Role of the Pharmacist in Caring for Patients with HIV/AIDS: Clinical Practice Guidelines

Introduction and Impact of a Human Immunodeficiency Virus Education Package on the Knowledge and Confidence of Pharmacists

Background: Without specific pharmaceutical knowledge in specialist areas such as Human Immunodeficiency Virus (HIV) management, pharmacists may lack the ability and confidence to provide optimal pharmaceutical care and optimization of outcomes. Objective: To develop a pharmacy-specific, foundational HIV education and assessment package, and assess impact on pharmacist knowledge and confidence. Methods: A foundational HIV education package with assessment was developed. Participants' baseline knowledge and self-reported confidence in HIV management were determined via an anonymous online questionnaire. Only participants who completed the pre-education questionnaire were then provided access to the self-paced, online education package. Participants completed a second questionnaire after completion of the package at a time of their choosing, within 2 months of the first questionnaire completion. Both questionnaires were similar in knowledge difficulty and addressed similar clinical domains. Mean differences in knowledge and confidence levels were analyzed, with further subgroup analyses of knowledge categories. Results: A total of 57 pharmacists completed both questionnaires. HIV knowledge was higher post-education compared with pre-education (mean correct score of 83.7% and 56.5% respectively, P < .001). The mean self-rated confidence of pharmacists in managing medications of people living with HIV, was higher post-education (73.3%) compared with pre-education (33.9%) (P < .001). Conclusion: The use of a pharmacy-specific, foundational HIV management education package significantly increased pharmacist knowledge in HIV management and improved self-reported confidence in the management of this specialty area. Future studies should assess the sustained impact of educational materials on pharmacist knowledge and confidence and investigate translation into improved outcomes for people living with HIV.

Patients, Social Workers, and Pharmacists' Perceptions of Barriers to Providing HIV Care in Community Pharmacies in the United States

Retaining people living with HIV (PLWH) in clinical care is a global priority to end the HIV epidemic. Community pharmacies in the United States have structural influences on the success or failure of retention in HIV care by supporting patients’ complex needs. However, to date, barriers to retention in care in the community pharmacy setting have not been examined beyond pharmacy services of medication therapy management. We utilized the patient-centered medical home model to examine the barriers to HIV care in the community pharmacy setting. We utilized semi-structured interviews to collect data from 15 participants: five PLWH, five community pharmacists, and five social workers from a midwestern state. Interview data were transcribed and analyzed using directed content analysis. Four key themes emerged regarding the barriers that impact utilization of community pharmacy services by PLWH: the perception of the role of community pharmacists in HIV care, perceptions of pharmacists’ HIV knowledge, perceptions of pharmacy operation and services, and negative experiences within the community pharmacy space. Participants’ perceptions of solutions for improving HIV care in the community pharmacy focused on improving the relationship between pharmacists and patients, ensuring that the community pharmacy is a private and safe space for patients, and having a diverse pharmacy staff that is equipped to take care of the diverse and marginalized HIV population, such as transgender people.

Medical Devices-Related Counseling Practices Among Community Pharmacists: A Nationwide Cross-Sectional Study from Saudi Arabia

Objective

The current study was conducted to assess medical devices-related counseling practices among community pharmacists in Saudi Arabia.

Methodology

This was a cross-sectional study conducted among community pharmacists from Saudi Arabia using a convenience sampling technique. An online questionnaire based on Google forms was used to collect data. Descriptive and inferential analyses were conducted using SPSS statistics 22. Student t-test, one way ANOVA, and Pearson correlation statistics were used where applicable. Results with a p-value of <0.05 were considered statistically significant.

Results

One thousand and six community pharmacists responded to the survey. Males’ rating of their ability to operate medical devices was significantly higher than females (overall average score of 3.8 versus 3.5, p=0.033). As years of experience increased there were slight but significant increases in the overall scores on ability to operate medical devices (p=0.002) and confidence to counsel patients about the devices (p=0.032). Those who got a board certification used devices for self-treatment significantly more than their counterparts (on average 6.9 devices versus 5.2, p=0.003). Those who received clinical training reported higher rates of ability to use/operate devices (p=0.011), confidence to counsel patients on devices (p=0.001), and counseling practice (p=0.044) than those who did not receive clinical training.

