The Role of Pharmacist in PMTCT of HIVAIDS in Barbados

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The Role of Pharmacist in PMTCT of HIV/AIDS in
Barbados

• Rosamund Lovell
• Pharmacist 1
• Ladymeade Reference Unit
• 2009.02.05

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Role of the Pharmacist

• Review prescriptions
• Recommend changes to regimen
• Monitor adherence to treatment
• Remove barriers to treatment
• Manage adverse effects
• Monitor drug interactions
• Pharmacovigilance
• Manage drug supply

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Classes of Antiretroviral (ARV) Medications

• Non-nucleoside Reverse Transcriptase inhibitors
  (NNRTIs)-reduce the growth of HIV
• Nucleoside Reverse Transcriptase Inhibitors
  (NRTIs)-keep HIV from making copies of itself
• Protease Inhibitors-prevent HIV from being formed
  

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Highly Active Antiretroviral Therapy (HAART)

• Combination of at least 3 drugs, usually
• 2 NRTIs (the NRTI backbone), plus
• 1 NNRTI or 1-2 PIs
• Therapy with only one or two agents allows HIV to
  overcome therapy through resistant mutations

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Antiretroviral Treatment vs.Prophylaxis for PMTCT

• ARV treatment- Long term use of ARVs to treat
  maternal HIV/AIDS and for PMCT
• Treatment is for the mother's own health
• ARV prohylaxis- Short-term use of ARVs to reduce
  HIV transmission from mother-to-infant

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Regimens used in PMTCT in Barbados

• Viramune (nevirapine) Combivir
  (lamivudine/zidovudine) (NNTRI NRTI)- Long-term
  use
• Kaletra (lopinavir/ritonavir) Combivir
  (lamivudine/zidovudine) (PI NRTI)- Short-term
  use
• Zerit (stavudine) 3TC (lamivudine) Kaletra
  (lopinavir/ritonavir) (2 NNTRI PI)- used
  according to individual

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Considerations in choosing ARV Regimens

• Treatment starts after first trimester-
• Pregnant women suffer frequently from nausea, a
  common side effect of most ARVs
• Effect of ARVs on important feotal development
  during first semester
• E.g. Forming of vital organs such as the brain

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Efavirenz

• Potentially dangerous to the development of the
  foetus
• Not recommended in the first trimester of
  pregnancy
• Should not be given to women of childbearing age
• Nevirapine is given instead. However, the
  individual is monitored in the 1st 14 days for
  RASH (definitive)

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Managing Side Effects

• Kaletra (lopinavir/ritonavir) - G.I upset
• Avoid milk
• Decrease intake of high fat foods
• Increase intake of low fat foods
• Eat small regular meals

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Managing Side Effects

• Combivir (lamivudine/zidovudine)
• Anaemia
• -increase intake of iron (supplement and
  dietary)
• GI upset (Nausea and vomiting)
• - issue Dimenhydrinate to counteract this

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Benefits of ARV Therapy

• Prevents transmission of virus to baby
• Preserves health of mother
• Suppresses virus
• Increases CD4 count
• Decreases viral load

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Adherence- Key Role

• Key to successful HAART- doses taken correctly
• Determines success of PMCT
• Determines degree and duration of viral
  suppression
• Extends patients lifespan
• Poor adherence leads to virologic failure
• Reduces drug resistance
• Reduces transmission of HIV and HIV that is
  resistant to ARVs

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Adherence- Barriers

• Stigma
• Non disclosure of status and lack of privacy
• Low Intelligence
• Poor diet may be due to social status
• G.I. upset vomiting, nausea, diarrhea and other
  side effects.

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Adherence- Strategies

• Encourage clients to bring ARVs at each visit to
  the Pharmacy
• Encourage clients not to take any
  over-the-counter medications-
• Counseled on how to take ARVs correctly- timing
  of doses, with or without meals
• Emphasize the importance of taking ARVs-
  suppression of HIV

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Adherence- Strategies

• Do pill counts
• Provide pill boxes ( supplied by drug companies)
  
• Relate possible side effects
• Liaise with multidisciplinary team members if a
  problem arises e.g. drowsiness, shift worker. May
  warrant change in regimen.
• Encourage support of family member or friend.
• Be a very good listener.

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Pharmacovigilance
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Pharmacovigilance

• New development in Pharmacy practice
• To ensure the safe and rational use of
  anti-retroviral drugs as an essential tool and
  component of Public Health policy in Barbados.

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Pharmacovigilance

• To detect unknown adverse reactions and
  interactions
• To detect increases of frequency of (known)
  adverse reactions
• To identify risk factors/mechanisms underlying
  adverse reactions

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Managing Drug Supply

• To ensure adequate and continuous supply of ARVs
• To prevent stock outs
• To liaise with local Pharmaceutical companies
• Inventory control, including reducing expired
  stock

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Thank you for listening