What Pharmacists Need to Know About HIV Treatment and Prevention

August 31, 2018

Article

1.1 million Americans live with HIV-here’s how you can help.

The evolving and complex nature of healthcare for HIV patients has made an interdisciplinary team approach the norm for treating the estimated 1.1 million people living with the disease in the United States. The pharmacist’s role on the team includes dispensing medications, educating and providing psychosocial support to patients, treatment monitoring, and advising the rest of the team on new pharmacological developments.

It’s a role Amina Abubakar, PharmD, AAHIVP, knows well. Her first exposure to how devastating HIV came as a child growing up in Kenya in the 1990s. She witnessed people dying every day from the disease, and watched grim HIV warnings on TV. “I think I had an emotional scar and wanted to be a solution to this epidemic,” she recalls.

Abubakar graduated from the Philadelphia College of Pharmacy, where she completed an HIV rotation. She also became credentialed by the American Academy of HIV Medicine (AAHIVM) as a certified HIV Pharmacist.

Today she owns and operates Rx Clinic Pharmacy in Charlotte, NC, serving more than 500 HIV patients there and at the nearby Ballantyne Family Medicine East clinics.

Going Beyond the Pills

Abubakar understands the social and medical aspects of the disease and its changing demographics. “Our role in HIV medicine is beyond the pill,” she explains, adding that pharmacists involved in HIV care are part of an important population health management strategy.

“Learning how to treat an HIV patient as a whole has become crucial for us because now we’re having patients with HIV who are in their 70s and 80s. We need to be a one-stop shop that knows how their HIV will be affected by everything else in their life.”

The challenges of caring for HIV patients are many. For example, Abubakar notes that opioid abuse is an ongoing concern. Her pharmacists are trained to understand the drug interactions between HIV medications and illicit drugs.

“We tell patients, you can be honest with us. Tell us what you’re using so we can make sure you’re on the right drugs for HIV,” she says. It’s a trust-building approach that Abubakar says has paid off with improved adherence, which leads to better outcomes on more than one level.

The goal is to get patients to take their HIV medication consistently to reduce their viral load. Then the pharmacist can discuss with them strategies and resources to get them off the other drugs they’re abusing, such as cocaine and alcohol, she says.

Collaborating with Physicians

At Ballantyne Family Medicine, Abubakar collaborates closely with Wesley Thompson, MHS, PA-C, AAHIVS, a Duke University graduate who has been in practice since 1987 and is one of the first physician assistants in the nation to be certified as an HIV specialist. He advocates strongly for community pharmacists to be included on the treatment team.

“They are absolutely positioned to be exactly what we need. They work from protocol, they extend the prescribing provider’s ability, and the overall cost of the system is less,” he notes. “They are more than a resource. They’re an asset and a colleague to me, and they extend our ability to be more comprehensive in care.”

Abubakar and the other pharmacists who work with Thompson interact with HIV patients on multiple levels, including conferring on abnormal lab results, side effects, and other acute issues. As a result, they help to build up the patients’ level of security and confidence, improving their adherence and overall continued care, Thompson says.

“Many patients get in front of me and it’s as if I’m an authority figure-they get the ‘deer in the headlights’ look,” he explains. “But the pharmacist is infinitely more approachable. They get to hear the nuts and bolts that I don’t get to. I would not want a clinic without them,” he says.

Changing World of HIV

Roger Paganelli, RPh, has been involved in HIV care since graduating from St. John’s University College of Pharmacy in 1987, during the early years of the epidemic. Over the subsequent decades, the co-owner and supervising pharmacist at Mount Carmel Pharmacy in the Bronx, NY, has been through a major evolution in treatments.

“People were dying at a severe rate because they couldn’t get a handle on how to manage the disease from a pharmacological perspective. To say that it was profound is an understatement,” he remembers.

“Now there are mainstream commercials for Truvada and the PrEP program. I think the world has changed dramatically,” he says.

Not everything has changed, however. The HIV patients he sees still experience bouts of depression, mental anguish, and general anxiety disorder that require talk therapy and psychiatric medications. Patients with comorbidities-including diabetes and hypertension-are an ongoing concern. “We have to help them understand that they have to be on multiple medications to stay alive,” Paganelli notes.

To address the issue of adherence, Mount Carmel Pharmacy relies on a medication synchronization program. “Once we get them on a schedule, we can make sure that the patient gets their medication every month,” Paganelli says. “We make sure that the patient is contacted, that we have a med reconciliation with them, and that they’re staying compliant.”

Four Ways to Help HIV Patients

Take the time to get to know HIV patients in-depth as individuals. “Spend more than just a couple of minutes at the counter. Take them private and make them understand that the disease is manageable and is not a death sentence,” says Paganelli.

Encourage patients to keep their appointments with their doctors and to make sure their blood results are done on a regular basis. “And encourage them to keep themselves as healthy as possible because that will ultimately, along with the right drug therapy, give them as long a life as they can possibly have,” says Paganelli.

Brush up on your skills and knowledge. Abubakar urges pharmacists to become more involved in HIV treatment and prevention while acknowledging that many aren’t as comfortable in the HIV arena as they are treating patients with other chronic diseases. “HIV is a life-long condition, so you will be managing these patients for a long time with newer medications onboard,” she says. Thompson says he has a very easy question for pharmacists who don’t feel at ease treating HIV patients. “Are you comfortable handling diabetes?” he asks. “If so, let me remind you that statistically people live longer and healthier with HIV than diabetes. If you can handle diabetes, it won’t take much for you to feel comfortable with HIV.”

Work closely with other providers. For pharmacists who encounter resistance to their role on the interdisciplinary care team, Thompson offers these words of advice: “Don’t be discouraged when clinicians don’t understand your role. Forgive them because bitterness will only result. Work with them and educate them. As a community pharmacist, it will be worth it to endure.”