Conclusion

The present study revealed good to very good self-reported medical devices-related counseling practices. There is a need for more future rigorous research to evaluate pharmacists' actual practice in this area. Pharmacy educators and CPD programs should pay attention to updating pharmacists’ knowledge and skills and improve their contribution to medical devices supportive services.

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.

Pharmacist-led HIV and hepatitis C point-of-care testing and risk mitigation counseling in individuals experiencing homelessness

Introduction

Over half a million people experience homelessness on any given night in the United States. As a result of increased exposure to disease, violence, stigma, substance misuse and limited accessibility to health services, individuals experiencing homelessness are disproportionately affected by communicable diseases such as HIV and HCV with prevalence estimates as high as 21% and 36%, respectively. Pharmacists, being some of the most trusted and accessible healthcare providers, are in a unique position to have a significant impact on the nationwide initiatives in Ending the HIV Epidemic: A Plan for America and the National Viral Hepatitis Plan by offering preventative testing services and patient-centered risk mitigation counseling and education. This research looks to assess the health impacts associated with pharmacist-led HIV and HCV screening coupled with comprehensive education and risk mitigation counseling in adults experiencing homelessness.

Methods

This study was conducted in a single independent community pharmacy in Spokane, Washington which specializes in mental health services and serves a large proportion of patients who are experiencing homelessness. Study participants are walk-in patients of the pharmacy, over the age of 18, are currently experiencing homelessness, and have not received an HIV or HCV screening within the past 6 months. The study intervention includes a Risk Determination interview, administration of HIV and HCV point-of-care antibody test, comprehensive diseases state education and personalized risk mitigation counseling. Participants are then referred to a local health clinic for confirmatory testing, anonymous partner notification, and evaluation for pre-exposure prophylaxis if indicated.

Results

A total of 10 participants were included in the final data analysis. Majority of study participants were male (80%), heterosexual (90%) and over the age 30 (90%). A total of 8 participants (80%) had a reactive HCV screening and there were no reactive HIV screenings. Many of participants reported IV drug use with methamphetamine being the most used illicit substance. Half of all participants (50%) admitted to borrowing a needle for injection drug use within the past 6 months. Two participants admitted to having sexual intercourse with a partner who was known to be HCV-positive and both participants had a reactive HCV screening. All study participants reported at least one serious mental illness diagnosis and ongoing recreational drug use was cited as a coping mechanism in all participants.

Conclusion

Since efficacy of treatment is no longer the limiting factor in eradicating HCV and suppressing HIV viral load, public health efforts need to be refocused on patient engagement through preventative services in an environment that is less stigmatized than traditional testing sites, such as community pharmacies. Study participants were highly receptive to pharmacist-provided point-of-care screening services in the community pharmacy. Combining HIV and HCV point-of-care testing with comprehensive patient-centered education and risk mitigation counseling may result in lower rates of community transmission, improve linkage to care and may lead to long-term retention of marginalized populations such as those experiencing homelessness.

Knowledge, empathy, and willingness to counsel patients with HIV among Indonesian pharmacists: a national survey of stigma

This study aimed to assess the level of HIV treatment knowledge, empathy, and HIV stigma of pharmacy students and pharmacists working with patients as well as potential factors associated with stigma. This survey included 250 hospital pharmacists within 33 provinces and 1013 final-year pharmacy students from Java, the most populated island in Indonesia. The data were collected via Qualtrics® and distributed by WhatsApp. The mean age of the participants was (Mean ± SD) 24.68 ± 5.30 years, and 80.0% were female. The mean knowledge score of students and pharmacists were 14.14 ± 2.01 and 15.39 ± 1.87, respectively, out of the maximum score of 21. The mean empathy score of students and pharmacists was 72.06 ± 5.39 and 77.40 ± 1.35, respectively out of the maximum score of 105. The mean stigma score of students and pharmacists was 21.02 ± 4.65 and 20.66 ± 4.41, respectively, out of a maximum score of 48. Regression analysis showed that knowledge, empathy, and willingness to counsel patients were negatively associated with stigma. Working with patients was positively associated with stigma. A multi-level intervention including education may reduce stigma and strengthen the role of pharmacists in caring for patients.

Joint Predictors of Hypertension and Type 2 Diabetes Among Adults Under Treatment in Amhara Region (North-Western Ethiopia)

BACKGROUND

One of the chronic diseases, all over the world, due to its significant contribution to the existence of other health problems is hypertension. It is known that hypertensive patients exposed to diabetes and the reverse is also true. The objective of the current investigation was to identify joint risk factors for hypertension and type 2 diabetes for adults under treatment.

