HIV Treatment & Prevention

Introduction

 The impacts of human immunodeficiency virus (HIV) and Acquired Immunodeficiency syndrome (AIDS) endemic continue to soar globally calling for concerted interventions among health professionals and structures in the prevention and treatment of HIV and AIDS. The profound impacts of HIV and AIDS has necessitated and highlighted the role that pharmacists can play in the prevention and treatment of the pandemic (1). In Australia, though significant milestones have been achieved in the management of the HIV and AIDS scourge since the nation’s first diagnosis of the disease three decades ago, recent statistics from the UNAIDS Australia Country progress report indicates that the incidence  of fresh HIV diagnosis cases have been on the increase albeit gradually (2). The rising number of persons diagnosed with HIV has been attributed to ambitious efforts and campaigns that have increased the rates of testing for HIV and enhanced access to antiretroviral drugs (3).By the close of 2014 for instance, about 26, 600 persons in Australia were living with the HIV virus, with 1, 236 new diagnosis and 350 new HIV infections (4). While the number of people dying from AIDS related symptoms are extremely low in the country thanks to accessibility of a number of various regimes of antiretroviral therapy (ART), there is still more room for improvement in the prevention, treatment and management of this pandemic, and the pharmacists are seen to have great potential in making positive contributions on efforts towards combating this scourge (1). Through research and as part of the health professionals, pharmacist’s role in addressing the HIV and AIDS is vital in various respects such as ensuring confidentiality and fostering a healthy relationship between themselves and the patients ( 5). The declaration by the WHO and the International Pharmaceutical Federation (FIP) underscore the role of pharmacy as a profession in the war to eradicate the HIV and AIDS epidemic (7). Pharmacists’ role is especially crucial not just in the manufacturing of affordable and effective antiretroviral (ARV) drugs, but also in enhancing drug compliance through proper monitoring, engaging in research, disseminating relevant information on HIV and AIDS to the public and encouraging other intervention for the prevention of the virus (7).  The author of this paper argues that pharmacists play a crucial role in the prevention and treatment of HIV and AIDS majorly through facilitating access to safe needles and syringes especially among the risky populations and encouraging compliance among patience already using ARVs so as to reduce the viral load, hence HIV transmissions.

Contributions in HIV Testing

As the impacts of the HIV pandemic expands not just in Australia but world over, consider HIV testing is one of the most important roles that pharmacists can make contributions towards combating HIV and AIDS (6). The protracted nature of HIV and AIDS requires that pharmacist role also be expanded, and participating in testing of patients would increase HIV diagnosis and promote HIV status awareness, hence reducing the rates of individuals living with the virus but are unaware of their status (1). According to the center for Disease Control and Prevention ( CDC), a good percentage of the population are living with the virus but are unaware of their HIV status hence facilitating the spread of the virus (6). Expertise of the virus stress the value of routine testing especially among adults which should be performed in healthcare setting (4). For adults especially, it has been realized that ubiquity encourages voluntary testing and pharmacist do not just promise the confidentiality and proper setting through which individuals can be tested for the virus, but also pharmacies are known to be flexible enough in terms of working hours to accommodate a large number of those wishing to test at their own convenient hours (8). Given that pharmacists are part of the larger health fraternity, their advocacy roles in matter concerning public health, in addition to the conducive environment present in most pharmacies gives pharmacist this important role in the testing of HIV among adults and even providing the necessary counselling required when testing for the virus (8). This role that pharmacists play of initiating and helping other healthcare practitioners in the testing for the virus is very crucial since it is widely acceptable in the management of HIV and AIDS that early diagnosis of HIV, which is only possible through testing, has desirable health outcomes (6). Pharmacists’ participation the testing of the HIV virus thus goes a long way in the prevention and treatment of HIV and AIDS since individual with the virus can be immediately begin treatment therefore leading a better quality life, reducing the viral load, and preventing further transmission of the virus especially among married adults (6).

Interpretation of HIV test results

In addition to stocking pharmacies with HIV testing kits where pharmacists can assist healthcare practitioners in the testing of HIV, pharmacist also play a major role in the interpretation of HIV test results (3) This means that in addition to testing, one crucial role that pharmacists play in the efforts towards prevention and treatment of HIV and AIDS is that clinical pharmacist provide assistant to other healthcare professionals or providers in making individuals understand the implications of their test results (7). One way of diagnosing and detecting HIV virus is through serological assays, and HIV screening tests that are reactive usually require a confirmatory or supplementary testing and given the expertise of especially clinical pharmacists, they can be of great assistance when HIV test results are discordant (6). Pharmacists should also be conversant with new and improved ways of improving HIV testing such as the fourth generation HIV testing assays (4). Testing of HIV is one thing, and accurately interpreting results for accurate diagnosis is another crucial role which pharmacist plays and this is seen as crucial since it’s a necessary step towards HIV and AIDS prevention, treatment and care (4). This role is thus serves as an expansion of pharmacists’ efforts in the management of HIV and AIDS.

