PHARMACIST EXCELLENCE IN HIV CARE
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1 PHARMACIST EXCELLENCE IN HIV CARE HEATHER LEAKE DATE CONSULTANT PHARMACIST, BRIGHTON & SUSSEX UNIVERSITY HOSPITALS HONORARY SENIOR LECTURER, UNIVERSITY OF BRIGHTON
2 We ve come a long way baby! Arts EJ, Hazuda DJ. HIV-1 Antiretroviral Drug Therapy. Cold Spring Harb Perspect Med 2012; 2(4): a007161emin
3 ART: 2018 VS 1998 Effective Compact Easier to take Fewer side effects
4 ART: 2018 VS 1998 Effective Compact Easier to take Fewer side effects?
5 READ ALL ABOUT IT
6 WHAT DO THE BHIVA STANDARDS SAY? Outpatient care: part of the multidisciplinary team Antiretroviral clinics Treatment support Prescribing Clinically checking Rxs Prevention: access to PrEP Inpatient advice Pregnancy and birth Joint clinics Virtual clinics choice of ART
7 TREATMENT SUCCESS = AGEING COHORT Brown AE, Kirwan PD, Chau C, Khawam J, Gill ON, Delpech VC. Towards elimination of HIV transmission, AIDS and HIV-related deaths in the UK 2017 report. November 2017, Public Health England, London
8 PEOPLE-RELATED ISSUES Ageing population / comorbidities / polypharmacy Co-infections: TB, Hepatitis C Mental health / social isolation Chems Herbal products, gym supplements etc DRUG-RELATED ISSUES >95% PLWH are prescribed ART Extensive hepatic metabolism Interactions with OTC, prescribed and online medicines
9 HEALTH AND SOCIAL CARE ISSUES More patients less money fewer staff Evolving models of care Outpatient and primary care-focused Engage community and practice pharmacists Technology (eg Apps, virtual clinics, EPR)
10 HOLISTIC CARE NEEDS Presented at 4 th Joint Conference of BHIVA with BASHH, Edinburgh, April 2018 M Kall, C Kelly, M Auzenbergs and V Delpech Public Health England, London, UK
11 TREATMENT SUPPORT STILL NEEDED Lifelong treatment life is challenging Treatment for all engaging & maintaining hard to reach people with additional needs Generics and splitting fixed-dose combinations Identifying and preventing medicines-related problems
12 PHARMACISTS CAN PROVIDE Medicines reviews prevent, identify, and resolve issues Telephone and advice Continuity of care Communication with patients and health care professionals
13 DRUG INTERACTIONS IN THE INTEGRASE ERA Propensity for DDIs: Nucleoside analogue reverse transcriptase inhibitors (NRTIs) Non-nucleoside analogue reverse transcriptase inhibitors (NNRTIs) Protease Inhibitors (PIs) Entry inhibitors Integrase inhibitors except cobicistat boosted INI
14 BUT! Modern regimens interact with many over the counter medicines Multivitamin and minerals Antacids (mineral or acid suppression) H2 receptor antagonists Proton pump inhibitors Viagra (sildenafil) Corticosteroids (eg fluticasone nasal spray)
15 BUT! Modern regimens interact with many over the counter medicines Multivitamin and minerals Antacids (mineral or acid suppression) H2 receptor antagonists Proton pump inhibitors Viagra (sildenafil) Corticosteroids (eg fluticasone nasal spray)
16 DRUG INTERACTIONS & PATIENT INFORMATION HIVPA PILs Drug interactions: Liverpool Toronto BNF
17 THE BIG PICTURE: TOWARDS ZERO Brown AE, Kirwan PD, Chau C, Khawam J, Gill ON, Delpech VC. Towards elimination of HIV transmission, AIDS and HIV-related deaths in the UK 2017 report. November 2017, Public Health England, London
18 THE FIRST 90 : TESTING Women and older people often access community pharmacies Brown AE, Kirwan PD, Chau C, Khawam J, Gill ON, Delpech VC. Towards elimination of HIV transmission, AIDS and HIV-related deaths in the UK 2017 report. November 2017, Public Health England, London
19 THE FIRST 90 : TESTING
20 TOWARDS ZERO NEW INFECTIONS PHARMACISTS CAN: Provide access to PrEP & PEP Signpost to specialist services HIV prevention (sex & drugs) STI test kits HIV home testing / sampling
21 TOWARDS ZERO NEW INFECTIONS PHARMACISTS CAN: Provide access to PrEP & PEP Signpost to specialist services HIV prevention (sex & drugs) STI test kits HIV home testing / sampling Need awareness, training, confidence, funding
22 TOWARDS ZERO STIGMA Every member of the health care team has a role to play
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