Evaluation of a pharmaceutical care program to improve adherence to antiretroviral therapy

• Published in: Farmacia hospitalaria Vol. 28; no. 6 Suppl 1; pp. 19 - 26
• Main Authors: Codina Jané, C, Tuset Creus, M, Ibarra Barrueta, O, Delgado Sánchez, O, Morancho Echevarría, O, García Díaz, B, Escobar, A, Martínez, B, Butiñá, T, Amador, P, Estaún, E, Sáinz, A, Martínez, N, Cal, S, Gómez, M R, López, R M, Carmona, A, Jiménez, I, Moriel, C, León, J, Iranzo, M D, Caro, L, Castillo, I, Bachiller, P, Irastorza, B, Gine, M, Sala, M L, Requena, T, Santolaya, R, Lluch, A, Iruin, A, Alfaro, J
• Format: Journal Article
• Language: Spanish
• Published: Spain 2004
• Subjects: Adult; Aged; Anti-Retroviral Agents - therapeutic use; Female; Humans; Male; Middle Aged; Patient Compliance - statistics & numerical data; Pharmacy Service, Hospital; Program Evaluation; Prospective Studies
• ISSN: 1130-6343

To establish the impact of a pharmaceutical care program on the improvement of adherence to antiretroviral therapy, and on patient immunologic and virologic outcome.
A multicenter, observational, prospective study in a HIV-infected patient cohort under treatment with antiretrovirals selected by random sampling in 19 Spanish hospitals. The study lasted 12 months, in which the program was applied through a baseline preprocedural visit and 4 quarterly visits. Adherence estimation was based on pill counting. An adherence > or = 90, or > or = 95% was considered adequate (in two time points).
541 patients were included, most of them were males (68.8%) between 20 and 78 years of age. Major risk groups included injecting drug users (43.4%) and heterosexuals (29.4%). Sixty percent had already received treatment for more than 3 years. Mean baseline viral load and CD4 count values were 32,866 copies/ml and 485 cells/mm3, respectively. Throughout the study a slight increase in the percentage of adherent patients was seen; however, statistical significance was not reached (64.3 and 79.2% of patients showed an adherence > 95 and > 90%, respectively, during the fourth quarter, versus 59.8 and 75.5% at baseline). A statistically significant decrease in viral load and increase in CD4 cells was seen following program application. The percentage of patients with a viral load < 200 copies/ml was 72.2, 76.7, and 75.0% at the 2nd, 3rd, and 4th quarters, respectively, versus 64.2% at baseline. CD4 cell counts increased by 50 cells/mm3 on average from the start to the end of follow-up.
Patients included in the program had a good immunologic and virologic outcome, and a trend towards an increased percentage of patients with good adherence was also seen. These results confirm the need to implement follow-up programs for patients receiving antiretrovirals in order to ensure maximum therapeutic benefits.