December 26, 2024 • 9 mins
In this episode, Katie Meyer and Kevin Astle discuss key strategies pharmacists can use to improve patient adherence in HIV care.
Each month, APhA will release two podcast episodes offering a fresh dose of education highlights, practice pearls, and insights to inform your pharmacy practice and advance patient care. Listen to new episodes at your convenience! Both members and nonmembers can log into their APhA pharmacist.com Learning Library account to successfully complete a short assessment at the end of each month to earn 0.5 hours of CE credits (.05 CEU).
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:03):
Welcome to the First Fill Podcastand Happy Holidays.
I'm Katie Meyer,Senior Director of Content Creation here at APhA.
And I'll be your host for today's episode.
With HIV and AIDS Awareness Month uponus, it's essential to highlight the critical role
that pharmacists play in improving outcomesfor people living with HIV,
from ensuring patients have the right access
to the right antiretroviral therapy,to providing ongoing support and counseling.
(00:28):
Pharmacies are key players in HIV care.
Your dedication makes a significant differencein the lives of those affected by HIV.
So thank you for all that you do.
In part one,we discussed the latest updates to HIV treatment
guidelines, which included several updatesrelated to pharmacotherapy management,
reiterating the pharmacist roleand optimizing care for people living with HIV.
(00:50):
Today, I'm excited to be joined by Kevin Astle,a clinical pharmacist
specialist with extensive experience in HIV care.
Welcome, Kevin, why don't you tell listenersa little bit about your roles
and responsibilities as a clinical pharmacistspecialist.
Yeah. Thank you so much for having me.
So as a clinical pharmacist specialist,I'm involved in the treatment and prevention
(01:11):
of HIV in multiple different practice settingswith a focus on adult and adolescent care.
In my role, I'm able to kind of operateunder two different hats.
So one is doing direct patient care for patients,primarily with HIV prevention,
and they'll get added to my scheduleand I'm able to help manage
their regimen and help make surethat they taking their medications as prescribed.
(01:32):
And then also as a consult service.
So if we do have any difficult patientsor a history of resistance and any concerns
of the providers can use me as a counseland help develop the most appropriate regimen.
And sometimes that does involve going to seethe patients right alongside those providers.
Awesome.
Karen, thanks so much for sharing a little bitabout the good work that you're doing every day.
So as we discussed last week,there were several new updates
(01:56):
to the recent guidelines that were just publishedfocusing on optimizing antiretroviral therapy
for people of HIV viral suppression,and then some also key considerations
in managing AIDS related comorbiditiesas the population continues to age.
I'm sure that managing complex cases on the day today can be very challenging, but also rewarding.
So Kevin, could you sharemaybe a particularly difficult case that you can
(02:19):
that you've had that you can reflect uponinvolving a patient with viral suppression
and maybe an age related considerationand how you approached it?
Yeah.
So that's kind of been an exciting partin our progression in HIV treatment,
is having this aging populationand now bringing in comorbid condition management.
I'm trained classically as an amcare pharmacist,so I'm happy to bring that chronic disease
(02:42):
state management perspective to HIV treatment,
particularly complicated aspects.
I've had relatively recently as a patientto not only live with HIV
but has diabetes, dyslipidemiaand is at high risk for cardiovascular disease.
And so really trying to understandsome of their behaviors.
So this patient in particular was not takingany of their medications really at all.
(03:05):
And so trying to understandwhat their goals of treatment were and what
their understanding of their conditionsis, is was really essential.
And so, you know, first,
trying to get by and about the importanceof managing their diabetes was a really big step.
But then being able to translate that conversationover to their HIV management
was really critical.
So the patient could understand,you know, what the long term goals were,
(03:27):
and that while, yes, we want to see the viral loadcome down and achieve that viral suppression,
we're now looking at,can we prevent this chronic inflammation?
Can we really help manage these conditions thatare going to help you live longer and healthier
and having more data
now for specifically with our lipidsand the Reprieve trial, you're now
we're able to be a lot more confident in howwe can recommend some of that preventative care.
(03:51):
Yeah, Kevin, that's a great example.
You know, when you think about HIVin the aging population, there's,
you know, the multiple different comorbiditiesthat also have to be addressed as well.
So certainly a great perspective.
Thank you for sharing that with our listeners.
All right.
Let's shift gears a little bitand talk about patient adherence.
So we know challenges like stigma, access to carecan be significant
(04:12):
barriers for people living with HIV.
