Pharmacists and HIV/AIDS prevention: Review of the literature

doi:10.1331/JAPhA.2010.09039

Journal of the American Pharmacists Association

Volume 50, Issue 3, May–June 2010, Pages 411-415

https://doi.org/10.1331/JAPhA.2010.09039 Get rights and content

Abstract

Objectives

To provide a summary of the available literature on pharmacists' participation in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) prevention efforts, excluding needle exchange programs or highly active antiretroviral therapy (HAART) education, and to offer strategies based on the literature to expand pharmacists' roles in HIV/AIDS prevention efforts.

Data sources

Data were collected from published reports indexed from database inception through December 2008 and identified through the Centers for Disease Control and Prevention's Prevention Research Synthesis database, Ovid, PubMed, Embase, and Cochrane Library. Search terms used were pharmacist or pharmacy and HIV and/or prevention or counseling or testing or screening.

Study selection

Only English language reports were included; studies that focused on needle/syringe exchange programs and HAART therapy education and adherence counseling were excluded.

Data synthesis

13 reports were identified. The majority of articles were from international sources, and all focused on pharmacists and pharmacies as HIV/AIDS information resources.

Conclusion

Findings from the available literature showed that most pharmacists served in treatment and prevention information resource roles but were interested in expanding their roles into other prevention efforts, including HIV testing with additional training. Pharmacists described in the reports expressed a need for specific training regarding HIV/AIDS knowledge and transmission.

Section snippets

Objectives

The purpose of this review is to provide a summary of the available literature regarding pharmacists' participation in HIV/AIDS prevention efforts other than in needle/syringe exchange programs or HAART therapy education and to offer strategies based on the literature to expand the role of pharmacists in HIV/AIDS prevention efforts.

Methods

A literature review was conducted on published reports indexed from database inception through December 2008 and identified through CDC's Prevention Research Synthesis database, Ovid, PubMed, Embase, and Cochrane Library. The following search terms were used to obtain reports: pharmacist or pharmacy and HIV and/or prevention or counseling or testing or screening. English language articles were considered for inclusion in the review; reports that focused solely on needle/syringe exchange

Results

A total of 13 reports, including 5 research articles, were identified in the review. The remaining eight reports were commentaries, policy or position articles, executive summaries, or editorials. Three reports were from the United States.^8–11 No published reports were found that focused on pharmacist involvement in the delivery of behavioral interventions or HIV testing.

Excluding the research articles, a summary of the major points from the citations^6–13 rather than specifics from each are

Discussion

The main focus of the reports identified in the current work was pharmacists and pharmacies as information resources, and the majority of the literature was from other countries. In general, the findings indicated that although most pharmacists served in a treatment and prevention information resource role, a willingness existed among pharmacists to expand their current role into HIV testing and prevention interventions with additional training. Most pharmacists expressed a need for specific

Limitations

The findings presented in this report have several limitations. The majority of the reports were from studies conducted in other countries. The findings in these studies may have limited generalizability to pharmacists practicing in the United States. The results of the U.S. study are dated and may no longer be relevant. Finally, none of the reports reviewed assessed pharmacists' awareness of or interest in behavioral interventions.

Conclusion

The current HIV/AIDS epidemic in the United States requires a multifaceted approach that uses a multidisciplinary team of health care providers and researchers. Pharmacists are uniquely qualified to play an important role in HIV/AIDS prevention and have been limited in their involvement to date, perhaps because of lack of training. Additional research is needed to determine pharmacists' interest in and specific training needs around HIV/AIDS prevention in order to engage pharmacists in future

References (0)

Cited by (21)

