The impact of HIV clinical pharmacists on HIV treatment outcomes: a systematic review

Figures & data

Table 1 Example of search strategy used in PubMed

Search #	PubMed search terms
#7	Search #5 AND #6
#6	Search randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized controlled trials[mh] OR random allocation[mh] OR double-blind method[mh] OR single-blind method[mh] OR clinical trial[pt] OR clinical trials[mh] OR “clinical trial”[tw] OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind*[tw])) OR Placebos[mh] OR placebo*[tw] OR random*[tw] OR nonrandomi*[tw] OR before after study[tw] OR time series[tw] OR “case control”[tw] OR prospective*[tw] OR retrospective*[tw] OR cohort[tw] OR cross-section*[tw] OR research design[mh:noexp] OR comparative study[pt] OR evaluation studies[pt] OR follow-up studies[mh] OR prospective studies[mh] OR controlled[tw] OR control[tw] OR volunteer*[tw] OR longitud*[tw] OR descripti*[tiab] OR study[tiab] OR evaluat*[tiab] OR “odds ratio”[tw] OR “hazard ratio”[tw] OR “relative risk”[tw] OR “risk ratio”[tw] OR AOR[tiab] OR RRR[tiab] OR NNT[tiab] OR design*[tiab]
#5	Search #1 AND #2 AND #3 AND #4
#4	Search HAART[tiab] OR ART[tiab] OR ARV[tiab] OR ARVs[tiab] OR anti-retroviral*[tiab] OR antiretroviral*[tiab] OR “antiviral”[tiab] OR antiviral[tiab] OR “anti-HIV” OR antiHIV OR “Antiretroviral Therapy, Highly Active”[mh] OR “Anti-Retroviral Agents”[mh] OR CD4[tw] OR immune[tw] OR immunolo*[tw] OR immunology[sh] OR lymphocyte[tw] OR CD4-Positive T-Lymphocytes[mh] OR CD4 Lymphocyte Count[mh] OR CD4 count* OR “viral load”[tw] OR virol*[tw] OR viral[tw] OR virology[sh] OR outcome OR outcomes OR prognosis OR “outcome and process assessment(health care)”[mh] OR th[sh:noexp] OR dt[sh] OR effective*[tw]
#3	Search adhere*[tiab] OR complian*[tiab] OR adhere*[tw] OR complian*[tw] OR Patient Compliance[mh] OR Medication Adherence[mh] OR Counseling[mh] OR counsel*[tw] OR education[tw] OR monitor*[tw] OR interven*[tw] OR self administration[mh]
#2	Search pharmacist*[tiab] OR PharmD[tiab] OR “Pharm D”[tiab] OR pharmacy[tiab] OR pharmacies[tiab] OR pharmacists[mh] OR pharmacy[mh] OR community pharmacy services[mh] OR medication therapy management[mh] OR pharmacy service, hospital[mh] OR pharmaceutical services[mh:noexp]
#1	Search HIV Infections[mh] OR HIV[mh] OR HIV[tiab] OR HIV-1[tiab] OR HIV-2[tiab] OR HIV-1[tiab] OR HIV-2[tiab] OR HIV infect*[tiab] OR human immunodeficiency virus[tiab] OR human immune deficiency virus[tiab] OR human immuno-deficiency virus[tiab] OR ((human immun*) AND (deficiency virus[tiab])) OR acquired immunodeficiency syndrome[tiab] OR acquired immune deficiency syndrome[tiab] OR acquired immuno-deficiency syndrome[tiab] OR ((acquired immun*) AND (deficiency syndrome[tiab])) OR HIV/AIDS[tiab] OR “HIV AIDS”[tiab] OR “Sexually Transmitted Diseases, Viral”[mh]

Figure 1 Selection process for study inclusion.

