Three Trends Shaping HIV Pharmacy Care

More than 1 million people in the United States live with HIV. Thanks to decades of research and improvements in care, the virus has evolved from a condition of high unmet need that was universally fatal to one with a mature field of treatment that can be managed much like other chronic diseases.

Although the quality of life has significantly improved for individuals with HIV, there are several factors influencing how we provide care and treat patients now and in the future.

Living with HIV for Life and Addressing Multimorbidity

Due to effective treatments and care, most patients with HIV are reaching ages where they are starting to develop “normal” aging diseases, such as high blood pressure, cardiovascular disease, diabetes, and cancer, but to a greater degree. Rates of mental health issues are also higher among people with HIV compared with the general population. One study found 36% of people with HIV suffer from major depression.¹

HIV experts, particularly pharmacists, need to address how multimorbidities and behavioral health are affected by HIV and assist in managing care for complex patients. Many common HIV treatments have drug-drug interactions or require dosing adjustments, and a patient’s care team must be able to modify a person’s full treatment regimen to ensure positive outcomes.

Treatment Resistance and New Drugs

Due to the success of HIV treatments, we have a growing population of people who have been taking them for a long time. Any long-term treatments aimed at viruses can eventually see their efficacy decline, as the virus learns new ways of evading its effects. That, in turn, drives further research into newer treatments.

According to Datamonitor Healthcare, there are 47 drugs in the pipeline for HIV treatment and 4 drugs for HIV pre-exposure prophylaxis (PrEP). While most are still in the early stages of development, there are some standouts, including a long-acting injectable that could be on the market in the near-term. As new research and drugs become available, physicians, clinicians, and pharmacists will need to stay proactive and leverage tools at their disposal to ensure new treatments are understood by and available to patients.

Health Disparities and Stigma

HIV disproportionately affects marginalized communities, including members of the LGBTQ+ community and communities of color—particularly Black and Latinx individuals, gay and bisexual individuals, and transgender women. There are also other dynamics at play with lower socioeconomic classes and intravenous drug users sometimes receiving a different level of diagnosis and care.

Despite advancements in care, stigma and discrimination around HIV persist and have created social and structural barriers, limiting options for treatment and discouraging patients from seeking prevention and care services.² This can lead to:

• Decreased access to key social care services, convenient and affordable health care, pharmacies, and insurance, as well as health education and transportation.
• Lower levels of community/social support, leading to behavioral health-related issues such as depression or other mental illness.
• A lack of access to stable housing, which can limit options for marginalized groups to access the HIV-related services they need.³

These challenges make it difficult for patients to start and stick with treatment. In fact, nearly one-third of people with HIV do not take their medication as prescribed. Medication adherence is critical both to effectively treat people living with HIV, and to prevent spreading the disease. When people take their medications as prescribed, it makes HIV undetectable in their bodies and non-transferrable to their partners.

Specialized Pharmacy Services Drive Better Adherence

It is critical to bridge the gap for these patients and ensure they can receive and adhere to the medical care and treatment they need. There are pharmacies that specialize in specific conditions such as HIV and mental health. Serving chronic, complex patients with compassionate and unbiased care, these pharmacy teams are equipped to deal with the medication barriers and social determinants faced by this community.

Pharmacies located onsite in HIV clinics allow patients to walk out the door with medications the same day they get their diagnosis. From there, pharmacy teams develop trusting relationships with patients and closely partner with providers.

Being in the same location as the care team makes it easier to ask questions, clarify treatment or manage adverse effects, and collaborate to get medications adjusted when needed. This approach, combined with simple yet impactful actions such as refill reminder calls, prior authorization assistance, and pre-filled medication packaging, was found to help patients achieve a more than 91% adherence rate.⁴ This improves health outcomes by lowering hospitalizations, reducing sickness and death, and stopping the transmission of new disease.

Over the past few decades, the health industry has worked tirelessly to advance care and patient prevention for the treatment of HIV. With so many complexities at play, it’s imperative that we continue making integrated pharmacy and clinical care a reality to further improve the quality of life for patients living with HIV.

References

1. Mental health and HIV/AIDS: the need for an integrated respo... : AIDS (lww.com)
2. Mawar N, Saha S, Pandit A. Mahajan U. The third phase of HIV pandemic: Social consequences of HIV/AIDS stigma & discrimination & future needs. Indian J Med Res. 2005;122:471-484.
3. CDC.gov. HIV Prevention in the United States: Mobilizing to End the Epidemic. Available at https://www.cdc.gov/hiv/policies/strategic-priorities/mobilizing/introduction.html. Last Accessed September 2022
4. Integrated Pharmacies at Community Mental Health Centers: Medication Adherence and Outcomes; W. Abel Wright, MS; Jack M. Gorman, MD; Melissa Odorzynski, PharmD, MPH; Mark J. Peterson, RPh; and Carol Clayton, PhD; J Manag Care Spec Pharm. 2016;22(11):1330-36.