Pharmacist-led counselling intervention to improve antiretroviral drug adherence in Pakistan: a randomized controlled tr
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RESEARCH ARTICLE
Open Access
Pharmacist-led counselling intervention to improve antiretroviral drug adherence in Pakistan: a randomized controlled trial Zeenat Fatima Chatha1, Usman Rashid2, Sharon Olsen2, Fakhar ud Din1* , Amjad Khan1*, Komal Nawaz1, Siew Hua Gan3 and Gul Majid Khan1*
Abstract Background: Pakistan is facing a growing population of people living with human immunodeficiency (HIV). In this randomized controlled trial, we investigate if a pharmacist-led intervention can increase adherence to antiretroviral therapy (ART) for people living with HIV (PLWH). Methods: Adults with HIV, who have been taking ART for more than 3 months were randomly assigned to receive either a pharmacist-led intervention or their usual care. Measures of adherence were collected at 1) baseline 2) just prior to delivery of intervention and 3) 8 weeks later. The primary outcomes were CD4 cell count and self-reported adherence measured with the AIDS Clinical Trial Group (ACTG) questionnaire. Results: Post-intervention, the intervention group showed a statistically significant increase in CD4 cell counts as compared to the usual care group (p = 0.0054). In addition, adherence improved in the intervention group, with participants being 5.96 times more likely to report having not missed their medication for longer periods of time (p = 0.0086) while participants in the intervention group were 7.74 times more likely to report missing their ART less frequently (p < 0.0001). Conclusions: The findings support the improvement in ART adherence and HIV management. Trial registration: The trial is registered with Australian New Zealand Clinical Trials Registry (ACTRN12618001882213). Registered 20 November 2018. Keywords: ART adherence, HIV, Counselling, Pharmacist intervention, Prevention
Background The human immunodeficiency virus (HIV) is a global pandemic affecting mostly both low- and middle-income countries [1]. Pakistan, a lower to middle-income country, has seen a rapid growth in HIV epidemic [2]. Some factors contributing to this phenomena include low level of education on HIV transmission, poor infection control practices and insufficient HIV prevention programs, * Correspondence: [email protected]; [email protected]; [email protected] 1 Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan Full list of author information is available at the end of the article
particularly in relation to condom use among sexworkers, male homosexuals, transgenders and intravenous drug-users as well as poor safety on injection practices [2–4]. It is estimated that Pakistan has an estimated 160,000 people living with HIV (PLWH) [5] and the number is growing rapidly, making treatment programs a priority. Recently, some studies from Pakistan reported a low adherence to ART among intravenous and nonintravenous drug users [6]. Similarly, a systematic review was reported earlier to determine the relationship between socioeconomic status and adherence among the HIV patients in low- and middle-income countries
© The Author(s). 2020 Open
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