Table 2 Summary of studies with primary outcomes

Source	Country, City (State) Study start year Estimated study end* Sample size Mean age (years) % Male % MSM % BL % WH	Study design and objectives	If examined interventions, description of intervention	Inclusion/exclusion criteria	Description of pharmacist’s role Pharmacist’s role central or peripheral to study	Outcomes
						Method of ARV adherence assessment ARV adherence outcomes	HIV viral load (copies/mL)	CD4^+ cell count (cells/mm^3)	Other outcomes
Ostrop^Citation10	Canada, Alberta NR NR N = 64 36** 95% NR NR NR	Cohort study to examine ARV adherence and duration of therapy via tool usage (computer generated individualized schedule, pill box, and electronic reminder device)	Received medication and adherence counseling, monitoring, medication interventions, introduction to adherence tools. Provided individualized schedules, pill boxes, and pagers	Replied to questionnaire ≥1 time, ≥18 years, starting ≥1 new ARV. Exclude: not responsible for taking own medications, enrolled in other research, unable to complete questionnaire	Created computer-generated schedules in collaboration with patient (taking account patient needs and regimen requirement). Programmed electronic reminders using beepers Role: Peripheral	Refill Median adherence = 95%; 75% patients had >91% adherence. No significant difference in adherence between use of schedule (92%) or pill box (89%). Adherence with beepers was 76%	NR	NR	Tool usage: 61% used a tool at 6 and 12 months. Schedules used by 48%, pill box by 20%, pagers by 8%. ARV persistence: 74% remained on ARVs at 12 months
McPherson-Baker^Citation11	USA, Miami (FL) NR NR N = 42 46 100% 14.3% 73.8% 11.9%	Controlled before-after study to test efficacy of brief medication counseling and behavioral intervention in improving ARV adherence	Intervention: Monthly pharmacist visits x5; given pill box and adherence counseling; instructed on how to fill pill box. Control: usual care including only pharmacy overview of medications but no pill boxes. Matched on age, CD4^+, risk factor, ethnicity	Nonadherent (failure to refill ARVs and OI medications or hospitalization for OI); function independently. Exclude: Karnofsky <60, has primary caregiver, living in facility, mental disability, history of clinic loss to follow-up	Educated patient on basic HIV information, impact of HIV on body, purpose of ARVs, clarification of regimen and potential toxicity. Gave pill box and taught how to fill it. At follow- up visits reviewed regimen, adherence barriers, AEs, and gave positive reinforcement Role: Central	Refill Significant increase in adherence at 5 months post-intervention (t = 4.2 1, P < 0.01). Intervention group: Baseline = 46.9% 5 months post-intervention = 75.8% Control group: Baseline = 54.4% 5 months post-intervention = 39.3%	Mean VL from baseline to 5 months post-intervention: Intervention: 99, 213 to 81,600 c/mL. Control: 142,848 to 119,275 c/mL	Mean CD4^+ from baseline to 5 months post-intervention: Intervention: 143.1 to 136.50 Control: 193.5 to 166.1	Significant increase in adherence to clinic appointments (P < 0.05) Significant decrease in hospitalizations (P < 0.05)
Mathews^Citation12	USA, San Diego (CA) 1998 1999 N = 235 NR 86% 52% NR 52%	Cohort study to assess prevalence and predictors of early ARV adherence using multiple indicators and to estimate effects of early adherence on subsequent VL and CD4^+	Patients referred to ARV monitoring clinic for therapy initiation or change. Conducted baseline interview then 30 days of EDM, interview at 30 days, and VL monitoring	Consenting HIV+ adults, receiving care at study clinic, referred to ARV monitoring clinic for treatment initiation or change, candidates for VL suppression to <400 c/mL	Selected regimen after PCP consult and review of prior ARV history, drug interactions, contraindications, patient preferences. Provided adherence counseling. Estimated average duration of therapeutic drug levels following dosing events Role: Peripheral	EDM and self-report Adherence predictors: male, nonBlack, ARV naïve, fewer urgent appointments, no substance use, prior adherence, health beliefs, pharmacist prediction of high adherence, number of ARVs in regimen, high ARV knowledge, low ARV pessimism	Mean change in VL from baseline to 6 months inferior in EDM noncompleters (0.5 log10 change) vs completers (1.7 log10 change)	Predictors of CD4^+ response were baseline CD4^+ and prior ARV experience	EDM noncompletion was risk factor for worse VL and CD4^+ outcomes
