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Pharmacist Involvement in HIV Management of Patients With Mental Illness Leads to Better Outcomes

Pharmacist involvement in the HIV management of patients with mental illness could increase the appropriateness of antiretroviral therapy (ART), laboratory testing, and opportunistic infection (OI) prophylaxis.

In findings presented at the 22nd annual Making a Difference in Infectious Diseases (MAD-ID 2019) meeting, investigators with Jackson Health System in Miami, Florida, explored the role of pharmacist intervention in a psychiatric patient population with HIV. Patients with mental illness are more than 4 times more likely to have HIV, and management can be challenging and conflicted by factors such as substance abuse, drug interactions, and non-adherence.

In an institutional review board-approved, single-center, retrospective study, investigators looked at 3 arms of 37 patients each admitted to a psychiatric hospital with an order for 1 or more antiretroviral medications. The group admitted between October 2016 and March 2017 had no pharmacist involvement; the group admitted between October 2017 and March 2018 had partial pharmacist involvement; and the group admitted between November 2018 and January 2019 had consistent pharmacist involvement.

The primary outcome was difference in appropriateness of ART prior to and during pharmacist involvement, according to US Department of Health and Human Services guidelines, while secondary outcomes included appropriateness of OI prophylaxis and laboratory testing.

Compared with no pharmacist involvement, a greater number of appropriate antiretroviral regimens were initiated with partial pharmacist involvement (62% vs. 32%, p = 0.0096), and a greater number still with consistent pharmacist involvement compared with partial (84% vs. 62%, p = 0.0327).

“There was a trend towards increased HIV viral load draws with partial versus no pharmacist involvement (54% vs. 43%, p = 0.24) and additionally with consistent versus partial pharmacist involvement (62% vs. 54%, p = 0.32),” investigators wrote in the study abstract. “With consistent pharmacist involvement, more patients had a resulted CD4 cell count (65%) than with both partial and no pharmacist involvement (57%).”

Alice Margulis, PharmD, PGY-2 Pharmacy Resident at Jackson Memorial Hospital and an investigator on the study, discussed the findings with Contagion® at MAD-ID 2019 (see video)

Appropriate OI prophylaxis was initiated in more patients with consistent pharmacist involvement (57%) than with partial (50%) or no pharmacist involvement (11%).

“Pharmacist involvement in HIV management in a psychiatric patient population increased appropriateness of ART, laboratory testing, and OI prophylaxis,” investigators concluded.

The study, “Pharmacist Impact on HIV Management in a Psychiatric Patient Population,” was presented at MAD-ID 2019, held May 8-11, 2019, in Orlando, Florida.
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