METHODS

A random sample of 748 hypertensive and type 2 diabetic patients was selected. A retrospective longitudinal study was conducted with the selected patients who were receiving treatment for both hypertension and type 2 diabetes. A joint linear mixed-effect model was used for data analysis in this investigation.

RESULTS

The current investigation revealed that age (β = 0.18, p-value = 0.04 for hypertension, β = 0.81, p-value = 0.02 for type 2 diabetes) and weight of patients (β = 0.52, p-value <0.01 for hypertension, β = 0.32, p-value <0.01 for type 2 diabetes) were positively and significantly associated with existence of hypertension and type 2 diabetes whereas visiting times (β = -0.08, p-value = 0.04 for hypertension, β = -0.38, p-value = 0.03 for type 2 diabetes) were negatively associated with the variables of interest. Similarly, patients who do not exercise, who smoke, and drink and patients with a family history of disease were positively associated with the existence of the variables of interest.

CONCLUSION

Hypertension and diabetes are highly correlated and one is the causes of the other. Hypertensive and diabetic patients should be aware that they should stop drinking alcohol and smoking and should attend properly to their medication as prescribed by health staff. They should also be advised to undertake physical exercise to reduce risks related to these two correlated diseases.

Pharmacist-led counselling intervention to improve antiretroviral drug adherence in Pakistan: a randomized controlled trial

Background

Pakistan is facing a growing population of people living with human immunodeficiency (HIV). In this randomized controlled trial, we investigate if a pharmacist-led intervention can increase adherence to antiretroviral therapy (ART) for people living with HIV (PLWH).

Methods

Adults with HIV, who have been taking ART for more than 3 months were randomly assigned to receive either a pharmacist-led intervention or their usual care. Measures of adherence were collected at 1) baseline 2) just prior to delivery of intervention and 3) 8 weeks later. The primary outcomes were CD4 cell count and self-reported adherence measured with the AIDS Clinical Trial Group (ACTG) questionnaire.

Results

Post-intervention, the intervention group showed a statistically significant increase in CD4 cell counts as compared to the usual care group (p = 0.0054). In addition, adherence improved in the intervention group, with participants being 5.96 times more likely to report having not missed their medication for longer periods of time (p = 0.0086) while participants in the intervention group were 7.74 times more likely to report missing their ART less frequently (p < 0.0001).

Conclusions

The findings support the improvement in ART adherence and HIV management.

Trial registration

The trial is registered with Australian New Zealand Clinical Trials Registry (ACTRN12618001882213). Registered 20 November 2018.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-020-05571-w.

Opinion, experience and educational preferences concerning pharmacogenomics: an exploratory study of Quebec pharmacists

Aim: To evaluate the current opinion, experience and educational preferences of pharmacists in Quebec concerning pharmacogenomics. Method: A web-based survey containing 25 questions was sent to all Quebec pharmacists. Results: Most pharmacists were willing to advise patients (81%) and physicians (84%) on treatment choices based on pharmacogenomic test results after proper training. Only 31% had been previously exposed to pharmacogenomic test results, and 91% were favorable to pharmacogenomics training, with e-learning through interactive video sessions (69%). The preferred training session length was between 1 and 3 h (59%). Hospital pharmacists were more often exposed to pharmacogenomic tests (p < 0.0001) and more frequently advised patients on treatment choices (p < 0.001) than community pharmacists. Conclusion: Pharmacists remain favorable toward pharmacogenomics, but its use in clinical practice stays limited. Identifying the educational preferences of pharmacists may help in the development of educational programs to help them integrate pharmacogenomics in their clinical practice.

The Excellence of Pharmacy Practice

Over the past 50 years, the role of pharmacists has evolved along with the health care needs of our population. In addition to dispensing medications and ensuring patient safety, today’s pharmacists are taking a larger role as medical counselors, educators and advocates. They are integral part of the health care team, and are among the most trusted and accessible health care professionals. This accessibility allows them to perform more patient care activities, including counseling, medication management, and preventive care screenings. Beyond the care provided to individual patients, pharmacists have expanded their reach to influence the public health of communities. A pharmacist is uniquely positioned to provide disease state management through appropriate medication therapy management that has been demonstrated to improve patient outcomes and decrease overall health care costs. This role is more important than ever as the environment is demanding new practice and payment models that are required to further optimize care and outcomes while addressing the unsustainable increases in health care costs.

