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

Jennifer M Cocohoba,¹ Keri N Althoff,² Mardge Cohen,³ Haihong Hu,⁴ Chinazo O Cunningham,⁵ Anjali Sharma,⁶ Ruth M Greenblatt<sup>1,7

1</sup>University of California, San Francisco School of Pharmacy, San Francisco, CA; ²Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ³Department of Medicine, Stroger Hospital and Rush Medical College, Chicago, IL; ⁴Department of Medicine, Georgetown University, Washington, DC; ⁵Albert Einstein College of Medicine, Bronx, NY; ⁶SUNY Downstate Medical Center, Brooklyn, NY; ⁷University of California, San Francisco School of Medicine, San Francisco, CA, USA

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/mm³, 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.

Keywords: human immunodeficiency virus, acquired immunodeficiency syndrome, antiretroviral therapy, community pharmacy, pharmacy practice, women’s health