Pharmacist's role in HIV care in France. Implication for clinical improvement of people living with HIV worldwide

Assessment Tools for Evaluating Pharmacy Students' Knowledge on HIV Prophylaxis: A Scoping Review

OBJECTIVES

This study aimed to identify and evaluate instruments used to measure pharmacy students' knowledge of HIV prophylaxis, focusing on both preexposure prophylaxis (PrEP) and postexposure prophylaxis.

METHODS

A systematic literature search was conducted using PubMed, Virtual Health Library, Web of Science, Scopus, ScienceDirect, and Embase. Article screening was performed independently by 2 reviewers. Studies assessing pharmacy students' knowledge of HIV prophylaxis were included.

FINDINGS

Eight studies involving 1,797 students, mostly from the U.S., were identified. All had a cross-sectional design, with only one assessing knowledge retention. Six assessment tools focused on PrEP, one on PEP, and one on both. While confidence in PrEP was evident, significant gaps were found in PEP awareness, prophylaxis access, and prescribing guidelines.

SUMMARY

There is a notable shortage of assessment tools for PEP. Further research is needed to develop validated instruments for measuring knowledge and addressing educational gaps. Longitudinal studies with pre- and post-tests are crucial to evaluate educational interventions and enhance pharmacy students' preparedness for HIV prophylaxis.

Aging with HIV: The Burden of Comorbidities, Polypharmacy, and Drug Interactions in Korean People Living with HIV Aged ≥50 Years

BACKGROUND

The life expectancy of people living with human immunodeficiency virus (PLWH) has significantly improved with advancements in antiretroviral therapy (ART). However, aging PLWH face a growing burden of non-communicable diseases (NCDs), polypharmacy, and drug-drug interactions (DDIs), which pose challenges in their management. This study investigates the prevalence of NCDs, polypharmacy, and DDIs among PLWH aged ≥50 years in Korea and their impact on quality of life (QOL).

MATERIALS AND METHODS

A cross-sectional study was conducted among 243 PLWH aged ≥50 years receiving ART for at least three months at three university hospitals in Korea between January and July 2022. Data were collected through electronic medical records and personal interviews, assessing demographics, comorbidities, polypharmacy, ART adherence, and QOL using the Korean version of WHOQOL-HIV BREF scale. Potential DDIs were analyzed using the University of Liverpool HIV Drug Interaction Database, and potentially inappropriate medications (PIMs) were identified using the 2023 American Geriatrics Society Beers Criteria. We classified participants into three age groups: 50-<65 years, 65-<75 years, and ≥75 years.

RESULTS

The prevalence of comorbidities was 71.6%, with older participants (≥75 years) showing a significantly higher burden, including bone diseases, osteoarthritis, and dementia (P<0.001). Polypharmacy was observed in 28.4% of participants and increased with age, with 53.3% of those aged ≥75 years taking ≥10 pills daily. Polypharmacy was associated with poorer QOL (71.6 vs. 76.6, P=0.010). Amber-flag DDIs were found in 81 participants (33.3%), most commonly involving metformin and divalent cations. No red-flag DDIs were identified. PIMs were observed in 6.6% of participants aged ≥65 years.

CONCLUSION

Aging PLWH in Korea face significant challenges from comorbidities, polypharmacy, and DDIs, which negatively impact QOL. Integrated, age-specific, and multidisciplinary care strategies are urgently needed to improve outcomes and ensure the well-being of older PLWH.

Ageing with HIV: Medicine Optimisation Challenges and Support Needs for Older People Living with HIV: A Systematic Review

BACKGROUND

Older people living with HIV (PLWH) are at increased risks of co-morbidities and polypharmacy. However, little is known about factors affecting their needs and concerns about medicines. This systematic review aims to describe these and to identify interventions to improve medicine optimisation outcomes in older PLWH.

METHODS AND DATA SOURCES

Multiple databases and grey literature were searched from inception to February 2022 including MEDLINE, CINAHL, PsycInfo, PsychArticles, the Cochrane Database of Systematic Reviews and the Cochrane Controlled Register of Trials, Abstracts in Social Gerontology, and Academic Search Complete.

ELIGIBILITY CRITERIA

Studies reporting interventions/issues affecting older PLWH (sample populations with mean/median age ≥ 50 years; any aspect of medicine optimisation, or concerns). Quality assessments were completed by means of critical appraisal checklists for each study design. Title and abstract screening was led by one reviewer and a sample reviewed independently by two reviewers. Full-paper reviews were completed by one author and a 20% sample was reviewed independently by two reviewers.

SYNTHESIS

Data were extracted by three independent reviewers using standardised data extraction forms and synthesised according to outcomes or interventions reported. Data were summarised to include key themes, outcomes or concerns, and summary of intervention.