Smith^Citation13	USA, Chapel Hill (NC) 1998 1999 N = 22 (A); 21 (B) NR (≥40 A: 32%; B: 33%) A: 77%; B: 81% NR NR A: 32%; B: 19%	RCT to examine whether a self-management intervention based on feedback of adherence and principles of social-cognitive theory improves adherence	Self-management program: based on information exchange, skills development, enlisting social support. 3 monthly follow-ups with RN or pharmacist. Usual care: Medication counseling and EDM, but no study follow-ups	≥18 years, give informed consent, starting new ARV regimen including a PI or change to a new PI-containing regimen	Educated on ARVs (ADRs, dosing, storage, interactions; gave medication grid, how to improve adherence, self-management and skills training. Gave diary to track nonadherence and events fostering it. Discussed diary notes and gave feedback by EDM outputs Role: Peripheral	EDM Adherence in A higher than B. Mean adherence by end of 12 weeks: A = 96%; B = 37%. OR of A vs B in taking ≥80% of doses per week = 7.8 (95% CI = 2.2–28.1)	At least one VL < 400 c/mL (as-treated analysis): A = 64%; B = 38%. At least one VL < 400 c/mL (ITT analysis): A = 41%; B = 24%	NR	Adherence self-efficacy: not significant for between-or within-subject effect according to treatment group
Castillo^Citation14	Canada, Vancouver 1997 2002 N = 489 (A); 98 (B); 201(C) A: 37; B: 39; C: 37** A: 86%; B: 85%; C: 70% NR NR NR	Cohort study to compare impact of differing levels of HIV-pharmacy care on adherence and time to VL suppression (time from initiating ARVs to VL < 500 x2)	–	≥18 years, treatment naïve when starting 2 NRTIs + PI or 2 NRTIs + NNRTI between August 1997–July 2000	AIDS-tertiary care hospital outpatient pharmacies (n = 2): pharmacists provided medication counseling, individualized regimens, monitored for AEs. Patients seen every 2 months Off-site pharmacies (n = 4): various levels of funding to provide HIV pharmacy care. Family physicians’ offices (n = 123): No pharmacist contact at ARV dispensing Role: Central	Refill Highest proportion with >90% adherence in A (70.4%) vs 59.2% in B and 55.7% in C; P = 0.0001). No difference between B and C (P = 0.52)	Highest likelihood of suppression at 12 months in A (75%) vs B (59%) and C (60%) (P = 0.001) Unadjusted RH of VL suppression, A vs B = 1.42 (95% CI: 1.09–1.84) Unadjusted RH of VL suppression, A vs C = 1.58 (95% CI: 1.30–1.92). Unadjusted RH of VL suppression, B vs C = 1.10 (95% CI: 0.82–1.48). RH of VL suppression, A vs B + C, adjusted for age, gender, physician experience, CD4^+, VL, IDU = 1.42 (95% CI: 1.10–1.84)	NR	–
Levy^Citation15	Australia, Melbourne 2002 2002 N = 52 42 88% 58% NR NR	Quasi RCT to determine the impact of an adherence education intervention on adherence	General education: on HIV and importance of adherence by pharmacist or RN. Individual session: pharmacist examined lifestyle and barriers; patient given medication planner, adherence devices, pharmacist pager number	≥18 years, written consent, ARVs from the clinic. Exclude: those planning to interrupt treatment, changing ARVs within next 3 months, 100% adherent, or VL undetectable	Educated on HIV and adherence; examined patient lifestyle (eg, sleep, diet, work, etc); integrated medicines into patient’s life; gave medication planner and adherence devices (eg, pill boxes, alarms), and pager number Role: Central	Self-report Missed doses in last 4 days: Pre = 1.9; Post = 1.0 (P < 0.001). 7 days: Pre = 3.0; Post = 1.8 (P < 0.001). 28 days: Pre = 7.4; Post = 4.2 (P < 0.001)	Mean VL: Pre = 21,801 c/mL; Post = 17,587 c/mL (P = 0.39)	Mean CD4^+ cell count: Pre = 382; Post = 406 (P = 0.70). Mean CD4^+%: Pre = 20; Post = 19.5 (P = 0.83)	–
Gross^Citation16	USA, Philadelphia (PA) 2001 2002 N = 110 NR (<50: 56%) 98% 35% 77% NR	Cohort study to determine if different refill mechanisms (ie, monthly pick-up at pharmacy, monthly mail order, or pharmacist-dispensed pill organizers) every 2 weeks were associated with differences in ARV refill adherence	–	Veteran’s administration patient, computerized records available, on stable ARV regimen >3 months	Biweekly pharmacist-dispensed pill organizers: If patient missed pick up, pharmacist called to encourage pick up. Monthly pharmacy pick up: Patients picked up ARVs. If unclaimed medications, pharmacist called patient. Monthly mail order: If unclaimed ARVs, pharmacist called patient. Role: Peripheral	Refill Total adherence: A = 99%; B = 80%; C = 91%. A vs B: P = 0.003 B vs C: P = 0.04 C vs A: P = 0.14 >85% adherence: A = 100%; B = 39%; C = 61% A vs B: P < 0.001 B vs C: P = 0.03 C vs A: P = 0.02	NR	NR	–
