Role of Pharmacists in AIDS Prevention and Treatment
FIP 2001 Singapore
World Congress of Pharmacy and Pharmaceutical Sciences
Further to the joint declaration of the World Health Organization and the International Pharmaceutical Federation that was signed at the Vancouver Congress in 1997, a session was held in Singapore on September 3 on the role of the pharmacist in AIDS prevention and treatment.
Opening the session, Marthe Everard, of the WHO?s department of essential drugs and medicines policy, Geneva, Switzerland, said that world-wide 15,000 people were infected with HIV every day. Of these, 95 per cent were in developing countries and 47 per cent were women. She explained that the United Nations had developed a strategy on access to HIV-related drugs which had been adopted by nine UN agencies. It was a four-part strategy intended to guide and co-ordinate activities in relation to access to drugs for AIDS treatment. The parts were ensuring
- rational selection and use of HIV drugs
- affordable pricing
- sustainable financing
- health systems were reliable
Rational selection was necessary because in different parts of the world different opportunistic infections were prevalent and this could make planning difficult. The affordability of HIV drugs also varied from country to country along with wholesale prices of the drugs. But differential pricing, where different prices were charged in different countries, could go some way towards making drugs more affordable. Reliable health systems were required because of the need for essential activities like voluntary testing and counselling, and providing psychosocial support and palliative care.
Ms Everard concluded by saying that it was WHO?s goal to have five million people on antiretroviral therapy by 2006, and she challenged FIP to come up with ways of involving pharmacists in that project.
How pharmacists could play a part in monitoring drug compliance in HIV disease was outlined by Michael Madalon, senior clinical pharmacist at the University of Wisconsin Hospital and Clinics, United States.
He explained that drug compliance in HIV patients really needed to be optimal in order to suppress detectable virus and reduce progression of the disease. Presently there were few drug regimens that were ?forgiving?; all were complex and had associated toxicities. Compliance was generally suspected to be insufficient and might be the ?weak link? in complex antiretroviral therapy.
Mr Madalon described some compliance management strategies that pharmacists could become involved in. The first was self-reporting by the patient. This was inexpensive and subjective but was often over-estimated, perhaps because of poor recall.
A second strategy was to look at insurance claims. However, Mr Madalon said that these records were not generally available to practitioners. They were more useful for looking at long-term compliance records and offered information without intruding into patients? lives.
Strategy three was directly observed therapy. This had been shown to be a powerful strategy, especially if the patient was new to treatment. It was more suitable for certain patient sites, for example, prisons and care centres, and would require modification for use in the community.
Fourthly, said Mr Madalon, electronic devices could be used. These were excellent tools for recording dosing patterns, but they were expensive and bulky.
Mr Madalon?s fifth strategy was therapeutic drug monitoring. This was a useful tool for adjusting dosage regimens, assessing drug interactions and managing toxicity because it gave a glimpse of what was going on at blood level.
Finally, there were laboratory markers, such as CD4 counts, although these were better suited as predictors of outcomes, he said.
So, what was the role of the pharmacist as a member of a compliance support team? First, pharmacists would have to know their patients. They would need to be available, be good listeners, be non-judgemental, knowledgeable, motivated, sensitive and trustworthy. They should discuss tools for improving compliance with patients and act as a monitor for drug interactions. They should telephone patients a few days after they start a new regimen to see if there are problems, and should then telephone every 30 days, Mr Madalon suggested. They could even offer some form of directly observed therapy, if that was felt to be necessary.
An AIDS prevention strategy in Thailand
The final speaker, Professor Porntip Chuamanochan, of the faculty of pharmacy at the University of Chiang Mai, Thailand, described the role of the pharmacist in HIV prevention in her country. She explained that when an increasing number of HIV-positive cases were being discovered in Northern Thailand in the early 1990s, pharmacists and drug store personnel took action. They participated in conferences and workshops and prepared themselves for giving advice on HIV prevention to their clients.
This HIV/AIDS prevention and care programme led to an awareness among the public that pharmacists and drug store personnel could provide qualified services. Professor Chuamanochan believed that this would lead to the recognition of the pharmacy as a ?community health station?.
Pharmacists played a role in HIV prevention in the community, too. Since the disease was seen to be spreading rapidly among adolescents and women, a group of pharmacists and sociologists set up a scheme targeted at young male and female migratory factory workers. Professor Chuamanochan said that ?peer education?, in the form of group discussion and problem-solving activities about gender roles, social norms and their impact on communities, had been found to be the most effective means of HIV and AIDS prevention education. This peer education also showed an increase in communication between boys and girls on their knowledge, beliefs and experiences related to HIV risk and prevention.
Peer education had since been implemented in 12 factories in the Chiang Mai area. Professor Chuamanochan said that the factory owners involved were able to foresee that it could strengthen the well-being of their employees and would be cost-effective.
A particular success was that factory workers extended the information received from peer education activities to their families and friends in their home villages.
Professor Chuamanochan concluded by saying that her experience had shown that active adolescent groups, housewife groups and Buddhist monks had potential for organising effective HIV/AIDS prevention education for their peers. Pharmacists, sociologists and village leaders needed to work together to provide appropriate information for these groups to help them communicate with their peer groups effectively. The information would then be disseminated throughout the community.
Sourced from:The Pharmaceutical Journal Vol 267 No 7164 p325-329
8 September 2001