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MANAGEMENT OF DRUG THERAPY IN HIV-POSITIVE PATIENTS: SYNERGY BETWEEN THE IMMUNOLOGY DEPARTMENT AND THE HOSPITAL PHARMACY

European Statement

Clinical Pharmacy Services

Author(s)

Noemi Tatti, Melania Rivano, Giacomo Bertolino, Valentina Mureddu, Raffaele Deidda, Arianna Cadeddu

Why was it done?

Patients are required to attend a follow-up visit every three months for viral load testing. A collaborative protocol has been implemented to facilitate treatment adherence, monitoring, and access to medication.

What was done?

Collaboration between the immunology department and the hospital pharmacy facilitated the management if drug therapy in HIV-positive patients, enhancing access to care and improving treatment adherence.

How was it done?

The visit schedule is shared monthly. Each patient is assigned an alphanumeric code to ensure anonymity. Any change in appointments, test results, visits, or therapy regimens is also communicated. Through the hospital’s electronic system, pharmacists can access each patient’s treatment plan, review the dates of medication pickups, and verify treatment adherence. In case of discrepancies, these are promptly reported to the physician before the patient’s next visit. Additionally, sufficient medication to cover three months of therapy is prepared in advance for each patient, simplifying the dispensing process and preventing unnecessary hospital visits.

What has been achieved?

This initiative has optimized adherence monitoring, which is particularly important for this category of patients. It has also facilitated the drug dispensing process. By reducing waiting times and hospital visits, it has improved treatment compliance and ensured the protection of their privacy. This project was implemented on 792 patients, and from 01/10/2024 to 01/10/2025, a total of 1,369 dispensations of antiretroviral drugs were carried out.

What next?

This approach has been used to improve the quality of care and overall experience of this patient group. We hope that it will soon be extended to all patients who collect their medication at our hospital.

Improving people living with HIV therapies compliance: a practical tool customised for patients and designed by hospital pharmacists

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European Statement

Patient Safety and Quality Assurance

Author(s)

Sabrina Trivellato, Daniele Mengato, Maria Mazzitelli, Anna Maria Cattelan, Francesca Venturini

Why was it done?

An optimal compliance is an essential requirement for people living with HIV (PLWHA) to grant drugs effectiveness and safety. Given the complexity of the therapeutic regimen, and the multiple changes to it due to the clinical status, compliance to therapy may be suboptimal. Patients who are not well educated on how to follow their therapy are more keen on quitting the treatment or facing virological failure. According to previous analysis, we reported that 120 patients out of more than 1500 managed by our centre experienced suboptimal adherence to therapy.

What was done?

We created a user-friendly tool to educate HIV-patients on their drugs’ adherence in our University Hospital.

How was it done?

We studied every drug prescribed in our centre and we analysed it from the patient’s point of view. The question we aimed to answer was: “If I were a PLWHA, what would help me assuming the correct drug, at the proper time, avoiding misunderstandings?”. We analysed the shape, colour and dimensions of both the package and the pills/capsules. We focused on the most appropriate way to take every drug and we investigated possible interactions with OTC drugs or dietary supplements.

What has been achieved?

A poster reporting all the drugs available in our formulary was developed: 34 medicines were described in alphabetical order, specifying for each one the image of the package, the usual dosage, the picture of the pill/capsule compared to the dimension of current coins and special warnings about possible drug-drug interactions. We also adopted practical symbols to indicate whether to assume the drug with or without food. The poster became available starting from April 2022 and during the following 5 months a cohort of 960 patients could rely on it.

What next?

In order to help our patients taking their therapies, we expect to get a digital form of this poster to make it available on the phone scanning a QR code. Alongside, we aim to enlarge and improve this digital version by adding a final section with an interactive survey to closely monitor the compliance of the patients and help them to improve it. Through this project we could also obtain an active pharmacovigilance setting.