Rathbun^Citation17	USA, Oklahoma City (OK) 2001 2003 N = 16 (A); 17 (B) A: 38; B: 38 A: 75%; B: 94% A: 63%; B: 76% A: 13%; B: 29% A: 75%; B: 65%	RCT to examine the impact of a pharmacist operated adherence clinic on adherence to HAART and viral suppression	Pharmacist adherence clinic: 1–1.5 hour visit at start of ARV; phone follow-up in 1 week; 30 minute follow-up after 2 weeks to assess AEs. Additional follow-up through week 12 if needing assistance. Standard of care: education during PCP office visits	Treatment naïve or experienced initiating >3 ARVs. Excluded: once-daily regimens, 3 NRTI regimen, salvage (resistance to >2 ARVs in regimen), in clinical trial, already followed in adherence clinic	Educated about ARV, food requirements, and AE management; monitored patient progress; used visual aids and reminder devices Role: Central	EDM, self-report ITT EDM at week 28: A = 74%; B = 51% (P = 0.08). As-treated EDM at week 28: A = 82%; B = 57% (P = 0.05). Dose precision (took ARVs on schedule) at week 28: A = 53%; B = 31% (P = 0.05)	Proportion with VL < 400 at week 16: A = 100%; B = 71% (P = 0.04). week 28: A = 94%; B = 65% (NSS). Proportion with VL < 50 at week 16: A = 63%; B = 35% (NSS). week 28: A = 63%; B = 53% (NSS)	Median increase in CD4^+ (CD4^+%) from baseline: A = 142 (5%); B = 97 (4%)	–
Frick^Citation18	USA, Seattle (WA) 1997 2000 N = 152 (A); 109 (B) NR (≥40 A: 32%; B: 23%) A: 93%; B: 84% A: 56%; B: 47% A: 12%; B: 20% A: 75%; B: 57%	Historically controlled trial to compare duration on ARVs, clinical indicators, and adherence between HIV+ patients in a multidisciplinary program (A) vs historical controls (B) from 6 months before initiation of HAART protocol)	–	HAART protocol: ≥18 years, treatment naïve, starting 1st HAART with PI or NNRTI, referred to protocol, filled 1st ARV within 365 days of starting protocol. Historical control: start 1st HAART 6 months prior to study start	HAART protocol: 1-on-1 appointments with pharmacist, dietician, social worker. Pharmacist educated on AEs and self-management. Corrected drug interactions, gave medication schedule, discussed adherence, identified psychosocial barriers. Historical control: no HAART protocol Role: Peripheral	Refill If stopped HAART before 12 months Mean adherence: A = 82%; B = 85% (P = 0.46). If continued ARVs for 12 months A = 89%; B = 87% (NSS)	If stopped HAART before 12 months- Mean log10 VL change: A = −1.98; B = −1.60 (P = 0.18). VL suppressed at 12 months: A = 66.7%; B = 48.8% (P = 0.11). If continued ARVs for 12 months- Mean log10 VL change: A = −3.22; B = −2.11 (P < 0.001). VL suppressed at 12 months: A = 88.3%; B = 84.6% (P = 0.55)	If stopped HAART before 12 months- Mean CD4^+ change: A = 132; B = 157 (P = 0.38). If continued ARVs for 12 months- Mean CD4 change: A = 227; B = 196 (P = 0.26)	Time on HAART: A > 360 days; B = 210 days (P = 0.02). If continued HAART at 12 months: A = 55%; B = 43%
Visnegarwala^Citation19	USA, Houston (TX) 1999 2004 N = 11(A); 21(B); 22(C) A: 38; B: 40; C: 39.6** 0% 0% A: 91%; B: 76%; C: 86% NR	Historically controlled study to compare VL from Directly Delivered Therapy (DDT) vs Adherence Coordination Services (ACS) vs Standard of Care (SOC) during intervention (at 4–8 months) vs post intervention (at 10–14 months)	DDT: ARV delivery in bubble packs for 6 months (4/03–9/2003). ACS: Health care team with manager/nurse educator, social worker/addictions counselor, HIV+ peer caseworker, pharmacist (9/01–3/2002). SOC: Historical controls (9/99–8/2001). PCP provided education	ARV naïve women, entering care and off ARVs for >2 years, restarting treatment with ≥2 new ARVs	ACS: Pharmacist made reminder calls for pharmacy refills and clinic appointments Role: Peripheral	Self-report (DDT and ACS); pill count by empty bubble pack (DDT) A = 85%; B = 81% with 100% adherence	VL < 400 during intervention: A = 85%; B = 54%; C = 36% (OR = 1.6; P = 0.003). 2-way comparison: OR (A vs C) = 10.5 (P < 0.001). OR (A vs B) = 0.4 (P = 0.08). OR (B vs C) = 2.1 (P = 0.3). VL < 400 post intervention: A = 80%; B = 54%; C = 45% (OR = 2.7; P = 0.1). 2-way comparison: OR (A vs C) = 4.8 (P = 0.03)	CD4^+ change during intervention: A = 19; B = 262; C = 115 (P = 0.05). CD4^+ change post intervention: A = 242; B = 153; C = 122	Appointment keeping: A = 76%; B = 75%; C = 54%. Cost: A = $347 per person per month; B = $667 per person per month