RESULTS

Seventy-nine (n = 79) studies met the eligibility criteria, most of which originated from the USA (n = 36). A few studies originated from Australia (n = 5), Canada (n = 5), Spain (n = 9), and the UK (n = 5). Ten studies originated from Sub-Saharan Africa (Kenya n = 1, South Africa n = 6, Tanzania n = 1, Uganda n = 1, Zimbabwe n = 1). The rest of the studies were from China (n = 1), France (n = 1), Germany (n = 1), Italy (n = 1), the Netherlands (n = 1), Pakistan (n = 1), Switzerland (n = 1), Saudi Arabia (n = 1) and Ukraine (n = 1). Publication dates ranged from 2002 to 2022. Sample sizes ranged from 10 to 15,602 across studies. The factors affecting older PLWH's experience of and issues with medicines were co-morbidities, health-related quality of life, polypharmacy, drug interactions, adverse drug reactions, adherence, medicine burden, treatment burden, stigma, social support, and patient-healthcare provider relationships. Nine interventions were identified to target older persons, five aimed at improving medication adherence, two to reduce drug interactions, and two for medicine self-management initiatives.

CONCLUSION

Further in-depth research is needed to understand older PLWH's experiences of medicines and their priority issues. Adherence-focused interventions are predominant, but there is a scarcity of interventions aimed at improving medicine experiences for this population. Multi-faceted interventions are needed to achieve medicine optimisation outcomes for PLWH.

TRIAL REGISTRATION

This study is registered with PROSPERO registration number: CRD42020188448.

HIV Patients' Satisfaction with Pharmaceutical Care at a Nigerian Tertiary Healthcare Facility During the Covid-19 Pandemic

Background: Patients' satisfaction is an important indicator of determining the quality of pharmaceutical care (PC). This study investigated Human Immunodeficiency Virus (HIV) patients' satisfaction with PC at Federal Medical Centre, Keffi-Nigeria and determined the statistical correlation between the respondents' socio-demographic variables and their satisfaction with PC. Methods: This cross-sectional survey study involved 351 randomly selected HIV-positive patients receiving PC in the facility. A Likert-type questionnaire was used for the data collection. Results: The Cronbach's alpha of the questionnaire was .916. The "overall perception of pharmacists' care or service" had a mean satisfaction score of 4.24 ± 0.749 and "the amount of time spent with the pharmacists" had a mean score of 3.94 ± 0.791. No significant association was found between socio-demographic variables and overall patients' satisfaction with PC. Conclusion: The reliability of the questionnaire was high and the HIV patients had a good satisfaction with the PC they received in the facility.

Real-World Impact of Transferring the Dispensing of Hospital-Only Medicines to Community Pharmacies During the COVID-19 Pandemic

OBJECTIVES

In Portugal, the dispensing of most outpatient specialty medicines is performed exclusively through hospital pharmacies and totally financed by the National Health Service. During the COVID-19 first wave, the government allowed the transfer of the dispensing of hospital-only medicines (HOMs) to community pharmacies (CPs). This study aimed to measure the value generated by the intervention of CP in the dispensing of HOM.

METHODS

A single-arm, before-and-after study with 3-month follow-up was conducted enrolling a randomly selected sample of patients or caregivers with at least 1 dispensation of HOM through CP. Data were collected by telephone interview. Main outcomes were patients' self-reported adherence (Measure Treatment Adherence), health-related quality of life (EQ-5D 3-Level), satisfaction with the service, and costs related to HOM access.

RESULTS

Overall 603 subjects were recruited to participate in the study (males 50.6%) with mean 55 years old (SD = 16). The already high mean adherence score to therapy improved significantly (P < .0001), and no statistically significant change (P > .5757) was found in the mean EQ-5D score between baseline (0.7 ± 0.3) and 3-month follow-up (0.8 ± 0.3). Annual savings account for €262.1/person, arising from travel expenses and absenteeism reduction. Participants reported a significant increase in satisfaction levels in all evaluated domains-pharmacist's availability, opening hours, waiting time, privacy conditions, and overall experience.

CONCLUSIONS

Changing the dispense setting to CP may promote better access and satisfaction. Moreover, it ensures the persistence of treatments, promotes savings for citizens, and reduces the burden of healthcare services, representing a crucial public health measure.

Pharmacist's role in HIV care in France. Implication for clinical improvement of people living with HIV worldwide

In France, antiretroviral (ARV) treatment can be dispensed by hospital and/or community pharmacies. Since January 2016, an online patient medication file can be used to optimize dispensing, but medication interviews have not yet been incorporated into this system. To understand both people living with HIV (PLHIV) and their pharmacists’ habits and expectations of patient medication file and interviews, two consecutive national surveys were organized. The first one, carried out in October 2016 in care centers, was an anonymous questionnaire for PLHIV. The second one was an online survey for community and hospital pharmacies conducted in February 2017. A total of 1137 PLHIV (68% men, of mean age 50.2 ± 11.5 years, CD4 count 671 ± 354, 90% with undetectable HIV viral load (VL) and 64.2% reporting comorbidities) and 246 pharmacies responded. While the existence of the online medication file is known by 58% of PLHIV, only 40% of pharmacists declare it to be systematically offered. It was offered to 120/694 (17%) PLHIV and 96 (80%) accepted it. Currently, 78 (7%) PLHIV feel well taken care of because they are offered medication interviews, 343/1078 (32%) would like to take advantage of this program, mainly those with a shorter ARV duration (OR ARV duration 0.97 [0.95‐0.99]), a VL less often undetectable (OR undetectable VL 0.55 [0.31‐0.98]), and those who feel anxious more often (OR anxious 2.38 [1.48‐3.84]). These results suggest that better implementation of medication files and interviews will strengthen current clinical pathways.