Dr Dena Behm Dillon on Treating Patients With HIV and Medication Affordability, Adherence

Knowing if a patient has been on pre-exposure prophylaxis (PrEP) before starting treatment for HIV is important, said Dena Behm Dillon, PharmD, AAHIVP, HIV clinical pharmacy specialist, University of Iowa Health Care. Once treatment begins, pharmacists can play a key role in addressing patient accessibility and affordability of HIV treatments and promoting adherence.

Transcript

Does past use of PrEP, or other medication use, influence treatment decisions when a patient does contract HIV?

It can. If somebody is on long-acting cabotegravir—the injectable for PrEP—then there's a possibility if they acquire HIV while they're taking it or even after they've taken it because it stays in the body a long time, there's a possibility for resistance to develop. We routinely get a genotype for anybody starting on treatment. But if they've been on cabotegravir for PrEP, it's really important to also make sure to get an integrase inhibitor genotype, which sometimes isn't included in the standard genotype. In addition, if we're starting the regimen before we have the genotype, which usually we would, the guidelines recommend using boosted darunavir along with tenofovir and emtricitabine or lamivudine instead of the standard that's usually used with integrase inhibitors.

What can health systems do to address patient accessibility and affordability of HIV medications while also promoting adherence?

It really takes a takes a village and the team approach is the best. Technicians even can apply for co-pay cards. They can help complete prior authorization forms. They can help apply for grants to help pay for the medications. And then it's important to prevent gaps in therapy to promote adherence. So, the pharmacy being persistent and contacting the patient to set up refills, which sometimes takes multiple calls, texts, emails—whatever route we can do that—and also efficient dispensing to make sure the patient is able to get the medicines as soon as possible.

To help with accessibility and adherence while somebody's admitted, it's a good idea to try to encourage the patient to bring their medications just in case it's not on the formulary. We can also encourage it by looking at the formulary. Studies have found that not having combination products on the formulary can increase the risk of medication errors. We can set up a process to order nonformulary medications. Sometimes I see where hospitals may have some of the medications of the regimen on formulary and not the others, and it's important to never dispense a partial regimen.