Pharmacy-Based HIV Care: New Frontiers and Patient Views

Every 2 years, the International AIDS Society puts on the world’s largest conference focused on HIV and AIDS, and all of the science, advocacy, and human rights contributions that are the building blocks to its enduring success and platform for evidence-based results. The global gathering took place this year in Munich, Germany, from July 22-26, and had more than 11,000 attendees.

Among those attendees—who included activists, politicians, community organizers, researchers, clinicians, health care professionals, people living with HIV, and the media—was Jennifer Cocohoba, PharmD, MAS, AAHIVP, McKesson Professor of Pharmaceutical Technology and interim chair, Department of Clinical Pharmacy, University of California, San Francisco (UCSF), School of Pharmacy.

A clinical pharmacist for the UCSF Women’s HIV Program since 2003, Cocohoba’s research focuses on the use of medications in people with HIV, and pharmacy-based interventions to improve adherence and access to antiretrovirals. At this year’s conference, she presented, "I Have to Feel Comfortable': Attitudes Towards Pharmacy-Administered Long-Acting Injectable Antiretroviral Therapy in a Sample of People With HIV.”

This interview has been lightly edited for clarity.

Jennifer Cocohoba, PharmD, MAS, AAHIVP | Image Credit: UCSF School of Pharmacy

The American Journal of Managed Care® (AJMC®): As an expert certified in HIV care by the American Academy of HIV Medicine (AAHIVM), can you explain the significance of this certification, and what motivates your focus on HIV/AIDS ambulatory care?

Cocohoba: The AAHIVM recognizes the importance of expert interdisciplinary HIV care, of which pharmacists are an important part. Maintaining my AAHIVP certification is important to me as a practitioner in this field. Early in my career, I saw the disproportionate impact of HIV on certain communities and women, and also witnessed the transformative power of antiretroviral therapy in helping people live longer and healthier lives. Although that was what drew me into HIV/AIDS ambulatory care, the relationships that I’ve built with my team and with the patients is what keeps me here, as well as the constantly evolving needs to manage medications—not only for HIV but for chronic diseases. There is always work to be done.

AJMC: How has long-acting injectable antiretroviral therapy (LA-ART) transformed treatment of HIV/AIDS?

Cocohoba: There are so many ways that LA-ART has transformed treatment. We have patients for whom LA-ART was a game changer because it solved the adherence challenges they had to taking daily medicines. For other patients, LA-ART seems to have changed the way that they view their disease; most patients in our clinic who have started on it are quite happy with their treatment. Now, however, we are running into different challenges that are more on the clinic side: nursing time, space, refrigeration, monitoring, preauthorization, and billing, for example. The ability to access and scale up LA-ART depends on resources available within health systems, and it will be important to ensure that these treatments are provided in places beyond where resources are more robust.

AJMC: In your view, why are pharmacists crucial to community health, and what are some key ways they facilitate access to care?

Cocohoba: We sometimes dismiss the act of providing people with their medicines. I think we’re going to see the relevance and importance of what is perceived as a “simple” service more poignantly with the closure of some pharmacies and the greater challenges neighborhoods will have to face to acquire medicines needed to maintain health. Apart from the medications, there is also the idea that pharmacists are rooted within the community. They are accessible, can provide advice regarding self-care, and can encourage people to seek medical advice when self-care is not appropriate. Now there is movement toward increasing the scope of practice for pharmacists. Their role in prevention, through immunizations and more, and management of test-and-treat conditions will continue to keep them as front-line health care providers.

AJMC: Could you discuss the findings you presented at AIDS 2024 and provide insights into the diverse patient population included in your analysis?

Cocohoba: Our research examines the attitudes of patients regarding pharmacy-administered LA-ART in 4 geographical regions. We focused on the idea of pharmacy-administered LA-ART as a potential alternative service delivery site to help offload clinics and increase patient access to these medications. Our research found that patients were generally supportive of pharmacy-administered LA-ART because of the idea of increased convenience, but also held concerns about privacy and pharmacy staff turnover.

AJMC: What led you to focus your research on the regions of northern California, southern Texas, central Alabama, and southern Florida?

Cocohoba: We wanted to get a sample of participants from different regions, and all of these areas have a moderate to high HIV prevalence but may have patients with different experiences with HIV and the health care system.

AJMC: Can you explain why opinions of pharmacy-administered LA-ART differed between those on long-acting injectable antiretroviral therapy and patients not on this treatment?

Cocohoba: Those on LA-ART have a more complete understanding of what the process is like—that as of right now, LA-ART doesn’t just consist of a shot in your arm and that your appointment to receive it will only take 5 minutes. The people in our study who were on LA-ART and held negative attitudes had already developed very trusting relationships with their clinic and/or doctors and could only fathom getting care there. Some also had negative experiences with pharmacies, and this did not help their views of accepting a new service like getting their HIV medication injections performed by a pharmacist.

I believe these negative attitudes—and all attitudes really—are strongly influenced by prior and existing relationships either with the pharmacy or clinic staff. So if a pharmacy were to set up an LA-ART administration service, and someone needed to transition from clinic-administered to pharmacy-administered LA-ART, I believe there would need to be some kind of warm handoff to make the patient feel more comfortable and confident in the pharmacy.

AJMC: What were the primary reasons each group gave for why they did or did not believe pharmacy-administered LA-ART was beneficial?

Cocohoba: The primary argument in favor of pharmacy-administered LA-ART was convenience. Individuals in our analysis thought it would be good to access the medicines in locations closer to their houses, like pharmacies, or that had different hours. Some people had strong relationships with their pharmacies already and would not mind getting their LA-ART administered by them. The primary arguments against pharmacy-administered LA-ART were lack of privacy, and concerns about workload and staff turnover—people didn’t totally feel comfortable with someone they didn’t know giving them their HIV medicine injections.