7 HIV Treatment Adherence Tips on World AIDS Day

As today is World AIDS Day, pharmacists across the globe may be renewing their interest in quashing HIV infection and providing support for infected patients.

Aaron Rigali, PharmD, recently launched a HIV specialty program that caters to the needs of this patient population. He is the director of Florida-based Empath Health Pharmacy, which provides pharmacy services for the network of care members of Empath Health, including Suncoast Hospice.

Dr. Rigali told Pharmacy Times that pharmacists play integral roles in medication adherence for many chronic conditions, but their roles in improving adherence among patients with HIV is especially critical. This is because HIV treatment nonadherence can lead to medication regimen changes due to the development of resistance, which can then lead to further nonadherence.

Here are 7 ways pharmacists can help boost patient adherence to HIV medications, according to Dr. Rigali:

1. Refill reminders through phone calls, texts, or e-mails.

• At Empath Health Pharmacy, the pharmacy staff often makes 3 or more attempts to deliver medication before they can track down a patient. If a patient cannot be reached, the staff notifies the patient’s clinic and case manager of their potential non-adherence.

2. Referrals to primary or secondary payer sources.

• These sources can be in the form of copay assistance programs, patient assistance programs, and social support networks such as AIDS Service Association of Pinellas.

3. Adherence blister cards.

• These cards provide a tangible way to keep tabs on whether or not a patient has taken his or her medication.

4. Collaboration with physicians.

5. Medical pill boxes or other mnemonic devices.

6. Delivery of medication to patients’ home, work place, or shelter.

7. Assistance with opting out of mail-order pharmacies that may cause problems for patients.

If HIV-infected patients still have adherence problems after implementing these efforts, pharmacists can create individualized plans to encourage them to take their medication as directed, Dr. Rigali suggested.

In addition, pharmacists should discuss nonadherence issues with patients’ prescribers.

Above all, Dr. Rigali emphasized taking time to listen to patients’ concerns and considering their unique circumstances.

“While some have had HIV for decades, survived medications with horrible side effect profiles, had medication regimens with a dozen pills or more that required a level of adherence that would seem impossible today, many patients are less aware and may see 1 or 2 tablets per day as difficult to keep up with,” Dr. Rigali said.

Other patients may be taking medications to manage other conditions, or they may also be experiencing cognitive deficits or psychosocial issues, he added.

One patient at Empath Health Pharmacy lived at a homeless shelter and needed specialized adherence packaging and medication delivery to his shelter, which was a complicated process, Dr. Rigali said. Despite the challenges, the pharmacy was able to coordinate delivery for many months until the patient left the shelter.

“The key here is no 2 patients are the same, and knowing your patient is the first step in assisting with adherence,” Dr. Rigali said.

The World AIDS Day campaign promoted several awareness messages today, including that 99.5% of children born in the United Kingdom from HIV-positive women do not have HIV. In addition, only 2% of people with HIV contract the infection through intravenous drugs.

Around 1.2 million Americans were living with HIV in 2012, and 12.8% did not know they were infected, according to the US Centers for Disease Control and Prevention.