A pharmacy’s role in the fight against AIDS

WASHINGTON, DC— The US government is looking for new partners to fight HIV/AIDS around the country.

And it hopes it found a new one: Walgreens.

At the 19th International AIDS Conference, Health and Human Services Secretary Kathleen Sebelius announced that the Centers for Disease Control and Prevention (CDC) and Walgreens Pharmacy will launch a Medication Therapy Management model to improve health outcomes for those living with and affected by HIV. The pilot will run for two years, at 24 sites—12 in urban areas and 12 in rural areas.

“The idea here is that so many people in the United States are HIV infected and are not benefiting from the effective antiretroviral treatments that are available. Only about 28 percent of HIV-positive people are maximally benefiting from their drugs,” said Dr. Kevin Fenton, Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention for the CDC.

Medication Therapy Management is a series of services, including counseling, mentorship, and quarterly assessments, which provide an opportunity for patients receiving HIV treatment to ask questions and share their experiences while undergoing treatment.

The announcement marks a shift in the role that pharmacists have been playing in the healthcare system.

“We are asking people to think about the role of a pharmacists differently,” said Glen Pietrandoni, Senior Manager of HIV/AIDS, and Hepatitis Pharmacy Services for Walgreens.

Pietrandoni said that Walgreens has been on the front line of changing the role of pharmacists, even before this pilot project began.

Walgreens has already certified more than 500 of its stores as “Centers of Excellence” in underserved communities. Centers of Excellence are designed to provide a safe space for people to get HIV tests and other routine medical screenings. Pharmacists at these locations receive training on how to test clients, side effects of the medication, and cultural competency surrounding issues of stigma and disclosure. Each pharmacy also keeps a detailed inventory to track a patient’s adherence to their medication, which helps pharmacists follow up on patients who may not be taking their pills.

But is a pharmacy the place for HIV testing?

Some HIV-positive people don’t think so.

“There are still complexities involved in dealing with pharmacists,” said Penny DeNoble, an HIV-positive woman who lives in Denver. “People still believe that pharmacies are not secluded and confidential and make people feel like their status could be outed.”

Patricia McNeill Shelton, from New York City, agreed, saying, “Everything should be done within a medical facility. You have to have testing and counseling, which go hand in hand. If they have counselors, then it is OK. But some people might think that this is the pharmacy that you go to if you have AIDS.”

Shelton has been living with HIV since 1991, and remembers visiting her doctor in the 1990’s. At that time, she said everyone thought that if you went to the third floor, you must have HIV/AIDS, because that is where people were tested.

Despite their caution, both women said that since they have had more than two decades to come to terms with their status, they would take advantage of the convenience of picking up their medication at their local pharmacy.

Issues of disclosure are complex and delicate. But Walgreens’ Pietrandoni said pharmacists are in a good position to address issues of stigma and disclosure within communities.

He pointed out that most people live within 10 minutes of a pharmacy, so pharmacists see their patients more than general practitioners and have a sense of what is going on in the community. In fact, the Centers of Excellence are required to do outreach in their community. These stores work with the local alderman, health department, or community-based organizations to spread the word about the education and testing that they offer, and to understand their constituents’ needs.

Fenton also said that no mechanisms can be discounted when working towards eliminating HIV. While pharmacies may not address the needs of everyone infected with HIV, he said, the epidemic won’t be brought to an end only by the actions of doctors. Many countries around the world have taken advantage of the concept of task shifting, where different kinds of health workers take on multiple roles when it comes to HIV care.

“There simply are not enough primary care physicians in the United States to deal with the size and scale of an epidemic such as HIV,” he said.

Fenton also noted that more nurses, community-based organizations, and other platforms need to get involved to bring HIV to an end. He said pharmacists are just one element of the equation.

It remains to be seen, however, how much it will cost to sustain these programs. In the two-year pilot program, the CDC will look into the total costs of HIV programs in pharmacies. They will also test and evaluate whether people want the service.

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