Can you share some strategies that you foundthat have worked well for you in
helping patients maintain adherenceto their antiretroviral drug regimens?
Yes, this has been a fun challenge for merecently.
In the last year, I've been integratedinto a young adult sexual health clinic
doing HIV treatment prevention,and so my patient population
(04:34):
is primarilyaround the 20 to 23 year old age range
and not the best at taking medications.
You know, these are for a lot of these patients,it's their first time taking chronic medications
and taking anything outside of acute treatments.
And so really understandingthat importance of adherence
has been fun to learnhow to help patients to grasp.
(04:57):
And so a strategy that I've used with themis to really emphasize
pillboxes and alarms and some of our classic toolswe use for adherence.
But then also trying to demonstratethat we really need
optimal adherence, missing no more than really,you know, 2 to 3 doses a month.
And then really that's on the higher end.
But I'm trying to help demonstrate to them.
So I've worked with some of my studentson rotations also to help develop some graphics
(05:22):
to really show them, you know, if you'retaking your antiretroviral therapy every day,
here's how your viral load can stay reduced.
Here's how we can have that drug concentrationsteadily throughout that time.
And when we have those missed dosesshowing how it can creep down and highlighting
what some of the consequences of that are.
So I found thatthat has been pretty helpful with these patients.
A lot of young adults, I feel, are muchmore visual than auditory learners.
(05:45):
And so having different tools availableto demonstrate that is certainly helpful.
Awesome.
Thanks, Kevin.
Yeah, it's funny, like we shifted gearsfrom the older adult to the younger population
and they all kind of have their uniquenessin all of the different scenarios.
So thanks for highlighting some of these.
All right.
So just one more question for you today, Kevin.
(06:07):
So for pharmacists listening who maybe they justdon't specialize in HIV care, I'm one of those.
What are some practical tips that they can useto support people living with HIV,
whether it bemaybe in the community setting, hospital setting,
regardless of the practicesetting that they fall in.
I think some of the biggest waysthat we can help any pharmacist provide
(06:30):
care for our patients with HIV is really helpingto advance our ability to remove that stigma.
And our medications for HIVare just like any of our other medications.
Now, thankfully, we are seeing reduced barriersto those, whether that's through
some of the copay assistance programs,through enhanced insurance coverage.
Where I see patients are a lot,have a lot easier access
(06:50):
to their medications than they hadwhen I was a student or trainee.
You know, I really think it's importantthat we can just bring our traditional principles
of medication adherence and healthyliving and preventative health counseling
to our patients with HIV and just realizethat there's nothing different there
compared to our other preventativehealth treatments that we have now.
I think we're fortunate to be in a timewhere we have our antiretroviral therapy
(07:12):
that is extremely effective, ableto get sustained viral suppression
within first couple of months and just very fewside effects and adverse effects for our patients.
So really helping to make sure that our patients
can take medicationsthat are working best for them.
Awesome.
Kevin, thanks so much for that perspective.
(07:33):
Just thinking about HIVas another chronic condition
is definitely an important thingto do as practitioners.
It kind of puts it into perspective
that we're not, a way,that we're not used to thinking and as previously.
So thank you so much for spending some timewith me today to highlight
kind of some best practices on the importance
of pharmacy and pharmacistsand supporting people living with HIV.
(07:55):
I'm going to just summarizea few major takeaways from our time here today.
First, shame and stigma are significant barriersfor people living with HIV,
affecting their ability to seek treatmentand care using things
like adherence tools, having candid conversationswith patients about the importance of adherence
and then also using graphics and imagescan be options to help improve adherence.
(08:19):
Additionally, as pharmacists, it's critical
that we communicate with patients without judgmentand work to eliminate that stigma.
So this means being self aware and understandingthat our interactions can have profound impact
on patient outcomesby breaking down these barriers, using
traditional principlesrelated to preventative health and management,
and realizing that HIV care is really no differentthan any other comorbid condition.
(08:42):
We help make treatmentadherence more effective and enhance
the overall careexperience for people living with HIV.
All right, folks.
Well, that's all the time we have here for today.
If you haven't listened to partone of this month's First Fill podcast yet,
it was released one week ago.
And that episode, APhA Executive Education
(09:04):
Fellows and I reviewed the latest updatesto HIV treatment guidelines.
So definitely check that outfor some other notable education from APhA
related to HIV, head over to our learning libraryto check out the webinar
titled Ending the HIV Epidemic PharmacistExpanding Role and Impact in our Learning Library,
as well as our newly released this yearHIV PrEP and PEP Certificate Training Program.
