Role of Pharmacist in HIV/AIDS and TB in Hospitals and community Pharmacies Dr. Ramesh Adepu Professor Department of Pharmacy Practice, JSS College of Pharmacy,Mysore D
Global statistics UN AIDS and WHO updates (2007) • Men : 32.2 million • Woman : 18.0 million • Children : 2.8 million • Total : 42.5 million
Indian Scenario • 5.7 million cases • On an average 3500 Indians are contracting HIV every day
EPIDEMIOLOGY • 9 out of 10 infected women are living in developing countries • 25% - 30% of the infected patients are women and 90% of them are between 20 to 49 yrs of age • Around 500,000 infants per year acquire HIV infection through mother to child transmission
Strategies to prevent the spread of HIV • Social mobilization • Improving treatment of STDs using the syndromic management approach • Work place programs • Community and home based care • Practical strategies for reducing mother to child (MTC) transmission
Role of Pharmacist • In Prevention • Treatment and care • Human legal rights • Monitoring, surveillance and research
Prevention • Promotion of safe and healthy sexual behavior • Improve the management and control of STIs • Reduce mother to child transmission • Provide appropriate post exposure services • Improve voluntary testing and counseling
Counseling the patients • Providing information to the patients regarding disease, medication, diet and life style modifications and assisting the patients in clarifying the doubts and in taking suitable decisions with respect to the management of the disease.
Why Counseling is needed? • To improve the patient’s understanding about the disease and its management • To improve the medication adherence behaviour and improved therapeutic outcomes • To adopt healthy lifestyles • To improve the quality of life
What is the evidence? • Psychological counseling and buffering effect of social support reduces the stressors and improves the ability of an individual to lead normal life. Susan S, J Mohr, N Singh et al. Quality of life in patients with human immunodeficiency virus infection: impact of social support, coping style and hopelessness. Int. J STD AIDS. 1999;10:383-391
Social support is the major factor in improving the quality of life in HIV patients. Murdaugh C. Health-related quality of life in HIV disease: Achieving a balance. J Asso Nurses in AIDS Care. 1998;9:59-71. Nunes JA. Raymond SJ. Nicholas PK et al. Social support, Quality of life, Immune function, and Health in persons living with HIV. J Holis Nursing. 1995;13:174-198.
Studies on adherence behavior have observed that educational interventional strategies have enhanced the medication adherence behavior in HIV/AIDS patients. Christopher M, Gordon. Commentary Meta-Analysis of Randomized Controlled Trials for HIV Treatment Adherence Interventions. J Acquired Immune Deficiency Syndrome.2006; 43:36-40.
Pharmacist’s educator role in analyzing barriers in adherence and strategies to overcome them in HIV-infected patients by providing pharmaceutical care. Cantwell-Mcnelis K, Christoper W, James. Role of clinical Pharmacist in Outpatient HIV Clinic. Medscape .2002; 59:447-52.
Mysore based studies • The Study findings conclude that structured education provided by the pharmacist to patients living with AIDS improved their awareness regarding the disease, coping with disease related challenges and in turn improved the overall quality of life scores showing a strong association of education with therapeutic outcomes and QoL. • Dinesh Jain, Ramesh Adepu, Nagavi B.G and S.N.Mothi, Unpublished thesis, RGUHS
In a randomized study conducted at a NGO AIDS Care research center, pharmacist provided counseling has shown a significant improvement in adherence behavior. The study also observed a significant increase (p<0.01) in the number of patients, shifting from positive screen to negative screen scores of BMQ. Mini, RameshAdepu, S.N.Mothi, T.Swami, Unpublished thesis, RGUHS 2008
Counseling about • Different modes of transmission • Condoms usage and Safe sex practices • Use of disposable syringes
Safe sex practices • Making a change in the sexual practices is an important way to minimize the risk of HIV transmission. • Limit the sex partner to one
Counseling regarding mode of transmission . . . • Not to share the needles of others. • Incase of any cut with sharp instruments, clean the area with disinfectant like soap or Dettol and consult the doctor.
Condoms – Proper usage • Use of good quality condoms protects against the transmission of disease. • Patients must be counseled regarding the proper use of condoms such as, How to open the condom packet, How to unroll, Use of the condom, Removal and disposal of the condom.
Counseling about medications • Counsel the patient about the name, purpose, dose, frequency, and importance of medication and its adherence in controlling the disease. • Brief the patient about the possible adverse effects of anti retroviral therapy and should be encouraged to report those adverse effects if at all they experience the same.
Counseling regarding diet • Diet should be balanced and nutritious with plenty of fibers and liquids. • Patients must be told not to use raw food items and unpasteurized milk. • They should be told to wash fruits thoroughly and preferably peel them, as there may be germs on them.
Life style modifications To maintain personal hygiene • To maintain personal hygiene, wash the hands with soap before and after taking food and after using the toilet.
Patients should be told to avoid alcohol, tobacco, narcotic drugs and situations, which force to indulge in to the activities, which worsens their problem.
Counseling regarding life style modifications • Patients should be encouraged to have friends and build their own associations that help them for recreational purposes.
They must be told to be away from sick people and check for opportunistic infections especially TB.
Patients should be encouraged to visit their clinician on a regular basis for better care.
Integrated counseling and testing centre (ICTC) • The HIV positive individuals are counseled in a private environment through integrated counseling and testing centers. • There are now more than 4000 ICTCs which are mainly located in government hospitals.
What is an integrated counseling and testing centre? • A place where a person is counseled and tested for HIV, on his own will or as advised by a medical provider. The main functions of an ICTC include: • Early detection of HIV • Provision of basic information on modes of transmission and prevention of HIV/AIDS for promoting behavioural change and reducing vulnerability • Link people with HIV prevention, care and treatment services.
Who needs to be tested in an ICTC? • Sex workers and their clients, • Men who have sex with men (MSM), • Transgender, • Injecting drug users (IDUS), • Truckers, migrant workers, • Spouses and children of men who are prone to risky behavior. • Patients who have a history of risky behaviour or have signs and symptoms suggestive of HIV/AIDS
Treatment care and support • Provide treatment, care and support services
Rational selection of drug therapy • Assisting the clinician to choose rational regimens • Providing unbiased drug information • Calculating dosing of drugs based on lab parameters.
In Hospital Pharmacy • By playing in an important role in procuring and supply of anti retro virals, antibiotics, TPNs, anti TB drugs and anti fungal drugs. • Providing information on rational use of anti retrovirals • Encouraging HIV patients with TB to have DOTS therapy.
In community pharmacy • Playing an active role in support groups in communities, patient counseling and home based care. • Pharmacists also have a role to play in offering advice in linking antiretroviral use, lifestyle modifications, and nutrition • Educating the public to minimise the social stigma.
Role of Pharmacist in creating awareness Displaying the charts, Calendars in the pharmacy, Displaying the messages on the leaflets given to the patients, Wearing a badge around the arm that he can give information on AIDS to the patients.
Human legal rights • Non judgmental • Empathetic
Research Studies • Maintaining the confidentiality of the patient details and data
Thank You . . . .