Impact of a pharmaceutical care program on clinical evolution and antiretroviral treatment adherence: a 5-year study

Abstract

BackgroundAntiretroviral treatments (ART) form the basis of adequate clinical control in human immunodeficiency virus-infected patients, and adherence plays a primary role in the grade and duration of the antiviral response. The objectives of this study are: (1) to determine the impact of the implementation of a pharmaceutical care program on improvement of ART adherence and on the immunovirological response of the patients; and (2) to detect possible correlations between different adherence evaluation measurements.MethodsA 60-month long retrospective study was conducted. Adherence measures used were: therapeutic drug monitoring, a simplified medication adherence questionnaire, and antiretroviral dispensation records (DR). The number of interviews and interventions related to adherence made for each patient in yearly periods was related to the changes in the adherence variable (measured with DR) in these same yearly periods. The dates when the laboratory tests were drawn were grouped according to proximity with the study assessment periods (February–May, 2005–2010).ResultsA total of 528 patients were included in the study. A significant relationship was observed between the simplified medication adherence questionnaire and DR over the 60-month study period (P < 0.01). Improvement was observed in the mean adherence level (P < 0.001), and there was a considerable decrease in the percentage of patients with CD4+ lymphocytes less than 200 cells/mm3 (P < 0.001). A relationship was found between the number of patients with optimum adherence levels and the time that plasma viral load remained undetected. The number of interviews and interventions performed in each patient in the first 12 months from the onset of the pharmaceutical care program (month 6), was related to a significant increase in adherence during this same time period.ConclusionThe results suggest that the establishment and permanence of a pharmaceutical care program may increase ART adherence, increase permanence time of the patient with undetectable plasma viral loads, and improve patients’ lymphocyte count.

<p>Adherence to HIV treatment regimens: systematic literature review and meta-analysis</p>

“…Of the 11 studies that used 95% as the adherence threshold, seven (64%) found that adherence was strongly associated with viral suppression 5,42,44,47,50,52,57. All three studies using 90% as a threshold showed improved virologic outcomes with adherence,32,53,55 and two studies found high levels of viral suppression when adherence was ≥80%40 and >75% 35.…”

“…The results of two suggested that higher (≥95%) adherence improved virologic outcomes,5,47 while three found that suboptimal adherence (self-reported non-adherence50 or <95% adherence)42,44 was associated with virologic failure. The remaining studies used a variety of other methods to assess adherence, including therapeutic drug monitoring,52 a simplified medication adherence questionnaire,52,56 pill counts,53,55 pharmacy refills,55 and the antiviral medication adherence form 53. All studies demonstrated a positive association between treatment adherence and virologic outcomes.…”

Is the HIV epidemic over? Investigating population dynamics using Bayesian methodology to estimate epidemiological parameters for a system of stochastic differential equations

“…Individuals with HIV may go many years without diagnosis, during which time they may expose uninfected individuals to the disease. Efforts to improve the diagnosis rate include educational programs, as an individual's perceived risk was shown to be highly correlated with the individual obtaining multiple HIV tests [6,9,11,22]. Several studies have found a 50% reduction in risky behaviors after diagnosis, including safer sex practices, reduction in partner number, and medications that reduce viral load [14,26,31].…”