Ahmed Ali, Abdulelah Dujaili Juman, Rehman Inayat Ur, Chuah Lay Hong, Hashmi Furqan Khurshid, Awaisu Ahmed, Chaiyakunapruk Nathorn
School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
Department of Pharmacy, Abdul Wali Khan University Mardan, Pakistan.
Res Social Adm Pharm. 2022 Jun;18(6):2962-2980. doi: 10.1016/j.sapharm.2021.07.020. Epub 2021 Jul 28.
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.
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.
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).
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/mm [95% CI 44.08, 89.57]). The strength of evidence ranged from moderate, low to very low.
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.
药剂师在人类免疫缺陷病毒（HIV）/获得性免疫缺陷综合征（AIDS）感染者（PLWHA）的多学科护理中发挥着重要作用。然而，关于药剂师作为个体团队成员对HIV护理影响的证据较少。
本研究旨在确定药剂师干预对提高PLWHA对抗逆转录病毒疗法（ART）的依从性、病毒载量（VL）抑制以及CD4-T淋巴细胞变化的影响。
我们检索了从数据库建立至2020年6月的六个数据库（PubMed、EMBASE、ProQuest、Scopus、Cochrane和EBSCOhost）中的相关记录。我们纳入了评估药剂师护理活动对PLWHA临床结局影响的研究。采用随机效应模型估计总体效应[二分法的比值比（OR）和连续数据的均值差（MD）]，并给出95%置信区间（CI）。使用推荐分级评估、制定和评价（GRADE）系统评估证据质量。该综述方案已在国际前瞻性系统评价注册库（PROSPERO）上发表（CRD42020167994）。
纳入了25项涉及3206例PLWHA的研究，其中药剂师提供的干预形式包括单独或作为跨学科团队成员进行有或没有药学服务的教育。8项研究为随机对照试验（RCT），17项研究为非RCT。汇总分析显示，与常规护理组相比，药剂师护理对依从性结局（OR：2.70 [95%，CI 1.80，4.05]）、VL抑制（OR：4.13 [95% CI 2.27，7.50]）以及CD4-T淋巴细胞计数升高（MD：66.83个细胞/mm [95% CI 44.08，89.57]）有显著影响。证据强度从中等、低到极低不等。
研究结果表明，药剂师护理可提高PLWHA的依从性、VL抑制以及CD4-T淋巴细胞水平；然而，应注意的是，大多数研究存在较高偏倚风险。需要进行更严格设计的更多研究，以再次确认药剂师干预对PLWHA临床和经济结局的影响。