Multidisciplinary Authorship Among Infectious Diseases Society of America Clinical Practice Guidelines: Examining the Contributions of Infectious Diseases Pharmacists

We describe the proportion of pharmacist representation among current and corresponding prior editions of Infectious Diseases Society of America (IDSA) clinical practice guidelines (CPGs). Pharmacist representation was 13% and 21% in previous and current editions, respectively, increasing significantly since 2011. We advocate for continued collaborations between IDSA and pharmacy organizations to enhance multidisciplinary representation in CPGs.

Role of a clinical pharmacist as part of a multidisciplinary care team in the treatment of HCV in patients living with HIV/HCV coinfection

Background

The objective of the study was to evaluate the role of a clinical pharmacist in hepatitis C virus (HCV) treatment of patients living with HIV/HCV coinfection.

Methods

We conducted a descriptive study to quantify the functions of a clinical pharmacist in HCV treatment of patients living with HIV/HCV coinfection who were initiating HCV treatment at a publicly funded clinic between March 18, 2015 and September 15, 2016. The clinical pharmacist’s role was categorized into eight categories: 1) HCV prior authorization (PA) completion; 2) HCV medication adherence counseling; 3) HCV drug-drug interaction (DDI) counseling and screening; 4) HCV medication counseling regarding common adverse events (AEs); 5) HCV counseling regarding HCV treatment outcomes and risk of reinfection; 6) ordering laboratory tests and interpretation of HCV laboratory values; 7) HIV medication AE assessment; and 8) other (including refilling medications and management of other comorbidities).

Results

One hundred and thirty-five patients initiated treatment during this timeframe: 77.0% were males, 56.3% non-cirrhotic, 77.0% HCV treatment-naïve, 45.9% HCV genotype 1a, and 83.0% initiated on ledipasvir/sofosbuvir. The clinical pharmacist completed 150 PAs, counseled on HCV medication adherence in 79.2% of patients, conducted HCV DDI counseling and screening in 54.2%, and monitored HCV medication AEs in 54.2%. The clinical pharmacist counseled patients on HCV treatment outcomes and risk of reinfection in 53.1%, ordered laboratory tests in 44.8%, and reported and interpreted laboratory values in 44.8%. The clinical pharmacist assessed HIV medication AEs in 54.2% of patients and participated in other activities in 42.7%.

Conclusion

A clinical pharmacist’s expertise as part of a multidisciplinary care team facilitates optimal treatment outcomes and provides critical support in the management of DAA therapy in individuals living with HIV/HCV coinfection.

Patient satisfaction with chronic HIV care provided through an innovative pharmacist/nurse-managed clinic and a multidisciplinary clinic

Background

Pharmacist/nurse-led clinics are an established model for many chronic diseases but not yet for HIV. At our centre, patients with HIV are seen by a multidisciplinary team (physician, nurse, pharmacist, social worker) at least yearly. Some attend an HIV-specialist pharmacist/nurse clinic (or "nonphysician clinic," NPC) for alternate biannual visits. Our objective was to assess patient satisfaction with care received through both clinics.

Methods

The Patient Satisfaction Survey for HIV Ambulatory Care (assesses satisfaction with access to care, clinic visits and quality of care) was administered by telephone to adults who attended either clinic between January and July 2014. Descriptive statistics described patient characteristics and satisfaction scores. Fisher's exact test compared satisfaction scores between the NPC and multidisciplinary clinic (MDC). Multivariate logistic regression examined associations between overall satisfaction with care and clinic type and patient characteristics (e.g., age, disease duration).

Results

Respondents were very satisfied with the overall quality of HIV care in both the NPC and MDC (89% vs 93%, respectively, p = 0.6). Patients from both clinics expressed satisfaction with access to care, treatment plan input, their provider's knowledge of the newest developments in HIV care and explanation of medication side effects, with no significant differences noted. Significantly more MDC patients reported being asked about housing/finances, alcohol/drug use and whether they needed help disclosing their status. Patient characteristics were not significantly associated with satisfaction with overall quality of care.

Conclusion

Patients are satisfied with both clinics, supporting NPC as an innovative model for chronic HIV care. Comparison of outcomes between clinics is needed to ensure high-quality care.

