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HIV/AIDS

Pharmaceutical Care for HIV Patients on Directly Observed Therapy

HIV Pharmacy Specialist, Northern Alberta HIV Program, Royal Alexandra Hospital and DOT for HAART Program, Boyle McCauley Health Centre, Edmonton, Alberta, Canada

Peter S Akai, MD ABIM PhD

Specialist, Internal Medicine and Infectious Diseases; Medical Director, DOT for HAART Program, Boyle McCauley Health Centre

Reprints: Michelle M Foisy PharmD, Pharmacy Department, Royal Alexandra Hospital, 10240 Kingsway Ave., Edmonton, Alberta T5H 3V9, Canada, fax 780/477-4482, michellefoisy{at}shaw.ca

BACKGROUND: Inner-city patients infected with HIV can be a challenging group to treat. Homelessness, mental illness, substance abuse, and hepatitis C infection may serve as barriers to effective treatment. A multidisciplinary team including the pharmacist can impact upon the delivery of care to the inner-city HIV patient population.

OBJECTIVE: To describe the implementation and provision of pharmaceutical care to inner-city patients taking directly observed therapy (DOT), as well as drug-related problems (DRPs) and their respective outcomes.

METHODS: Pharmaceutical care, including the prospective identification and management of DRPs, was provided by a clinical pharmacist.

RESULTS: Fifty-seven patients were followed over a 14-month period. Overall, 149 DRPs were identified and >95% were resolved. Those included (1) adverse effects (n = 56; gastrointestinal, central nervous system effects, allergies, laboratory abnormalities), (2) drug interactions (n = 32), (3) drugs indicated for comorbidities (n = 24; safety in pregnancy, tuberculosis, Pneumocystis carinii pneumonia prophylaxis, oral candidiasis, herpes zoster, nutritional supplements), (4) adherence issues (n = 20; altering timing of medication, changing formulation, decreasing pill burden), (5) drugs no longer indicated (n = 10; opportunistic infection prophylaxis, treatment of primary infection), and (6) dosage adjustment (n = 7) for weight and renal insufficiency.

CONCLUSIONS: In the provision of pharmaceutical care to HIV-infected patients on DOT, an HIV pharmacist significantly contributed to antiretroviral selection, monitoring of drug therapy, and managing DRPs. An HIV pharmacist can assist in promoting patient adherence and improved outcomes in this setting.

Key Words: directly observed therapy, HIV

Published Online, February 27, 2004. www.theannals.com, DOI 10.1345/aph.1D444

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