note that these elevated rates highlight a critical gap during discharge, emphasizing that structured transition strategies like enhanced counseling and post-discharge follow-up are necessary to improve outcomes.

Rebold emphasizes that establishing dedicated transitions-of-care pharmacists can directly address these vulnerabilities by bridging gaps before patients leave the building.¹

Historical data shows that medication errors during hospital stays occur in up to 72% of hospitalized individuals living with HIV due to therapy complexity and practitioner unfamiliarity with specialized regimens. When these errors go uncorrected at discharge, patients face treatment failure, drug resistance, and worsening clinical outcomes.²

At the University of Illinois Hospital, the rollout of a combined pharmacist-led antiretroviral stewardship and transition-of-care program dramatically improved patient safety metrics. Medication error rates associated with antiretroviral and opportunistic infection therapies dropped from 17% down to 6%, while overall error resolution reached 100% prior to patient discharge.

Furthermore, 30-day all-cause readmissions fell significantly from 27% to 12% under the pharmacist-guided workflow.²

Bridging Inpatient Care and Outpatient Continuity

Achieving long-term adherence requires expanding the clinical scope of pharmacists beyond traditional hospital walls. Pharmacists involved in transition programs actively assist patients by obtaining discharge medications, processing prior authorizations, and facilitating enrollment in assistance programs like the AIDS Drug Assistance Program.^2,3

These interventions led to a significant increase in 6-month linkage with outpatient HIV care, rising from 78% to 92%. High-risk individuals also received structured follow-up calls within 7 days of returning home to evaluate regimen adherence and reinforce instructions.²

The danger of care fragmentation during hospital-to-home transitions is equally critical for complex patients taking multiple medications.³

Pharmacists play a pivotal role in preventing adverse drug events and caregiver confusion by simplifying complex regimens and coordinating directly with patients in their communities. Studies in transition care demonstrate that reducing polypharmacy and training family caregivers on proper administration techniques significantly eases caregiving burdens while preserving medication safety.

By ensuring immediate medication access upon discharge and establishing tight coordination between inpatient teams, outpatient clinics, and community pharmacies, pharmacist-led models establish a robust safety net that keeps patients healthy at home.^2,3

READ MORE: HIV Resource Center

REFERENCES

1. Berry SA, Fleishman JA, Moore RD, et al. Thirty-day hospital readmissions for adults with and without HIV infection. HIV Med. 2016;17(3):167-177. doi:10.1111/hiv.12287

2. Brizzi MB, Burgos RM, Chiampas TD, et al. Impact of pharmacist-driven antiretroviral stewardship and transitions of care interventions on persons with human immunodeficiency virus. Open Forum Infect Dis. 2020;7(8):ofaa073. 2020 Aug 24. doi:10.1093/ofid/ofaa073

3. Arima Y, Sumitomo K, Miyauchi Y, et al. Pharmacist's support in the transition from hospital to home care in patients with multiple medications: avoidance of fragmentation of care. Cureus. 2025;17(7):e87751. 2025 Jul 11. doi:10.7759/cureus.87751