March^Citation20	USA, Los Angeles (CA) 2003 2005 N = 34 47 28% NR 26% 15%	Before-after study to evaluate the impact of HIV drug optimization clinic (DOC) pharmacists’ interventions on VL and CD4^+, rate of ADR, patients’ perception of own health status	PCPs referral if ARV nonadherence, ADRs, drug interactions, drug-resistant virus. Follow-up for 12 weeks or until discharged	≥18 years, gave informed consent. Exclude: participation in other study that limited pharmacist activities at DOC	Pharmacist highly trained in HIV pharmacotherapy. Educated patient, added or discontinued medication, adjusted dosage due to renal/hepatic impairment or interaction, interpreted resistance tests, devised best-fit regimens that minimized insult to other diagnoses Role: Central	– DOC referral for poor adherence: 47%	Mean VL decrease during study period = 1.02 log10 c/mL (P < 0.004); 62% attained undetectable VL during study. 47% DOC referral for poor adherence: Mean VL decrease = 1.02 log10 c/mL (P < 0.01). 32% DOC referral for management of viral resistance: Mean VL decrease = 1.17 log10 c/ml (P < 0.004)	Mean CD4^+ increase over study period = 54 (P < 0.0002); 63% attained CD4^+ > 200. 47% DOC referral for poor adherence: Mean CD4^+ increase = 88 cells (P < 0.01). 32% DOC referral for management of viral resistance: Mean CD4^+ increase = 79 (P < 0.004)	253 interventions: 53% HIV related; 47% primary care related; 100% accepted by physician. 45% patient education; 20% addition of medication; 20% dosage adjustment; 10% medication discontinuation; 4% resistance test results. ARV toxicity score decrease = 1 (P < 0.001)
Horberg^Citation21	USA, Northern CA 1997 2004 N = 733 (A); 838 (B) A: 40.7; B: 40.3 A: 95%; B:82% A: 71%; B: 50% A: 12%; B: 26% A: 60%; B: 44%	Ecological study to assess the association of clinical pharmacists with health outcomes (CD4^+, VL, adherence) and utilization measures (number of hospital days, ED visits, office visits) among HIV+ patients	–	≥18 year, initiating HAART with no prior record of ARVs, ≥12 months of health plan membership prior to ARVs, used KP pharmacy for filling medications	Medical centers with HIV pharmacist: provided consultative visits at ARV initiation and at every regimen change. Conducted regimen counseling, adverse effects management, arranging appointments, and case management. Medical centers without HIV pharmacist: case managers or HIV provider expected to perform above duties Role: Central	Refill At 12 months: A = 81.1%; B = 74.0% (P = 0.04). At 24 months: A = 76.7%; B = 68.9% (P = 0.02)	OR of VL < 500: at 12 months = 2.06 (P = 0.06); at 24 months = 1.31 (P = 0.53). OR NSS after adjusted for variables (demographics, regimen type, number of pills/day, provider panel size, baseline CD4^+/VL, years known to be HIV+). Relative change in log10 VL in A vs B: at 12 months = −0.72 (P < 0.001); at 24 months = −0.33 (P = 0.005). Change in log10 VL statistically significant after adjusted for variables	Difference in CD4 in A vs B at HAART: initiation = 22 (P = 0.04); at 6 months = 23 (P = 0.06); at 12 months = 14 (P = 0.22); at 24 months = −2 (P = 0.90). CD4^+ difference NSS after adjusted for variables	Change in office visits RR at 24 months = 0.95 (P = 0.06). Adjusted for provider panel ≤50 = 0.81 (P < 0.001); provider panel >50 = 0.98 (P = 0.49). Change in hospital days RR = 1.29 (P = 0.003). Change in ED visits RR = 0.68 (P = 0.008).
Hirsch^Citation22	USA, 10 cities (CA) 2005 2006 N = 1353 (A); 5665 (B) A: 46; B: 46.7 A: 76.3%; B: 81% NR A: 29.4%; B: 25.2% A: 44.6%; B: 46.5%	Cohort study to examine 1st year of HIV/AIDS pharmacy MTM program by comparing patient characteristics; ARV regimens, adherence, excess fills, contraindicated regimens, OI occurrence; pharmacy and medical costs in pilot (A) vs nonpilot (B) pharmacies	Participation in pilot Medi-Cal program (pharmacies providing MTM services for HIV+ patients by participating in the special CA Department of Health Care Services program). Pharmacies had to have >90% HIV+ patients, ability to provide specialized HIV services, identify patients who should receive MTM services	HIV+, Medi-Cal beneficiary, ≥18 years, enrolled 1/2004–12/2005, at least 1 ARV and 1 medical claim with