Self-health care behaviors and knowledge of youth living with HIV
2022, Journal of the American Pharmacists Association
Citation Excerpt :
The WHO also outlined an approach to the elimination of MTCT by supporting countries in strengthening the capacity of health systems (e.g., avoiding unwanted pregnancy, preventing HIV transmission from mothers to their infants, and providing appropriate medication, care, and support).96 As a result, health care providers should provide information and counseling to youth living with HIV regarding the MTCT issue.18,20,21,25,26 The study’s limitation is that it had a limited sample size, had only 1 female adolescent, and was done at 1 hospital, which may not reflect Thai adolescents.
Thailand is facing problems with the increasing number of youths living with the human immunodeficiency virus (HIV).
The objective of this research was to study the self-health care behaviors and knowledge of youths living with HIV who were receiving antiretroviral therapy (ART).
This mixed-methods study consisted of quantitative self-administered online questionnaires and qualitative telephone interviews using a topic guide. Data analysis used descriptive statistics and thematic analysis.
A total of 22 youths aged between 15 and 24 years living with HIV who were receiving ART were recruited. Overall self-health care behavior mean scores (out of 4) among the participants were good (3.17 ± 0.41). The mean scores of the 6 self-health care behavior domains in descending order were as follows: spiritual growth (3.35 ± 0.21), health responsibilities (3.26 ± 0.43), stress management (3.10 ± 0.31), nutrition (3.08 ± 0.33), interpersonal relations (3.05 ± 0.36), and physical activity (2.87 ± 0.72). Most of the participants (63.64%) had a good level of knowledge about HIV/Acquired Immune Deficiency Syndrome (AIDS) with a mean score of 16.68 ± 2.21.
The majority of individuals maintained healthy habits. However, some domains, such as physical exercise, food, and interpersonal interactions require support. The majority of respondents had a good level of knowledge about HIV/AIDS. In addition, the participants expressed a desire for a system that would support their future career opportunities.
Predicting pharmacy syringe sales to people who inject drugs: Policy, practice and perceptions
2018, International Journal of Drug Policy
Pharmacies have much to contribute to the health of people who inject drugs (PWID) and to community efforts in HIV and hepatitis C (HCV) prevention through syringe access. However, little is known about what predicts pharmacy syringe sales without a prescription.
To identify factors predicting pharmacy syringes sales to PWID.
A hybrid staggered online survey of 298 Indiana community pharmacists occurred from July-September 2016 measuring pharmacy policy, practice, and pharmacist perceptions about syringe sales to PWID. Separate bivariate logistical regressions were followed by multivariable logistic regression to predict pharmacy syringe sales and pharmacist comfort dispensing syringes to PWID.
Half (50.5%) of Indiana pharmacies sold syringes without a prescription to PWID. Pharmacy syringe sales was strongly associated with pharmacist supportive beliefs about syringe access by PWID and their comfort level selling syringes to PWID. Notably, pharmacies located in communities with high rates of opioid overdose mortality were 56% less likely to sell syringes without a prescription than those in communities with lower rates. Pharmacist comfort dispensing syringes was associated with being male, working at a pharmacy that sold syringes to PWID and one that stocked naloxone, having been asked about syringe access by medical providers, and agreement that PWID should be able to buy syringes without a prescription.
As communities with high rates of opioid overdose mortality were less likely to have pharmacies that dispensed syringes to PWID, a concerted effort with these communities and their pharmacies should be made to understand opportunities to increase syringe access. Future studies should explore nuances between theoretical support for syringe access by PWID without a prescription and actual dispensing behaviors. Addressing potential policy conflicts and offering continuing education on non-prescription syringe distribution for pharmacists may improve comfort distributing syringes to PWID, and therefore increase pharmacy syringe sales.
Knowledge, attitudes and beliefs regarding human immunodeficiency virus and in-home testing among a regional sample of student pharmacists
2017, Currents in Pharmacy Teaching and Learning
Pharmacists identify the importance of education on human immunodeficiency virus (HIV); however, research suggests deficits in knowledge regarding recommendations and testing devices. With proper training, student pharmacists can play an important role in counseling patients on the importance of HIV testing and providing instruction on in-home testing. The objective of the study was to assess student pharmacists’ knowledge, attitudes and beliefs of HIV and the use of an in-home, over-the-counter HIV testing device.
