Pharmacists' experiences providing care to HIV-infected patients: Perspectives on adherence barriers, strategies and challenges to promoting adherence

Background: Despite advancements in antiretroviral therapy, HIV-infected patients struggle to maintain adequate adherence to improve clinical outcomes and enhance their quality of life. Our study provides pharmacists' perspective on the barriers HIV-infected patients' face in adhering to ARVs, and the strategies pharmacists use to promote adherence to therapy. Methods: We interviewed nineteen pharmacists providing pharmacy services to HIV-infected patients in 4 Mid-Western states. We asked pharmacists the reasons patients' gave for not adhering to antiretroviral therapy. We used MAXQDA qualitative software for data analysis. Results: Pharmacists reported a range of adherence barriers that were patient-specific (e.g., cognitive factors and lack of social support), therapy-related (e.g., side effects and intolerable medications), and structural-level barriers (e.g., strained provider relationships). They used a combination of individually-tailored patient-specific interventions to not only identify and remove actual adherence barriers, but to proactively anticipate and address potential adherence barriers. Pharmacist interventions included medication-specific education to enhance patient self-efficacy, follow-up calls to monitor adherence, practical and social support to motivate adherence, and patient referrals to other health providers. However, the pharmacists faced internal challenges (lack of time and enough trained personnel), and external challenges (insurance policies that disallowed patient enrollment in automatic prescription refill program). Conclusions: Pharmacists in community settings went beyond prescription counseling mandated by law, to provide additional pharmacy services that were tailored to HIV-infected patients needs. Given that many HIV-infected individuals are living longer, more research is needed on the effectiveness and cost-effectiveness of pharmacists' interventions in clinical practice to inform insurance reimbursement policies.