HIV diagnosis in 2004 and intervention periods (2005). Pilot pharmacy: filled ≥50% of ARVs in 2005 at pilot pharmacy. Nonpilot pharmacy: filled ARVs at any pharmacy	Counseled and evaluated adherence, consulted with providers, managed ADR, tailored regimen to fit patient’s lifestyle or needs, discussed therapy, offered adherence packaging (eg, blister packs), offered refill reminders and weekly phone calls or home visits after ARV initiation, identified peer advocates, counseled when ARV under-or over-use detected Role: Peripheral	Refill 56.3% of A patients were 80%–120% adherent vs 38.1% of B patients (P < 0.001)	NR	NR	Cost: Mean annual cost per patient was 10% higher in A vs B (P = 0.001); driven by medication use and mental health services. Regimen persistence: A = 56.8%; B = 34.2%. Contraindicated regimens identified: A = 11.6%; B = 16.6% OIs: A = 28.2%; B = 26.1%
Pirkle^Citation23	Burkina Faso, Ouagadougou and Mali, Bamako 2003 2004 N = 56 38 44.6% NR NR NR	Before-after comparison to explore whether measuring VL plus mDAART (1–2 doses/day is witnessed) can be used in resource limited settings for nonadherent individuals	1 month of mDAART with weekly visits with pharmacist or adherence counselors. Intervention done by family, friend, or health care professional chosen by patient	Treatment experienced, on ARVs for 6 months before study, VL > 500 c/mL, agree to intervention	NR Role: Peripheral	Self-report NR	VL decreased by at least 1 log10 in 1/3 of mDAART group but no decrease noted in remaining 2/3 (baseline log10 VL = 4.18 log10 c/mL)	NR	54% of mDAART group had major drug resistance before study entry
Krummenacher^Citation24	Switzerland, Lausanne and Basel 2006 2008 N = 21 (A); 11 (B) A: 36; B: 38** A: 48%; B: 45% A: 24%; B: 0% A: 43%; B: 36% A: 57%; B: 64%	Nonrandomized controlled pilot study to evaluate the feasibility of an interdisciplinary program for enhancing adherence to first and second line ARVs	Intervention: Pharmacy visit at 0, 4, 8, 12, 24 weeks. Phone call at week 18 if needed more support. EDM given. Counseling: cognitive intervention; motivational intervention; behavioral intervention. Adherence report given to physician. Control: Enhanced usual care (EDM minus MI)	≥18 years, spoke French or German, outpatients started 1st or 2nd line ARV regimen within last 4 weeks or inpatients started 1st or 2nd line ARV regimen in hospital and were at point of discharge from hospital	Educated on nonadherence management and MI. Pharmacist technicians trained on how to handle EDMs Role: Central	EDM Persistence (% of patients with treatment interruption): A = 97%; B = 81% (P = 0.03). Execution (% of days with correct ARV dosing): A = 97%; B = 95% (P = 0.04). Adherence (persistence + execution): A = 93%; B = 87% Adherence decreased faster in controls	NR	NR	Study successfully conducted in Lausanne but Basel recruitment was stopped due to unsuccessful recruitment
Ma^Citation25	USA, Vallejo (CA) 2006 2009 N = 75 49.3 78.7% NR 25.3% 60%	Before-after comparison to investigate the changes in HIV clinical outcomes, ARV regimen complexity, and ARV adherence, 6 months before and after the clinical care activities of an HIV clinical pharmacist	–	HIV+, received pharmacist-recommended ARV modification. Exclude: not using KP pharmacies for refills, newly starting ARVs during study period	Reviewed ARV history, resistance tests, medication intolerance, comorbidities, drug interactions, laboratory abnormalities, etc, for ARV modification to treat HIV while simplifying regimens to improve adherence. Counseled on adherence and monitored progress Role: Central	Refill Pre = 81%; Post = 89% (P = 0.003)	% undetectable: Pre = 63%; Post = 96% (P < 0.0001)	Absolute CD4^+: Pre = 462; At = 423; Post = 491 (P-value comparing At vs Post < 0.001). CD4^+%: Pre = 23%; Post = 25%; (P = 0.007).	Mean pill burden (pills/day): Pre = 7.2 ± 3.9; Post = 5.4 ± 2.8 (P < 0.001). Dosing frequency (times/day): Pre = 2.0 ± 0.5; Post = 1.5 ± 0.5 (P < 0.001)