Contribution in the Treatment of HIV and AIDS

Apart from pharmacy based HIV testing, pharmacist also play a major role in ensuring that those with the virus receive proper treatment for HIV and AIDS, particularly through antiretroviral therapy (ART). Proper treatment of persons living with HIV and AIDS requires participation of various teams in treatment using various drug regimens and the pharmacist are also part of the equation (9).The current practice towards HIV and AIDS management overall ambulatory care is shifting towards providing a care model that is patient tailored (9). One prerequisite of providing an integrated, patient centered, and comprehensive treatment is through an interdisciplinary approach requiring concerted efforts of various healthcare teams including pharmacists as well (2). Since pharmacist are members of the healthcare teams, they have a role to pay not just in the interpretation of laboratory results of HIV, but also contributing in the care and treatment of HIV positive patients in various ways including using their expertise to recommend appropriate treatment and drug regimes for such patients (9). On the treatment of HIV positive through ART, pharmacist need to be aware of a patient’s laboratory results to detect presence of other baseline diseases such as hepatitis B which and provide a correct or proper ARVs (3). Pharmacists therefore contribute in the treatment of HIV positive patients through providing a recommendation for drug regimens for the patient and helping in the selection of ARVs, influencing and providing expert advice on when some HIV drugs should be used in terms of timing, and initiating other forms of treatments for HIV positive patients (6). Through initiating treatment o for HIV positive patients and providing drug recommendations that is patient centered is a big role that pharmacist play in the efforts towards reducing transmission of the virus and prevention of disease progression to full brown HIV and AIDS (6).

Monitoring and Managing HIV Treatment Failure

Once a HIV positive patient ART regimen has been identified and treatment initiated, pharmacists still have a role to play in the monitoring of the success of the recommended drugs for persons with the HIV virus (1). It is recommended that in the treatment and management of HIV virus, patients that are on ART undergo routine or periodic assessment to monitor their CD4 and T lymphocyte count, as well as their viral load. Pharmacists, due to their specialization and training are better placed to monitor treatment success and even ascertain situation in which treatment option with a certain drug regimen has failed or a drug resistance has developed (10). Pharmacists can identify treatment failure through examining a patient’s viral load and CD4 count, and work jointly with other healthcare professionals in identifying the cause of the treatment failure as well as providing solutions to the failure in treatment (9). Since treatment failure is commonly associated with non-adherence to the ART, specialized pharmacists are well able not just to determine the possible cause of ART failure, but also promote drug adherence where this is established to be the reason for true treatment or drug failure (10). Pharmacists can do this through various interventions such as coming up with strategies that will help and encourage patents to adhere to recommended treatment such as establishing rapport with HIV positive patients so as to identify and assist in eradicating factors acting as barriers to adherence to treatment such as psychological problems, and lack of other social resources and support, substance use just to mention (4). By providing tools to HIV positive patients such as calendars, reminder alert tools, and even pill boxes, pharmacists are playing a great role in promoting ART adherence and this is ultimately essential in treating the virus and reducing viral load among patients making them less likely to transmit it to other individuals (1).

Facilitating provision of safe needles

One of the core roles that pharmacists play in the prevention and treatment of HIV and AIDS is containing the spread of the virus by facilitating the supply of clean syringes especially to the risky population that use injecting drugs (12). In Australia for instance, an approach to reducing the transmission of diseases such as HIV and AIDS and hepatitis among the risky population using injecting drugs (12). The increase in the drug injecting community has profound impact in the rates of HIV infections especially when numerous barriers exists towards acquisition of clean syringes among this population (1). This is because faced with the difficulty in accessing syringes perhaps due to financial barriers or other restrictive practices increases the chances of the drug injecting community to re-use a syringes and even share it with others hence and when such syringes are contaminated with the HIV virus, there is a great likelihood of spreading the virus across this segment of the population (12). It is against this background that pharmacist role is very crucial even in as far increasing convenience in the accessibility of safe needles to contain the spread of infectious diseases including HIV and AIDS (13). While some critiques might argue that facilitating provision of syringes and needles implies condoning of use of illicit drugs, pharmacist, and in particular the pharmacy guild of Australia play an important role in preventing the spread of HIV infections among this risky community by ensuring affordable supply of syringes and increasing convenience in the acquisition of safer syringes to limit chances of sharing, reuse and ultimately spread of HIV (2).