DEVELOPMENT AND IMPLEMENTATION OF A PRE-EXPOSURE HIV PROPHYLAXIS DISPENSATION PROGRAM

European Statement

Clinical Pharmacy Services

Author(s)

Natalia Toledo Noda, Víctor Quesada Marqués, Laura Majuelos Aicart, Milagros Varela González, Maria Victoria Morales León

Why was it done?

Despite advances in the control of HIV infection, the number of people who become infected annually in the island (European ultra-periphery region) remains high. The implementation of a PrEP dispensing program would prevent many of these infections since it is known that there is a high number of undiagnosed infected people. In addition, the implementation would allow legally access to this therapy, being an effective, cheap and easily to use therapy.

What was done?

Development and implementation of a medication dispensing program for HIV pre-exposure prophylaxis (PrEP) in adults.

How was it done?

In 2016, the European Medicines Agency authorized the indication of tenofovir disoproxil fumarate 245mg + emtricitabine 200mg as a preventive treatment. In December 2019 the Ministry of Health incorporated it into the National Health System for people who met certain minimum criteria. The hospital was formed since then with the aim of establishing a prescription and dispensing circuit.

What has been achieved?

The following circuit was established:
1. The primary care physician will screen candidates who want to apply to the program and request an initial study. If the candidate meets the criteria, he will consult the infectious diseases unit.
2. The unit value the entry into the program and carry out clinical follow-up. The request for outpatient dispensing is generated for the Pharmacy Service.
3. The Pharmacy Service informs about how to take the medication and its adverse effects. It is dispensed for a maximum period of 3 months. If any problem related to the drug or lack of adherence is detected, it will be communicated to the doctor.
4. A clinical and analytical follow-up is carried out every 3 months to assess the correct use of the medication as well as the appearance of safety problems (renal function and bone involvement). The continuity in the program is evaluated annually.

Since then, the Pharmacy Service has dispensed medication to 20 users and only one discontinued due to lack of adherence.

What next?

Achieve a reduction in the incidence of HIV, which for years has remained stable. Contribute to generate data that support the efficacy and safety of these therapies in real life. Avoid the illegal sale of these drugs.

HIGHLY ACTIVE ANTIRETROVIRAL THERAPY PRESCRIPTIONS IN NAIVE PATIENTS: IMPROVEMENT PLAN

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European Statement

Patient Safety and Quality Assurance

Author(s)

A. Rodríguez-Perez, M.I. Sierra-Torres, M.D. Toscano-Guzmán, A. Monzón-Moreno, M. Soriano-Martinez, A. Lluch-Colomer, M.D. Santos-Rubio

Why was it done?

According to the guidelines and recommendations for the rational use of medication, prescriptions of HAARTs must be standardised following the principles of efficiency and based on the best evidence available.

What was done?

A multidisciplinary group of clinical pharmacists and physicians made an easy-to-read handout that summarised the main recommendations of GESIDA for the treatment of naive patients, treated with highly active antiretroviral therapy (HAART). The hand-out consisted of a table with the allowed and not-allowed antiretroviral combinations and the exceptions. The multidisciplinary group disseminated the handout to the prescribers through clinical sessions. The multidisciplinary group made a 6 month study to evaluate the adherence to GESIDA, previous and after the implementation of the easy-to-read handout.

How was it done?

We did not have any problem implementing these recommendations or organizing the clinical sessions.

What has been achieved?

The multidisciplinary group made a retrospective study of the 6-months previous the implementation of the handout, by a chart review of the prescriptions. One hundred naive patients were evaluated. We found an eleven per cent of deviations of the recommendations, none of them justified. The multidisciplinary group made a prospective study during a 6-months period after the implementation of the handout, by a chart review of the prescriptions. Seventy-one naive patients were evaluated. We found a 7% of deviations of the recommendations, three of them were justified because of co-morbidity that contraindicated the recommended medication. We also made a follow-up of the treatment of the patients of the retrospective study, six of the eleven patients of that group changed their HAART to the recommended ones.

What next?

The multidisciplinary team has periodic meetings to evaluate the adherence to the recommendations and to study news reported by GESIDA. The economic impact of the practice is planned to be evaluated.