Shifting tasks from pharmacy to non-pharmacy personnel for providing antiretroviral therapy to people living with HIV: a systematic review and meta-analysis

OBJECTIVES

Lay people or non-pharmacy health workers with training could dispense antiretroviral therapy (ART) in resource-constrained countries, freeing up time for pharmacists to focus on more technical tasks. We assessed the effectiveness of such task-shifting in low-income and middle-income countries.

METHOD

We conducted comprehensive searches of peer-reviewed and grey literature. Two authors independently screened search outputs, selected controlled trials, extracted data and resolved discrepancies by consensus. We performed random-effects meta-analysis and assessed certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Three studies with 1993 participants met the inclusion criteria, including two cluster trials conducted in Kenya and Uganda and an individually randomised trial conducted in Brazil. We found very low certainty evidence regarding mortality due to the low number of events. Therefore, we are uncertain whether there is a true increase in mortality as the effect size suggests, or a reduction in mortality between pharmacy and non-pharmacy models of dispensing ART (risk ratio (RR) 1.86, 95% CI 0.44 to 7.95, n=1993, three trials, very low certainty evidence). There may be no differences between pharmacy and non-pharmacy models of dispensing ART on virological failure (risk ratio (RR) 0.92, 95% CI 0.73 to 1.15, n=1993, three trials, low certainty evidence) and loss to follow-up (RR 1.13, 95% CI 0.68 to 1.91, n=1993. three trials, low certainty evidence). We found some evidence that costs may be reduced for the patient and health system when task-shifting is undertaken.

CONCLUSIONS

The low certainty regarding the evidence implies a high likelihood that further research may find the effects of the intervention to be substantially different from our findings. If resource-constrained countries decide to shift ART dispensing and distribution from pharmacy to non-pharmacy personnel, this should be accompanied by robust monitoring and impact evaluation.

PHIRST Trial - pharmacist consults: prioritization of HIV-patients with a referral screening tool

The role of pharmacists in HIV outpatient clinics has greatly increased in the past decades. Given the limited resources of the health system, the prioritization of pharmacist consults is now a main concern. This study aimed to create a scoring system allowing for standardized prioritization of pharmacist consults for patients living with HIV. Data was retrospectively collected from 200 HIV patients attending the Chronic Viral Illness Service at the McGill University Health Center. An expert panel consisting of four pharmacists working in the field of HIV prioritized each patient individually, after which a consensus was established and was considered as the gold standard. In order to create a scoring system, two different methods (Delphi, statistical) were used to assign a weight to each characteristic considered to be important in patient prioritization. A third method (equal weight to each characteristic) was also evaluated. The total score per patient for each method was then compared to the expert consensus in order to establish the score cut-offs to indicate the appropriate categories of delay in which to see the patient. All three systems failed to accurately prioritize patients into urgency categories ("less than 48 h", "less than 1 month", "less than 3 months", "no consult required") according to expert pharmacist consensus. The presence of high level interactions between patient characteristics, the limited number of patients and the low prevalence of some characteristics were hypothesized as the main causes for the results. Creating a prioritization tool for pharmacy consults in HIV outpatient clinics is a complex task and developing a decision tree algorithm may be a more appropriate approach in the future to take into account the importance of combinations of patient characteristic.

Optimizing hepatitis C virus treatment through pharmacist interventions: Identification and management of drug-drug interactions

AIM

To quantify drug-drug-interactions (DDIs) encountered in patients prescribed hepatitis C virus (HCV) treatment, the interventions made, and the time spent in this process.

METHODS

As standard of care, a clinical pharmacist screened for DDIs in patients prescribed direct acting antiviral (DAA) HCV treatment between November 2013 and July 2015 at the University of Colorado Hepatology Clinic. HCV regimens prescribed included ledipasvir/sofosbuvir (LDV/SOF), paritaprevir/ritonavir/ombitasvir/dasabuvir (OBV/PTV/r + DSV), simeprevir/sofosbuvir (SIM/SOF), and sofosbuvir/ribavirin (SOF/RBV). This retrospective analysis reviewed the work completed by the clinical pharmacist in order to measure the aims identified for the study. The number and type of DDIs identified were summarized with descriptive statistics.

