Pharmacist counseling in a cohort of women with HIV and women at risk for HIV

BACKGROUND AND METHODS Achieving high adherence to antiretroviral therapy for human immunodeficiency virus (HIV) is challenging due to various system-related, medication-related, and patient-related factors. Community pharmacists can help patients resolve many medication-related issues that lead to poor adherence. The purpose of this cross-sectional survey nested within the Women's Interagency HIV Study was to describe characteristics of women who had received pharmacist medication counseling within the previous 6 months. The secondary objective was to determine whether HIV-positive women who received pharmacist counseling had better treatment outcomes, including self-reported adherence, CD4(+) cell counts, and HIV-1 viral loads. RESULTS Of the 783 eligible participants in the Women's Interagency HIV Study who completed the survey, only 30% of participants reported receiving pharmacist counseling within the last 6 months. Factors independently associated with counseling included increased age (odds ratio [OR] 1.28; 95% confidence interval [CI] 1.07-1.55), depression (OR 1.75; 95% CI 1.25-2.45), and use of multiple pharmacies (OR 1.65; 95% CI 1.15-2.37). Patients with higher educational attainment were less likely to report pharmacist counseling (OR 0.68; 95% CI 0.48-0.98), while HIV status did not play a statistically significant role. HIV-positive participants who received pharmacist counseling were more likely to have optimal adherence (OR 1.23; 95% CI 0.70-2.18) and increased CD4(+) cell counts (+43 cells/mm(3), 95% CI 17.7-104.3) compared with those who had not received counseling, though these estimates did not achieve statistical significance. CONCLUSION Pharmacist medication counseling rates are suboptimal in HIV-positive and at-risk women. Pharmacist counseling is an underutilized resource which may contribute to improved adherence and CD4(+) counts, though prospective studies should be conducted to explore this effect further.