CDC, Walgreens develop MTM for HIV patients

MTM pilot program hopes to improve health outcomes for a thousand patients with HIV

Pharmacy manager Ambrose Delpino, PharmD, oversees a Walgreens HIV Center of Excellence (an HIV-focused community pharmacy) in Wilmington, DE, on August 21, 2012. (Photo credit: William Bretzger/The News Journal)

Aiming to improve health outcomes for 1,000 HIV patients, CDC and Walgreens will develop and test a 3.5-year medication therapy management (MTM) pilot program provided by pharmacists in collaboration with primary care providers at HIV-focused community pharmacies.

“The initiative is in its formative stages and we are still finalizing details related to the overall program,” Paul Weidle, PharmD, MPH, Medical Officer in CDC’s Division of HIV/AIDS Prevention, told Pharmacy Today.

Set to launch January 1, 2013, the MTM pilot will include an initial comprehensive medication review and quarterly MTM, as well as monthly services including refill reminders, managing adverse effects, and figuring out insurance benefits, according to Walgreens. Patient participation will be voluntary. Walgreens anticipates donating nearly $1 million in in-kind services.

The MTM pilot will seek to improve retention in care, adherence to drug treatment regimens, and health outcomes. The pilot will examine the impact of MTM on HIV patients in the community pharmacy setting, and the data will be used to measure benefits and costs associated with a pharmacy-based program.

The MTM pilot was one of four HIV-related, public–private initiatives announced by U.S. Department of Health & Human Services Secretary Kathleen Sebelius at the XIX International AIDS Conference held July 22–27 in Washington, DC.

Improvements in HIV care needed

Weidle connected the MTM pilot to meeting the goals of the White House Office of National AIDS Policy’s National HIV/AIDS Strategy and breaking the cycle of HIV transmission in the United States.

Improvements are needed at each stage in the continuum of care, Weidle said—the number of people diagnosed with HIV, linked to care, retained in care, prescribed antiretroviral therapy (ART), and virally suppressed. He noted that only an estimated 25% of all HIV-infected persons in the United States are virally suppressed, largely because among those with diagnosed infection, 37% are receiving regular HIV care and even fewer are prescribed and adhering to ART.

“The HIV MTM model will potentially involve patients visiting their local community pharmacist for maintenance and immediate care needs between visits to the primary provider,” Weidle said. “This program could lead to improvements at some of the weakest points along the continuum of HIV care by improving patient retention in care, adherence to ART, and ultimately HIV viral load suppression.”

Role of community pharmacists

The role of the community pharmacist in caring for HIV patients is vast, said Jennifer Cocohoba, PharmD, MAS, AAHIV-E, Health Sciences Associate Clinical Professor in the Department of Clinical Pharmacy at the University of California, San Francisco (UCSF) School of Pharmacy and Clinical Pharmacist in the UCSF Womens HIV Program. She was not privy to the details of the CDC–Walgreens partnership but has conducted research in HIV-focused community pharmacies (see sidebar).

HIV community pharmacists “often list the practical ways they assist with adherence, such as counseling on proper medication administration, encouraging the use of reminder devices like medicine boxes, setting up automatic refills, and smoothing out insurance issues,” Cocohoba told Today. “However, the HIV-positive patients I speak with identify less tangible forms of pharmacy adherence support—their pharmacists know them by name, they check on them by telephone, they ask about their adherence, they encourage them to speak with their clinicians about any medication problems they are having.”

Cocohoba explained that adherence for HIV patients may be hindered by inability to pay for medications, complicated insurance systems, lack of understanding about the importance of adherence, stigma around HIV disease, and other comorbid health conditions. “I think many patients feel that it’s sort of up to them to adhere to their antiretrovirals, but when given extra support and encouragement, many welcome it,” she said.

Adding that HIV community pharmacists link the patient back to medical care when something goes awry with the medications, Cocohoba said, “There is an amazing opportunity to develop a lasting, trusted, sensitive, and supportive relationship.”

Implications for chronic conditions

The relationships that community pharmacists form with HIV patients may be a model for caring for patients with other chronic illnesses.

“By developing these relationships and closely studying how they impact outcomes for HIV patients, this collaboration will put community pharmacy in a great position to be even more effective and relevant when it comes to retention in care for those with chronic conditions,” said Kermit Crawford, BSPharm, Walgreens President of Pharmacy, Health, and Wellness Services and Solutions, according to a Walgreens news release.

“This is an exciting opportunity for pharmacists to further integrate MTM programs into their practice settings,” said APhA Senior Vice President of Government Affairs Brian Gallagher, BSPharm, JD.

For APhA’s MTM resources, visit www.pharmacist.com/MTM.


Improved adherence for HIV patients

Clinicians working with HIV-positive patients struggling with adherence to antiretroviral therapy may consider minimizing pill burden and referring them to an HIV-focused pharmacy, according to a study in the September/October 2012 issue of the Journal of the American Pharmacists Association (JAPhA) by Jennifer M. Cocohoba, PharmD, MAS, AAHIV-E, of the University of California, San Francisco (UCSF) School of Pharmacy, and colleagues from Walgreens and UCSF School of Pharmacy.

“Community pharmacies remain an underused resource to detect and intervene in response to poor adherence,” wrote Cocohoba and colleagues in JAPhA. “Pharmacists make ideal treatment advocates because they can build trusted relationships with patients and are trained to discuss medication-related problems and adherence when conducting MTM [medication therapy management] evaluations.”