A cross-sectional electronic survey was conducted among an estimated sample of 2077 students from six regional schools of pharmacy. The questionnaire consisted of 40 closed-ended, fixed-choice items delivered using school/organizational listservs. Surveys were e-mailed during March and April 2016 with a reminder e-mail sent two weeks later. Key outcomes included real and perceived knowledge, attitudes and beliefs of HIV in general and of the OraQuick^® In-Home HIV test.
A total of 387 student pharmacists participated (response rate of 18.6%). Respondents expressed positive perception of knowledge regarding HIV in general (67.6% highly agree/agree to five-item scale) but considerably lower attitude/beliefs for the in-home HIV test (16.7% highly agree/agree overall to five-item scale). Perceptions of general HIV knowledge were higher for students in later professional years (p < 0.001), post-completion of infectious disease curriculum with inclusion of the in-home HIV test (p < 0.001), and if the respondent had personally received an HIV test (p < 0.01).
Opportunities exist to improve knowledge of HIV and the use of the OraQuick^® In-Home HIV test among student pharmacists.
Evaluating community pharmacists' HIV testing knowledge: A crosssectional survey
2015, Journal of the American Pharmacists Association
Citation Excerpt :
Still, pharmacists who are younger than 50 years of age performed poorly on multiple areas of HIV testing, emphasizing the need for CPE programs on HIV treatment and testing for all pharmacists. A recent study demonstrated that most pharmacists, with additional training, are interested in expanding their roles with regard to HIV testing.11 This is consistent with what was observed in our study.
To assess community pharmacists’ knowledge of human immunodeficiency virus (HIV), antiretroviral therapy, and new in-home oral fluid HIV test.
A cross-sectional questionnaire administered to pharmacists, student pharmacists, and technicians before an education program at the New Mexico Pharmacists Association 2013 Mid-Winter Meeting in Albuquerque, NM. The main outcome measure was community pharmacists’ correct response rate of 75% or more.
Overall survey response rate of attendees was 89% (173/194 attendees). Among them 87 participants were community pharmacists; 87% of community pharmacists responded correctly when asked how HIV antiretroviral medications work and 84.3% correctly identified known sources of HIV infection. The 75% predefined adequate knowledge threshold was not met on any HIV screening or in-home HIV test knowledge items. Only 65.1% of community pharmacists correctly identified the minimum number of antiretroviral drugs that should be included in an ideal HIV treatment regimen. The only variable that positively influenced pharmacists’ knowledge was age. An inverse relationship between pharmacist age and HIV knowledge was observed among study participants.
Community pharmacists from urban and rural areas in New Mexico possessed adequate basic HIV knowledge, but did not demonstrate adequate HIV screening or in-home HIV test knowledge. Future educational interventions aimed at improving pharmacist knowledge in this area are warranted.
Improvement of pharmaceutical care in a pediatric HIV/AIDS outpatient clinic
2015, Pharmacien Hospitalier et Clinicien
Il n’existe pas de normes de pratiques déterminant le nombre minimum de pharmaciens devant exercer au chevet des patients au sein des différents programmes de soins offerts dans le réseau de santé. Notre objectif était de mettre à jour le niveau de la pratique pharmaceutique en VIH/SIDA au sein d’une clinique ambulatoire pédiatrique.
Il s’agit d’une étude descriptive avec revue documentaire menée dans un centre hospitalier universitaire mère–enfant. À partir des preuves de la littérature, les retombées du pharmacien dans la prise en charge des patients atteints de VIH/SIDA ont été cotées selon sept indicateurs de résultats (mortalité, morbidité, coût, erreurs, effets indésirables, observance et satisfaction). La revue des activités pharmaceutiques en vigueur a servi de base à des discussions sur la mise à jour du secteur.
La recherche bibliographique a permis de recenser 86 articles. Trente-six articles et trois lignes directrices ont été retenus pour mettre à jour les activités pharmaceutiques. La mise à jour envisagée du secteur de pratique inclut la prise en charge des patients atteints de VIH par l’équipe de pédiatrie, l’implication d’un deuxième pharmacien, la mise à disposition d’un espace confidentiel, la documentation des interventions pharmaceutiques de manière structurée, la rédaction de protocoles et de feuilles d’ordonnances pré-rédigées, la déclaration proactive d’effets indésirables et la prise d’initiatives sur le plan de la recherche.
Cette étude descriptive met en évidence un grand nombre de publications sur le rôle et les retombées du pharmacien dans la prise en charge du VIH/SIDA et la prestation d’activités pharmaceutiques cliniques. Toutefois, il existait peu d’études expérimentales.
