Abstract
BackgroundThe World Health Organization (WHO) recommends that the role of pharmacists in low-income settings be expanded to address the increasing complexity of HIV antiretroviral (ARV) and co-infection drug regimens. However, in many such settings including in India, many pharmacists and pharmacy workers are often neither well trained nor aware of the intricacies of HIV treatment. The aims of our study were; to determine the availability of ARVs, provision of ARVs, knowledge about ARVs, attitudes towards HIV-infected persons and self-perceived need for training among community-based pharmacies in an urban area of India.MethodsWe performed a survey of randomly selected, community-based pharmacies located in Pune, India, in 2004-2005 to determine the availability of ARVs at these pharmacies, how they were providing ARVs and their self-perceived need for training. We also assessed knowledge, attitudes and perceptions on HIV and ARVs and factors associated with stocking ARVs.ResultsOf 207 pharmacies included in the survey, 200 (96.6%) were single, private establishments. Seventy-three (35.3%) pharmacies stocked ARVs and 38 (18.4%) ordered ARVs upon request. The reported median number of ARV pills that patients bought at one time was 30, a two week supply of ARVs (range: 3-240 pills). Six (2.9%) pharmacy respondents reported selling non-allopathic medicines (i.e. Ayurvedic, homeopathy) for HIV. Ninety (44.2%) pharmacy respondents knew that ARVs cannot cure HIV, with those stocking ARVs being more likely to respond correctly (60.3% vs. 34.8%, p = 0.001). Respondents of pharmacies which stocked ARVs were also more likely to believe it was a professional obligation to provide medications to HIV-infected persons (91.8% vs. 78.8%, p = 0.007) but they were also more likely to believe that HIV-infected persons are unable to adhere to their medicines (79.5% vs. 40.9%, p < 0.01). Knowledge of the most common side effects of nevirapine, abnormal liver enzyme profile and skin rash, was reported correctly by 8 (3.9%) and 23 (11.1%) respondents, respectively. Seven (3.4%) respondents reported that they had received special training on HIV, 3 (1.5%) reported receipt of special training on ART and 167 (80.7%) reported that they believed that pharmacy staff should get special training on ART.ConclusionThere is a high willingness to participate in HIV management among community-based pharmacies but there is a tremendous need for training on HIV therapies. Furthermore, stigmatizing attitudes towards HIV-infected persons persist and interventions to reduce stigma are needed, particularly among those that stock ARVs.
Highlights
The World Health Organization (WHO) recommends that the role of pharmacists in low-income settings be expanded to address the increasing complexity of HIV antiretroviral (ARV) and co-infection drug regimens
The majority of the survey respondents were the owners of the pharmacy (n = 183, 88.4%). (Table 1) Of 207 pharmacies, 200 (96.6%) were single, private establishments, 4 (1.9%) were private pharmacies that were part of a chain, and 3 (1.5%) were hospital pharmacies (2 were part of the randomly selected sample from the Pune Chemists and Pharmacists Association (PCPA) list and one was identified from the door-to-door mapping)
The reported median number of antiretroviral drugs (ARVs) tablets or capsules that patients bought from pharmacies at one time was 30, a two-week supply of ARVs
Summary
In HIV management, pharmacists in many high-income countries play an important role in working with other health care providers (HCP) to ensure quality care and treatment, including educating patients about medications, adherence counseling, and assessing drug-drug interactions [1,2] This requires being up-to-date regarding HIV and antiretroviral therapy (ART). Many, including the World Health Organization (WHO), recommend that this role be expanded to address the increasing complexity of ART and co-infection drug regimens[3] In these settings as in India, many pharmacists and pharmacy workers are often not well trained, yet engage in practices that extend beyond medicine dispensing, including providing inadequate advice about medications and ailments[4,5,6]. In the context of HIV/AIDS and TB, such practices are problematic and are likely to contribute to increasing drug resistance and treatment failure in the community[10]
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