(09:29):
And last but not least, don'tforget to head over to the Learning Library
at learn.pharmacist.comto earn your CE for this month's podcast.
We'd love to hear your feedback.
Thanks so much and take care.
Welcome to the First Fill Podcastand Happy Holidays.
I'm Katie Meyer,Senior Director of Content Creation here at APhA.
And I'll be your host for today's episode.
With HIV and AIDS Awareness Month uponus, it's essential to highlight the critical role
that pharmacists play in improving outcomesfor people living with HIV,
from ensuring patients have the right access
to the right antiretroviral therapy,to providing ongoing support and counseling.
(00:28):
Pharmacies are key players in HIV care.
Your dedication makes a significant differencein the lives of those affected by HIV.
So thank you for all that you do.
In part one,we discussed the latest updates to HIV treatment
guidelines, which included several updatesrelated to pharmacotherapy management,
reiterating the pharmacist roleand optimizing care for people living with HIV.
(00:50):
Today, I'm excited to be joined by Kevin Astle,a clinical pharmacist
specialist with extensive experience in HIV care.
Welcome, Kevin, why don't you tell listenersa little bit about your roles
and responsibilities as a clinical pharmacistspecialist.
Yeah. Thank you so much for having me.
So as a clinical pharmacist specialist,I'm involved in the treatment and prevention
(01:11):
of HIV in multiple different practice settingswith a focus on adult and adolescent care.
In my role, I'm able to kind of operateunder two different hats.
So one is doing direct patient care for patients,primarily with HIV prevention,
and they'll get added to my scheduleand I'm able to help manage
their regimen and help make surethat they taking their medications as prescribed.
(01:32):
And then also as a consult service.
So if we do have any difficult patientsor a history of resistance and any concerns
of the providers can use me as a counseland help develop the most appropriate regimen.
And sometimes that does involve going to seethe patients right alongside those providers.
Awesome.
Karen, thanks so much for sharing a little bitabout the good work that you're doing every day.
So as we discussed last week,there were several new updates
(01:56):
to the recent guidelines that were just publishedfocusing on optimizing antiretroviral therapy
for people of HIV viral suppression,and then some also key considerations
in managing AIDS related comorbiditiesas the population continues to age.
I'm sure that managing complex cases on the day today can be very challenging, but also rewarding.
So Kevin, could you sharemaybe a particularly difficult case that you can
(02:19):
that you've had that you can reflect uponinvolving a patient with viral suppression
and maybe an age related considerationand how you approached it?
Yeah.
So that's kind of been an exciting partin our progression in HIV treatment,
is having this aging populationand now bringing in comorbid condition management.
I'm trained classically as an amcare pharmacist,so I'm happy to bring that chronic disease
(02:42):
state management perspective to HIV treatment,
particularly complicated aspects.
I've had relatively recently as a patientto not only live with HIV
but has diabetes, dyslipidemiaand is at high risk for cardiovascular disease.
And so really trying to understandsome of their behaviors.
So this patient in particular was not takingany of their medications really at all.
(03:05):
And so trying to understandwhat their goals of treatment were and what
their understanding of their conditionsis, is was really essential.
And so, you know, first,
trying to get by and about the importanceof managing their diabetes was a really big step.
But then being able to translate that conversationover to their HIV management
was really critical.
So the patient could understand,you know, what the long term goals were,
(03:27):
and that while, yes, we want to see the viral loadcome down and achieve that viral suppression,
we're now looking at,can we prevent this chronic inflammation?
Can we really help manage these conditions thatare going to help you live longer and healthier
and having more data
now for specifically with our lipidsand the Reprieve trial, you're now
we're able to be a lot more confident in howwe can recommend some of that preventative care.
(03:51):
Yeah, Kevin, that's a great example.
You know, when you think about HIVin the aging population, there's,
you know, the multiple different comorbiditiesthat also have to be addressed as well.
So certainly a great perspective.
Thank you for sharing that with our listeners.
All right.
Let's shift gears a little bitand talk about patient adherence.
So we know challenges like stigma, access to carecan be significant
(04:12):
barriers for people living with HIV.
Can you share some strategies that you foundthat have worked well for you in
helping patients maintain adherenceto their antiretroviral drug regimens?
Yes, this has been a fun challenge for merecently.
In the last year, I've been integratedinto a young adult sexual health clinic
doing HIV treatment prevention,and so my patient population
(04:34):
is primarilyaround the 20 to 23 year old age range
and not the best at taking medications.
