After nearly four decades of HIV research and medical advancements, more novel medications are available for managing HIV than ever before. Despite this, the same basic principle of HIV therapy remains true: successful treatment and subsequent positive outcomes require engagement in care and good adherence to HIV medicines.
While HIV providers with all different types of credentials may continue to chant the mantra “Take your medicines” at every appointment, it remains difficult for some individuals. Given the strong data showing modern-day HIV medicine combinations work, any detectable viral load likely indicates a degree of incomplete adherence.1
Enter the pharmacist
When was the last time you talked to your pharmacist? Whether it is at the pharmacy down the street, at the doctor’s office or in the hospital, pharmacists are involved in providing care to people with HIV. More than 90% of people in the United States who live in urban areas are within two miles of a pharmacy and about 70% who live in rural areas are within 15 miles of one.2,3 Pharmacists are some of the most accessible health care providers, usually practicing in the community or settings where they regularly interact with patients and the general public. Pharmacies are non-stigmatizing venues in the community where individuals can do more than just pick up medications. In addition to just dispensing medications, pharmacies are now places where you can go to get vaccines, get information about your medications, get screened for various diseases and conditions, ask questions about your healthcare and much more.4
All in a day’s work for a pharmacist
Pharmacists are uniquely positioned throughout the healthcare system to support and focus on several aspects of care specifically relating to medications, such as regularly assessing
adherence to HIV medication or evaluating a patient’s barriers to care. Pharmacists may routinely connect with a patient, developing a strong rapport and thus helping to keep them engaged in care. They may also be aware of and assist with referring you to community resources or other professionals who may further support your goals of care.5
Before you pick up your prescription at the pharmacy, a lot of work was done behind the scenes to ensure that medication is safe and effective for you. A pharmacist’s involvement may have included, but is not limited to, making sure it is the correct drug, dose, directions, reviewing your drug resistance profile, possible side effects, medication-related allergies and cost, as well as evaluating for any possible drug interactions. HIV medications have many drug interactions with other medicines, vitamins, supplements, herbal products, recreational substances and more, so it is important to discuss all medicines, including over-the-counter products you take, with the pharmacist.5 See Table 1 for a list of common over-the-counter, herbal and recreational substances that have significant interactions with some HIV medications.
Reducing disparities
Pharmacists’ drug knowledge expertise paired with their relative accessibility to patients and providers will be essential to addressing healthcare disparities and expanding access to HIV treatment initiatives as new drug therapies continue to become available. By recognizing their expanding role in managing HIV and by including them as essential members of the healthcare team, pharmacists can become another advocate for promoting the pillars of the federal Ending the HIV Epidemic (EHE) Initiative and ultimately the goal of achieving and maintaining a suppressed viral load, preventing the spread of HIV, and ending the epidemic.4
Working with your pharmacist
Even if you don’t see your pharmacist every visit, there are several things you can do to be better prepared to discuss your medications and medication concerns with your healthcare providers.
According to the Institute for Safe Medication Practices, one of the “Key Elements of Safe Medication Use” is patient education. Patients should receive ongoing education from physicians, pharmacists and other healthcare team members about the medications they are receiving, their indications (what the medication is for), dose(s), possible side effects, drug or food interactions, and how to protect themselves from potential errors.
“Patients can play a vital role in preventing medication errors when they have been encouraged to ask questions and seek answers about their medications before drugs are dispensed at a pharmacy or administered in a hospital,” the institute noted in its report.6
The importance of shared decision-making between the patient and their provider(s) in the current era of HIV management cannot be overstated. See Table 2 for a list of ways you can be better engaged with your healthcare team about medications. Go to your medical appointment feeling empowered and prepared.
Eric K. Farmer, PharmD, BCPS, AAHIVP, is an HIV clinical pharmacist at the Indiana University Health LifeCare Clinic at Methodist Hospital in Indianapolis, one of the largest providers of HIV medical services in the state of Indiana.