Antiretroviral stewardship in a tertiary academic hospital: The need for a clinical pharmacist

Abstract

Background: South Africa has the highest prevalence of people living with HIV globally. Although antiretroviral therapy provides solutions, evidence of antiretroviral resistance emerged, requiring the application of antiretroviral-stewardship programmes to curb medication-related problems.

Aim: Identify and describe antiretroviral-stewardship pharmacist interventions in an active antiretroviral-stewardship programme.

Setting: HIV-positive adults admitted to medical wards at a tertiary academic hospital in South Africa.

Methods: A descriptive quantitative study was performed, utilising an antiretroviral-stewardship assessment tool to determine antiretroviral-related recommendations in the treatment of HIV-positive adults. The study employed purposive sampling. Treatment charts were evaluated to identify antiretroviral-stewardship recommendations. The number of recommendations highlighted the need for a clinical pharmacist in an active antiretroviral-stewardship programme. Descriptive data analysis with Pearson correlations was employed to display the data.

Results: Medication-related problems were identified in 100% of study patients (n = 41), with an average of 2.46 interventions per patient. One-hundred-and-one medication-related problems were identified by using the antiretroviral-stewardship assessment tool. The identified problems included a lack of viral load testing (41, 100%), lack of CD4 count monitoring (15; 36.6%) and lack of prophylactic treatment against opportunistic infections (10; 24.4%). Medication-related problems included the presence of clinically significant drug–drug interactions and serious side effects, CD4 count decline despite being on antiretroviral therapy, unnecessary treatment interruptions including risk for IRIS, inappropriate antiretroviral therapy regimen, non-adherence and absence of treating tuberculosis as co-morbidity.

Conclusion: Present study demonstrates the need of an active antiretroviral-stewardship programme’s benefits. The possible role of the clinical pharmacist as active participant and leader in this programme is highlighted.

Contribution: Highlight the role of clinical pharmacists in antiretroviral stewardship.