Effect of pharmacist care on clinical outcomes among people living with HIV/AIDS: A systematic review and meta-analysis

Ahmed A 1 , Abdulelah Dujaili J 2 , Rehman IU 3 , Lay Hong AC 4 , Hashmi FK 5 , Awaisu A 6 Show all authors , Chaiyakunapruk N 7

Affiliations 

  • 1 School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia. Electronic address: ali.ahmed@monash.edu
  • 2 School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia. Electronic address: jumandujaili@yahoo.com
  • 3 Department of Pharmacy, Abdul Wali Khan University Mardan, Pakistan. Electronic address: inayat.rehman@awkum.edu.pk
  • 4 School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia. Electronic address: Alice.Chuah@monash.edu
  • 5 University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, 54000, Lahore, Pakistan. Electronic address: furqan.pharmacy@pu.edu.pk
  • 6 College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar. Electronic address: aawaisu@qu.edu.qa
  • 7 School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia; College of Pharmacy, University of Utah, Salt Lake City, UT, USA. Electronic address: nathorn.chaiyakunapruk@monash.edu
Res Social Adm Pharm, 2021 Jul 28.
PMID: 34353754 DOI: 10.1016/j.sapharm.2021.07.020

Abstract

BACKGROUND: Pharmacists play a significant role in the multidisciplinary care of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). However, there is less evidence to clarify the impact of pharmacist as an individual team member on HIV care.

OBJECTIVE: This study aims to determine the effects of pharmacist intervention on improving adherence to antiretroviral therapy (ART), viral load (VL) suppression, and change in CD4-T lymphocytes in PLWHA.

METHODS: We identified relevant records from six databases (Pubmed, EMBASE, ProQuest, Scopus, Cochrane, and EBSCOhost) from inception till June 2020. We included studies that evaluated the impact of pharmacist care activities on clinical outcomes in PLWHA. A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and mean difference (MD) for continuous data] with 95% confidence intervals (CIs). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of evidence. The review protocol was published on PROSPERO (CRD42020167994).

RESULTS: Twenty-five studies involving 3206 PLWHA in which pharmacist-provided intervention either in the form of education with or without pharmaceutical-care either alone or as an interdisciplinary team member were included. Eight studies were randomized controlled trials (RCTs), while 17 studies were non-RCTs. Pooled-analyses showed a significant impact of pharmacist care compared to usual care group on adherence outcome (OR: 2.70 [95%, CI 1.80, 4.05]), VL suppression (OR: 4.13 [95% CI 2.27, 7.50]), and rise of CD4-T lymphocytes count (MD: 66.83 cells/mm3 [95% CI 44.08, 89.57]). The strength of evidence ranged from moderate, low to very low.

CONCLUSION: The findings suggest that pharmacist care improves adherence, VL suppression, and CD4-T lymphocyte improvement in PLWHA; however, it should be noted that the majority of the studies have a high risk of bias. More research with more rigorous designs is required to reaffirm the impact of pharmacist interventions on clinical and economic outcomes in PLWHA.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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