My HIV Care – Preferences of people living with HIV for medicine-related support from community pharmacists
Authors: Katusiime B , Sarma P , Corlett S , Cassidy R 
Published: November 2022

Abstract

Introduction
HIV is now a long-term condition, presenting new challenges for primary care providers. Hospital-based specialists have traditionally provided medicine-related support to people living with HIV (PLWH) within secondary care clinics,1 but with an aging population and rising polypharmacy2 other forms of support will be needed. Although community pharmacists (CPs) are already involved in sexual and reproductive health service delivery to varying magnitudes,3 it is unknown whether PLWH want them to be involved in their HIV treatment and medicine support.

Aim
To understand the pReferences and perceptions of PLWH towards CP involvement in their care.

Methods
An online survey, promoted to UK HIV charities and activists via social media (November 2021–July 2022), asked about pReferences for medicine-related support and the involvement of CPs in PLWH’s care. Questions explored factors that would influence use of CPs for all services. Views on sharing HIV diagnoses with CPs during medicine-related consultations were also obtained. Descriptive analysis was used. Institutional ethics approval was obtained.

Results
Approximately half (73/144) of those who accessed the survey fully completed it: 57.5% male; age 22-80 years. Of those who provided demographic data: 88.9%(n=48/54) were white; gay/lesbian (64.8%, n=35); University-level education (57.4%, n=31) and employed (55.6%, n=30). CPs were rated among the least helpful health professionals in terms of medicine support (2.7%, n=2) compared to general practitioners (13.7%, n=10), HIV clinic-based nurses (35.6%, n=26), specialist pharmacists (42.5%, n=31) or consultants (56.2%, n=41). Over half (56.1%, n=41) were unsure or did not want their CP to be involved in their HIV care. Patient autonomy/self-efficacy, mistrust, concerns around stigma and privacy/confidentiality of information shared in community pharmacy settings, and perceived lack of HIV-related knowledge among CPs influenced participants’ pReferences: “they don’t need to know or don’t have the understanding of HIV and HIV meds to correctly use this information. I check drug and treatment interactions or complications before procedures myself.” Many participants wanted more information on HIV-related drug interactions and less judgemental attitudes: "if they could be less racist and homophobic and normalise conversations about HIV.” Some participants wanted holistic supply of all their antiretroviral and non-HIV medicines from their community pharmacies. There was equal resistance from other participants: “I certainly wouldn’t want my HIV care to be done by a chemist...” Expectedly, more participants were willing to share information about their HIV status and antiretroviral drug history during private (39.7%, n= 29) compared to over-the-counter consultations (28.8%, n= 21). Reasons for sharing information with CPs were positive: “so that they fully understand my medical circumstances and help me accordingly” and “in case of interactions”.

Discussion/Conclusion
Whereas some PLWH want more involvement of CPs in their care, others are sceptical of their role in HIV, similar to other primary care providers.1 This study was limited to online respondents. Future research is needed to explore how to build confidence of PLWH in CPs with regards to their changing medicine support needs. Understanding training needs of CPs and promoting HIV-friendly community pharmacies will be key in supporting medicine needs of PLWH.

References
1. Rai T et al. Experience of primary care for people with HIV: a mixed-method analysis. BJGP Open, 2019;3(4):1-14
2. Baylis A et al. The future of HIV services in England -shaping the response to changing needs. Kings Fund Report. 2017;1-100
3. Public Health England (The UK Health Security Agency). The pharmacy offer for sexual health, reproductive health and HIV - a resource for commissioners and providers, 2019;1-25