Hirsch^Citation26	USA, 10 cities (CA) 2005 2008 N = 628 (A); 1606 (B) A: 47; B: 47.4 A: 66.7%; B: 71% NR A: 34.6%; B: 30.6% A: 35.7%; B: 44.8%	Cohort study to examine HIV pharmacy MTM program over 3 years by assessing the association between use of pilot pharmacies and ARV adherence, medication utilization, occurrence of OIs, medical and pharmacy costs	Participation in pilot Medi-Cal program (pharmacies providing MTM services for HIV+ patients by participating in the special CA Department of Health Care Services Medi-Cal pilot program). Pharmacies had to have >90% HIV+ patients, ability to provide specialized HIV services, identify patients who should receive MTM services	HIV+, Medi-Cal beneficiary, ≥18 years, enrolled from 1/1/2004–12/31/2007, at least 1 ARV and 1 medical claim with HIV diagnosis in 2004 and 1/1/2005–12/31/2007. Pilot pharmacy: filled ≥50% of ARVs in 2005 at pilot pharmacy. Nonpilot pharmacy: filled ARVs at any pharmacy	Counseled on adherence, consulted with other providers, managed ADR, tailored regimen to fit patient’s lifestyle or needs, offered adherence packaging (eg, blister packs), offered refill reminders and weekly phone calls or home visits after ARV initiation, identified peer advocates, counseled when ARV under- or over-use detected. Had advanced training in HIV medical care Role: Peripheral	Refill Adherence by end of 2007: A = 69.4%; B = 47.3% (P < 0.001). Factor associated with adherence: use of pilot pharmacy (OR = 2.74; 95% CI = 2.44–3.1; P < 0.001) after controlling for age, gender, race/ethnicity	NR	NR	Cost per patient in 2007: A = $38,983; B = $38,856 (P = 0.92). Per year nonARV cost about 30%–40% higher in A vs B. Cost for inpatient services lower in A vs B. Regimen Persistence: A = 71.7%; B = 49.1%. Contraindicated regimens identified: A = 8.9%; B = 12.2%. OIs: 35% per year in A and B
Krummenacher^Citation27	Switzerland, Lausanne 2004 2009 N = 104 39** 41% NR 42% 52%	Before-after comparison to examine patients in adherence program; reasons for enrolling; adherence rate; clinical outcomes; pharmacy visits; reasons for ARV adjustments; reasons for program interruption	–	Referred to program between 8/2004–4/2008, ARVs delivered in EDMs, completed at least 2 pharmacist MIs	Trained in MI. Conducts MI based on IMB model, provided EDM, prepared adherence report (visit summary and EDM report) sent to physician Role: Central	EDM Persistence (% with treatment interruption) = 87%. Execution (% of days with correct ARV dosing) = 88%. Adherence (persistence + execution) = 83%. Execution and adherence decreased over time	Undetectability increased significantly at end of study vs baseline. No statistically significant difference in median viral load (c/mL) between end of study and baseline	No statistically significant difference in median CD4^+ between end of study and baseline in those on ARVs throughout study	1388 pharmacy visits over study period; 35 minutes per visit
Henderson^Citation28	USA, Denver (CO) 2009 2010 N = 28 44** 79% 50% 25% 71%	Before-after comparison to assess impact of adherence activities in a pharmacist-managed clinic by measuring proportion of those with ≥95% adherence before and after referral to the program	–	18–75 years, on ARVs > 3 months, got medications from clinic pharmacy	Had 5 visits patient- tailored over 6 months (at referral, 2 weeks, 1 month, then every 2 months × 2).	Refill, self-report, therapeutic drug monitoring >95% adherence: 7% (pre) to 32% (post; P = 0.01).	15% increase in proportion of patients with undetectable VL (P = 0.10)	NR	–
					Discussed nonadherence reasons and strategies to improve it (eg, pill box, AE management, education, telephone refill reminders) Role: Central	Proportion days covered: 60% (pre) to 81% (post; P < 0.0001)

Notes:

* Estimated based on end of recruitment year plus maximum length of follow-up;

** Median age.

Abbreviations: ADR, adverse drug reaction; AE, adverse effect; ARV, antiretroviral; BL, Black; CA, California; CI, confidence interval; c/mL, copies/mL; CO, Colorado; ED, emergency department; EDM, electronic drug monitor; HAART, highly active antiretroviral therapy; IDU, intravenous drug use; IMB, information, motivation, behavioral skills; ITT, intention to treat; KP, Kaiser Permanente; mDAART, modified directly administered antiretroviral treatment; MI, motivational interview; MSM, men who have sex with men; MTM, medication therapy management; NC, North Carolina; NNRTI, nonnucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; NR, not reported; NSS, not statistically significant; OI, opportunistic infection; OK, Oklahoma; OR, odds ratio; PA, Pennsylvania; PCP, primary care provider; PI, protease inhibitor; PK, pharmacokinetic; RCT, randomized controlled trial; RH, relative hazard; RN, registered nurse; RR, rate ratio; TX, Texas; VL, viral load; VS, versus; WA, Washington; WH, White.

