Patient Involvement in Pharmacovigilance: The Development of an HIV Peer Educator Program Mercy Maina Bpharm, MPH, Pgdip Clinical Pharmacy, Moi Teaching and Referral Hospital, Eldoret Kenya Rakhi Karwa PharmD, BCPS Associate Clinical Professor, Purdue University College of Pharmacy
Development of AMPATH Academic Model for Prevention And Treatment of HIV/AIDS Academic Model Providing Access To Healthcare
AMPATH is Rooted in Partnerships 3
Tripartite Healthcare Mission in Kenya The AMPATH Tripartite Mission Lead With Care Train the Next Generation of Medical Leaders Advance Healthcare Through Research The AMPATH Tripartite Mission Care Research Education The largest HIV care provider in Kenya Across 8 counties in western Kenya Emerging into comprehensive scope of services from community to referral hospital levels Committed to partnerships at county and national levels to advance care delivery 4
Adverse Drug Reaction Reporting Strategy Study Evaluate the feasibility and effectiveness of five TSR approaches in the documentation of treatment threatening SADR to ART. Kenya National Suspected Adverse Drug Reaction or the Pharmacy and Poisons Board (PPB) form Routinely used clinical encounter forms In depth interviews peer vs pharmaceutical technologist Routinely captured pharmacy data - prescription forms and electronic dispensing records 1. http://www.who.int/news-room/fact-sheets/detail/hiv-aids 2. http://www.who.int/gho/hiv/epidemic_response/art_text/en/
In-depth Interviews Face to face interview Random allocation (1:1) to pharm tech and peer Assessments conducted: ADR symptoms screen, adherence, quality of life Categories of patients: adult and pediatrics, stable and newly initiated on ART, 1 st line ART and 2 nd line ART, and pregnancy
Study Results Preliminary Results 844/1000 patients recruited 1 st Line: 250 (adults), 38 (peds) 2 nd Line: 50 (adults), 6 (peds) Pregnant: 100 Stable: 200 (adults), 200 (peds) Sampled 44 random charts (at least 4 charts per category). The in-depth interviews documented 161 medication related symptoms vs 40 clinician documented symptoms Unexpected Findings: Patients recruited friends and family to join the study Study identified patients dealing with : Disclosure issues Social Stigma of HIV Non-adherence due to complex patient issues Food insecurity
Results
Turning Pilots into Programs Challenges: Reality of HIV associated stigma Lack of patient education Poor patientprovider relationships HIV Peer Program Resources: Stakeholder buy-in Established training programs Access to funding Study supported anecdotal reports
Implementation Inpatient HIV Peer Program: Approximately 100 PLWHIV admitted monthly to the adult internal medicine wards In 2017: 980 (80%) patients received peer assistance on the wards 2,422 counseling sessions provided (disclosure, adherence, treatment, disease state) 520 ART refills provided Outpatient HIV Peer Program: Development of an HIV Resistance Clinic: > 400 patients enrolled >80% of the patients with high viral load stayed on the regimen Targeting patient education at the pharmacy group discussions, one-on-one sessions, counseling new starts and treatment changes
Future Directions Global rise in non-communicable diseases In 2008: 36 million deaths due to non-communicable diseases globally Of these,14 million people died prematurely à 80% of these premature deaths occur in LMICs Transitioning lessons learnt from HIV: Development of peer delivery of cardiovascular and diabetes medications Creation of a peer support program in cancer-related care programs Global action plan for the prevention and control of noncommunicable diseases 2013-2020