You know, these are for a lot of these patients,it's their first time taking chronic medications
and taking anything outside of acute treatments.
And so really understandingthat importance of adherence
has been fun to learnhow to help patients to grasp.
(04:57):
And so a strategy that I've used with themis to really emphasize
pillboxes and alarms and some of our classic toolswe use for adherence.
But then also trying to demonstratethat we really need
optimal adherence, missing no more than really,you know, 2 to 3 doses a month.
And then really that's on the higher end.
But I'm trying to help demonstrate to them.
So I've worked with some of my studentson rotations also to help develop some graphics
(05:22):
to really show them, you know, if you'retaking your antiretroviral therapy every day,
here's how your viral load can stay reduced.
Here's how we can have that drug concentrationsteadily throughout that time.
And when we have those missed dosesshowing how it can creep down and highlighting
what some of the consequences of that are.
So I found thatthat has been pretty helpful with these patients.
A lot of young adults, I feel, are muchmore visual than auditory learners.
(05:45):
And so having different tools availableto demonstrate that is certainly helpful.
Awesome.
Thanks, Kevin.
Yeah, it's funny, like we shifted gearsfrom the older adult to the younger population
and they all kind of have their uniquenessin all of the different scenarios.
So thanks for highlighting some of these.
All right.
So just one more question for you today, Kevin.
(06:07):
So for pharmacists listening who maybe they justdon't specialize in HIV care, I'm one of those.
What are some practical tips that they can useto support people living with HIV,
whether it bemaybe in the community setting, hospital setting,
regardless of the practicesetting that they fall in.
I think some of the biggest waysthat we can help any pharmacist provide
(06:30):
care for our patients with HIV is really helpingto advance our ability to remove that stigma.
And our medications for HIVare just like any of our other medications.
Now, thankfully, we are seeing reduced barriersto those, whether that's through
some of the copay assistance programs,through enhanced insurance coverage.
Where I see patients are a lot,have a lot easier access
(06:50):
to their medications than they hadwhen I was a student or trainee.
You know, I really think it's importantthat we can just bring our traditional principles
of medication adherence and healthyliving and preventative health counseling
to our patients with HIV and just realizethat there's nothing different there
compared to our other preventativehealth treatments that we have now.
I think we're fortunate to be in a timewhere we have our antiretroviral therapy
(07:12):
that is extremely effective, ableto get sustained viral suppression
within first couple of months and just very fewside effects and adverse effects for our patients.
So really helping to make sure that our patients
can take medicationsthat are working best for them.
Awesome.
Kevin, thanks so much for that perspective.
(07:33):
Just thinking about HIVas another chronic condition
is definitely an important thingto do as practitioners.
It kind of puts it into perspective
that we're not, a way,that we're not used to thinking and as previously.
So thank you so much for spending some timewith me today to highlight
kind of some best practices on the importance
of pharmacy and pharmacistsand supporting people living with HIV.
(07:55):
I'm going to just summarizea few major takeaways from our time here today.
First, shame and stigma are significant barriersfor people living with HIV,
affecting their ability to seek treatmentand care using things
like adherence tools, having candid conversationswith patients about the importance of adherence
and then also using graphics and imagescan be options to help improve adherence.
(08:19):
Additionally, as pharmacists, it's critical
that we communicate with patients without judgmentand work to eliminate that stigma.
So this means being self aware and understandingthat our interactions can have profound impact
on patient outcomesby breaking down these barriers, using
traditional principlesrelated to preventative health and management,
and realizing that HIV care is really no differentthan any other comorbid condition.
(08:42):
We help make treatmentadherence more effective and enhance
the overall careexperience for people living with HIV.
All right, folks.
Well, that's all the time we have here for today.
If you haven't listened to partone of this month's First Fill podcast yet,
it was released one week ago.
And that episode, APhA Executive Education
(09:04):
Fellows and I reviewed the latest updatesto HIV treatment guidelines.
So definitely check that outfor some other notable education from APhA
related to HIV, head over to our learning libraryto check out the webinar
titled Ending the HIV Epidemic PharmacistExpanding Role and Impact in our Learning Library,
as well as our newly released this yearHIV PrEP and PEP Certificate Training Program.
(09:29):
And last but not least, don'tforget to head over to the Learning Library
at learn.pharmacist.comto earn your CE for this month's podcast.
We'd love to hear your feedback.
Thanks so much and take care.
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