RESULTS

Six hundred and sixty four patients (83.4% Caucasian, 57% male, average 56.7 years old) were identified; 369 for LDV/SOF, 48 for OBV/PTV/r + DSV, 114 for SIM/SOF, and 133 for SOF/RBV. Fifty-one point five per cent of patients were cirrhotic. Overall, 5217 medications were reviewed (7.86 medications per patient) and 781 interactions identified (1.18 interactions per patient). The number of interactions were fewest for SOF/RBV (0.17 interactions per patient) and highest for OBV/PTV/r + DSV (2.48 interactions per patient). LDV/SOF and SIM/SOF had similar number of interactions (1.28 and 1.48 interactions per patient, respectively). Gastric acid modifiers and vitamin/herbal supplements commonly caused interactions with LDV/SOF. Hypertensive agents, analgesics, and psychiatric medications frequently caused interactions with OBV/PTV/r + DSV and SIM/SOF. To manage these interactions, the pharmacists most often recommended discontinuing the medication (28.9%), increasing monitoring for toxicities (24.1%), or separating administration times (18.2%). The pharmacist chart review for each patient usually took approximately 30 min, with additional time for more complex patients.

CONCLUSION

DDIs are common with HCV medications and management can require medication adjustments and increased monitoring. An interdisciplinary team including a clinical pharmacist can optimize patient care.

The effects of shifting tasks from pharmacy to non-pharmacy personnel for providing antiretroviral therapy to people living with HIV: a systematic review protocol

INTRODUCTION

Shifting selected antiretroviral therapy (ART) tasks from specialised healthcare workers to those with shorter or less formal training has been implemented in resource-limited settings to alleviate critical shortages of human resources for health. However, the specifics of shifting ART dispensing from pharmacy to non-pharmacy personnel have not been addressed in a systematic review, although this can potentially increase access to ART. We will assess the effects of shifting dispensing and distribution of ART and adherence assessment from pharmacy to non-pharmacy personnel in low and middle-income countries.

METHODS AND ANALYSIS

We will search PubMed, CENTRAL, EMBASE, WHO Global Health Library and relevant grey literature for eligible controlled trials. Two authors will screen the search output, select eligible studies, assess risk of bias and extract data from included studies, resolving discrepancies by discussion and consensus. We will perform meta-analysis using both fixed and random effects models, investigate clinical and statistical heterogeneity, and assess our confidence in the overall evidence using standard Cochrane methods, including GRADE.

ETHICS AND DISSEMINATION

Only secondary data will be included in this review and ethics approval is not required. We will disseminate the review findings in various scientific fora, including peer-reviewed journals. The findings may help to inform policy makers in defining the scope of work of healthcare workers, and global recommendations for shifting the dispensing and distribution of ART from pharmacy to non-pharmacy personnel.

TRIAL REGISTRATION NUMBER

CRD42015017034.

Reporting of critical information in studies of pharmacists in HIV care

OBJECTIVE

To evaluate manuscripts documenting HIV pharmacist interventions and assess adequacy of reporting as defined by CONSORT and STROBE criteria.

METHODS

PubMed, EMBASE, Cochrane Library, Web of Science, BIOSIS Previews, and PsycINFO databases were searched from inception - 1 June 2011. Studies were included if pharmacists performed an intervention to improve HIV patient care, and the study evaluated the intervention's impact. Qualitative studies, non-English language reports, abstracts and studies where the pharmacist did not intervene were excluded. Manuscripts were independently evaluated by two reviewers for the presence, absence or lack of applicability of STROBE (observational studies) or CONSORT (randomized studies) criteria, for presence or absence of description of pharmacist's duties, CD4+ cell count, HIV viral load and adherence measurement. Reviewers met to discuss the rationale behind their evaluation; a third arbiter was consulted when reviewers could not agree on a particular criterion.

KEY FINDINGS

Twenty-two manuscripts met inclusion criteria. Observational studies of HIV pharmacists (n = 19) included 56% of applicable STROBE criteria. Randomized studies of HIV pharmacists (n = 3) adhered more closely to CONSORT reporting guidelines (average 80% of applicable criteria). Manuscripts published after 2004 more consistently evaluated pharmacist impact on HIV outcomes such as CD4+ and viral load.

CONCLUSIONS

Thorough reporting increases the reader's ability to critically evaluate manuscripts of HIV pharmacist services. Increasing pharmacist awareness of manuscript guidelines such as CONSORT and STROBE may improve clarity of reporting in studies of HIV pharmacist interventions and clinical programmes.