Pharmacist thus have great input in ensuring that this population at risk of contracting HIV through sharing of needles by initiating needle exchange programs which promotes the legal acquisition of syringes that are sterile among such the drug injecting populations (6). Further still, pharmacists are instrumental, through the arrangements and approval of state government, in the provision of needles and syringes fit packs hence acting as a promising intervention not just among the stereotyped populations using injecting drugs, but also other hidden population that use intravenous drugs (12). By such programs and arrangements of providing syringes and needles within acceptable legal terms, ad bearing in mind that of all healthcare professionals, pharmacists are the most accessible, pharmacists play a big role in even reducing marginalization and stigma among the drug injecting communities and even those using intravenous drugs (6).

Pharmacy Education, Career Development Structure and HIV AIDS Prevention

The existing pharmacy education and career development structure cannot be ignored in the discourse of the role of pharmacists in HIV and AIDS treatment and prevention (11). The current pharmacy education provides pharmacists with expertise that is unique, such as expert knowledge on drug therapy, interactions and efficacy, and other clinical and laboratory knowledge necessary in making then an integral part of the interdisciplinary team required to address the HIV scourge (14). The existing pharmacy education equips pharmacists with relevant and multifarious clinical skills such as counseling which enable them to handle objectively and impartially patients living with HIV without violation of privacy rights (11). The pharmacy education and career structure equips pharmacist with such specialized and transferable knowledge and skills as to be able to professional, sensitive, and non-judgmental when interacting with patients who are HIV positive (11). It can be said therefore, while room for improvement exists, the current pharmacy education and career development structure provides sufficient training grounds for pharmacists to able and professionally make significant contribution in the global war against the spread of HIV virus since pharmacists are taught, and in their career course, acquire listening skills, and other expertise skills for dispensation of ARVs, advising of drug regimens for HIVs and enhancing compliance through various ways including making telephone follow ups where this is necessary (12). For patients receiving ART, pharmacists, thanks to sufficient education and training, are well capable of marinating professionalism through ensuring confidentiality, building rapport with patients to foster trust, and this will go a long in promoting compliance to ARV (8). Additionally, as pharmacists progress in their career ladder, through practice and experience they become better and more involved with HIV positive patients through not just providing non-judgmental counseling and testing for individuals, but also providing suitable setting for ubiquitous testing, which is flexible enough (8).

While the pharmacy education and career structure play a vital role in providing a workforce that is sufficiently trained and prepared not just to be dispensers of ARVs and other drugs, the pharmacy education and career development structure for pharmacists also need to reinvent itself to provide adequate and well prepared pharmacists capable of serving in all kinds of settings that may present themselves (7). This implies that pharmacy education should consider provision of non-judgmentalcounselling and dissemination of ARVs in a variety of settings such as community, and hospital settings (7). Modernization of pharmacy career is also essential since this will provide a workforce that is not just trained, skills and knowledgeable, but also motivated, professional, and sensitive to the requirements of persons living with HIV and Aids (10). Modernization of the pharmacy practice will also ensure that all pharmacists are registered and operate legally hence reducing medical dispensation related risks and errors, and provide a new regime of pharmacists who are not just tied behind the counters, but also take a proactive role in serving the public, providing objective and appropriate pre and post testing services, hence promoting efforts and interventions for containing the spread of HIV virus (14)

Conclusion

 In conclusion playing advisory, monitoring, and dispensing roles, the pharmacy profession’s role is indeed crucial is various respects highlighted above such as HIV testing and confirmatory tests, enhancing n drug adherence, provision of safe or sterile needles and syringes, and by extension, initiating campaigns promoting safer disposal of syringes. As already intimated in the preceding paragraphs, the role of pharmacists in the prevention and treatment of HIV and AIDS is increasingly becoming more pronounced since the declaration by the International Pharmaceutical Federation (FIP) in conjunction with the WHO which increased the participation of the participation in making positive contributions through their expertise in pharmacy to assist in the management of HIV and AIDS. Both pretest and post-test counselling  is in essence provide by pharmacists and those with positive results able to be undergo confirmatory tests as well receive arrangements for suitable care setting.  Pharmacists, due to sufficient education and training that they undergo, acquire expertise useful in treating patients with HIV and play a role in prevention of the spread of the virus, especially among the risky populations such as the drug injecting community.

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