Cette étude montre qu’une mise à niveau est possible auprès d’un programme de soins où les pharmaciens sont impliqués à temps partiel dans un contexte de surspécialisation.
There are no practice guidelines stating how many decentralized pharmacists should work in each healthcare program. Our objective was to revisit pharmaceutical care in a pediatric HIV/AIDS outpatient clinic.
A descriptive study including a literature review was conducted in the 500-bed pediatric teaching hospital. Based on best evidence, the impact of pharmacists in HIV/AIDS specialized pharmaceutical care was assessed on 7 factors (mortality, morbidity, cost, errors, adverse effects, adherence and satisfaction). The review of actual pharmaceutical care provided a discussion ground for the improvement of the sector's development.
Eighty-six publications were assessed for eligibility. Thirty-six articles and three guidelines were included in the literature review in order to update our pharmaceutical activities. Main changes in this sector concerned the integration of the pharmacist's position within the pediatric team and the pairing with a second pharmacist, the availability of a confidential working space, the structured documentation of all pharmacists’ interventions, the editing of protocols and pre-written prescriptions, the proactive declaration of adverse effects and more initiatives for doing research.
This descriptive study highlights the high number of publications on the role and impact of pharmacists in the care of HIV/AIDS patients. However, there is a lack of experimental studies.
This study showed that it is possible to update the activities performed by pharmacists in a specialized healthcare program.
Exploratory survey of Florida pharmacists' experience, knowledge, and perception of HIV pre-exposure prophylaxis
2014, Journal of the American Pharmacists Association
Citation Excerpt :
To promote effective PrEP use, pharmacists should be aware of these resources for PrEP access so that adherence can be maintained. Pharmacists already provide a vital role in improving adherence to antiretroviral therapy, counseling on HIV/AIDS prevention, and enhancing needle and syringe exchange programs.27–31 To continue to provide comprehensive patient care in HIV prevention, pharmacists must familiarize themselves with PrEP use, including anticipated scenarios such as insurance challenges that will arise with this indication; recognizing the impact of PrEP interruptions on efficacy and implementing protocols to maintain continued access; and educating patients about potential adverse effects, importance of adherence, and behavioral interventions to reduce HIV acquisition.
To assess Florida pharmacists’ experience, knowledge, and perception of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and to identify areas for pharmacist training.
Cross-sectional survey.
Florida in March through July 2013.
Florida pharmacists.
In-person and online anonymous survey.
Florida pharmacists’ experience, knowledge, and perceptions of PrEP.
225 completed surveys were analyzed. Survey respondents were predominantly community pharmacists with mean age of 45.7 years and less than 20 years of experience. Only 22% of respondents reported dispensing PrEP to patients. Although 75% had completed HIV-related continuing education in the last 2 years, 63% were unaware of Centers for Disease Control and Prevention PrEP guidelines and 71% answered that they did not have sufficient knowledge to counsel patients with PrEP prescriptions. Importantly, 47% of respondents answered they were uncomfortable counseling patients about PrEP. By self-report, most pharmacists agreed PrEP leads to risky behavior (68%) and increased rates of sexually transmitted infections (65%), and is too costly to promote patient access (92%).
Surveyed Florida pharmacists reported limited understanding of PrEP. As a widely accessible health care counseling resource, pharmacists are positioned to improve patient understanding, promote medication adherence, and enhance PrEP efficacy. Especially during PrEP implementation, when patients may receive PrEP prescriptions from non-HIV specialist prescribers, improving pharmacists’ PrEP education presents a salient opportunity.

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: Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.

: Acknowledgments: To Julia DeLuca and Mary Mullins, Information Specialists, for assistance and guidance with the literature review.

: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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ReviewsPharmacists and HIV/AIDS prevention: Review of the literature

Abstract

Objectives

Data sources

Study selection

Data synthesis

Conclusion

Section snippets

Objectives

Methods

Results

Discussion

Limitations

Conclusion

Reviews
Pharmacists and HIV/AIDS prevention: Review of the literature