Abstract
BackgroundPakistan is facing a growing population of people living with human immunodeficiency (HIV). In this randomized controlled trial, we investigate if a pharmacist-led intervention can increase adherence to antiretroviral therapy (ART) for people living with HIV (PLWH).MethodsAdults with HIV, who have been taking ART for more than 3 months were randomly assigned to receive either a pharmacist-led intervention or their usual care. Measures of adherence were collected at 1) baseline 2) just prior to delivery of intervention and 3) 8 weeks later. The primary outcomes were CD4 cell count and self-reported adherence measured with the AIDS Clinical Trial Group (ACTG) questionnaire.ResultsPost-intervention, the intervention group showed a statistically significant increase in CD4 cell counts as compared to the usual care group (p = 0.0054). In addition, adherence improved in the intervention group, with participants being 5.96 times more likely to report having not missed their medication for longer periods of time (p = 0.0086) while participants in the intervention group were 7.74 times more likely to report missing their ART less frequently (p < 0.0001).ConclusionsThe findings support the improvement in ART adherence and HIV management.Trial registrationThe trial is registered with Australian New Zealand Clinical Trials Registry (ACTRN12618001882213). Registered 20 November 2018.
Highlights
Pakistan is facing a growing population of people living with human immunodeficiency (HIV)
In Pakistan data has indicated that 17% of people taking antiretroviral therapy (ART) have suboptimal adherence [13] and the majority (81%) of intravenous drug-users miss more than three ART treatments per month [6]
We evaluated the effect of a pharmacist-led education and counselling intervention, compared with usual care, on ART adherence and human immunodeficiency virus (HIV) control among individuals with HIV living in Pakistan
Summary
Pakistan is facing a growing population of people living with human immunodeficiency (HIV) In this randomized controlled trial, we investigate if a pharmacist-led intervention can increase adherence to antiretroviral therapy (ART) for people living with HIV (PLWH). Another study reported the fact that various factors can influence adherence to ART These include the disease status, therapy, and affiliation of the patient with the healthcare provider [8]. Individuals in low- and middle-income countries are said to be 1.6 times more likely to have suboptimal adherence to ART [12]. The WHO drug resistance report 2012 stated that with the increased number of people accessing ART, the prevalence of pre-treatment drug resistance has increased in several low-income and middle-income countries [17]. Available data shows that pre-treatment drug resistance is significantly more prevalent in people with previous ART exposure and leads to virological failure [18]
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