Table 3 Summary of studies with secondary outcomes

Source	Country, City (State) Study start year Estimated study end* Sample size Mean age (years) % Male/MSM/BL/WH	Study design and objectives If examined intervention, description of intervention	Inclusion/exclusion criteria	Description of pharmacist’s role Pharmacist’s role Central or peripheral to study	Outcomes
					Number of clinical care activities of interventions conducted % Accepted by physician/team	Majority of clinical care activities or interventions related to:	Other outcomes
Walji^Citation29	Canada, Vancouver 1989 1989 N = 285 NR NR/NR/NR/NR	Descriptive study to characterize the type, frequency, and acceptance by physician or patient of pharmacist-initiated clinical care activities regarding AZT in nonhospitalized patients with AIDS Intervention: none	NR	Interviewed patients; explained information about clinical trial, AZT, adverse effects and management; examined signs and symptoms of efficacy and toxicity using data from patient and chart; intervened if suboptimal utilization or adverse effects Role: Central	75 clinical care activities Accepted: 97%	NR	–
Geletko^Citation30	USA, Providence (RI) 1993 1994 N = 12 (HIV+); 19 (HIV−) HIV+: 42; HIV−: 64.7 100%/NR/NR/NR	Descriptive study to evaluate differences in pharmaceutical care between hospitalized HIV+ patients and ID consult HIV− patients Intervention: none	NR	Monitored HIV+ and hospitalized ID consult patients. Clinical care activities included decrease/increase dose, initiate/change/discontinue drug, prevent ADR/allergy/interaction, pharmacokinetics, provide drug information Role: Central	218 clinical care activities HIV+: 64% (97% significant to extremely significant); HIV−: 36% (55% significant to extremely significant) (NSS) Accepted: HIV+: 85%; HIV−: 86%.	Activities performed: (for HIV+/HIV− patients) Decrease dose: 8.6%/7.6% Increase dose: 10.1%/3.8% Discontinue drug: 26.6%/24.1% Initiate treatment: 10.8%/6.3% Prevent interactions: 4.3%/1.3% Prevent ADR/allergy: 7.9%/5.1% Provide drug info: 20.9%/16.5%	Cost avoidance = $1888.35 (mean cost-avoidance per clinical care activity = $49.69). Difference between groups with regard to expected outcome for cost-avoidance, prevention of ADR/errors, enhance treatment efficacy, knowledge gained were statistically significant
Bozek^Citation31	USA, Baltimore (MD) 1995 1996 N = 32 (HIV+); 32 (HIV−) HIV+: 36; HIV−: 50 HIV+: 63%; HIV−: 44% HIV+: 6%; HIV−: NR HIV+: 91%; HIV−: 72% HIV+: 9%; HIV−: 28%	Descriptive study to assess differences in the rate and cost of pharmacotherapeutic clinical care activities performed for HIV+ and HIV− inpatients and to compare medication use between HIV+ and HIV− patients Intervention: none	NR	Performed medical rounds, chart review, therapeutic drug monitoring. Intervened to change therapy for untreated indication, drug use without indication, subtherapeutic dose, overdose, ADR, interaction, inappropriate route Role: Central	HIV+: 4.6 clinical care activities per patient (95% CI: 3.2–6.1); HIV−: 1.9 per patient (95% CI: 1.2–2.6) (P < 0.05) Accepted: NR	DRP identified: 15%: drug without indication 13%: overdose 13%: ADRs 12%: improper drug 11%: subtherapeutic dosage 10%: monitoring 10%: incorrect drug route 7%: untreated indications 6%: not receive drug	Drug acquisition cost: decreased by 14% for HIV+ and increased by <1% for HIV−. Hospital length of stay: HIV+: 11.5 days; HIV−: 7.3 days (NSS)
Garey^Citation32	USA, Chicago (IL) 1998 1998 N = 60 NR NR/NR/NR/NR	Descriptive study to portray and characterize the pharmacist’s clinical care activities in an HIV clinic. Estimate the percentage of clinical care activities accepted by physician Intervention: none	NR	Compared inpatient orders to outpatient regimen; evaluated accuracy and appropriateness of orders; examined for dosing errors and interactions; contacted physician to clarify medication issued; intervened with house staff Role: Central	68 clinical care activities conducted (at least 1 intervention for 70% of patients): 94% rated clinically significant Accepted: 93%	DRP identified: 27%: interaction 20%: sub-therapeutic dosage 17%: drug omission 17%: wrong drug 14%: other problems (duplication, incorrect regimen, addition of PCP prophylaxis) 5%: overdosage	–
Geletko^Citation33	USA, Providence (RI) 1996 2000 N = 70 NR 100%/NR/27%/53%	Descriptive study to characterize pharmaceutical-related clinical care activities in a pharmacist-directed HIV clinic Intervention: none	NR	Evaluated adherence, made recommendations on ARV initiation, entered prescription, dispensed medications, called patient 1 week after initiation to assess adherence and tolerance Role: Central	1365 clinical care activities documented (mean of 1.7 per patient): 89% clinically significant 62% enhanced treatment efficacy Accepted: NR	Activities performed: 39%: medication counseling 17%: monitoring 7%: new drug therapy 6%: drug info to providers 5%: change dosage 5%: patient referral	–
Segarra-Newnham^Citation34	USA, West Palm Beach (FL) NR NR N = 51 49 NR/NR/NR/NR	Descriptive study to describe the utility of a clinical pharmacist’s evaluation of HIV+ patients upon hospital admission Intervention: none	HIV+, admitted for at least 24 hours	Monitored HIV+ inpatients; wrote Pharmacy Admission Note within 24 hours of admission; evaluated and communicated correct regimen; educated patients medications; made pharmacotherapy clinic appointment Role: Central	Total of 317 clinical care activities (median 4.2 per patient); 55% of recommendations avoided medication errors via reconciliation Accepted: 88%	Activities performed: 29%: drug information 20%: discontinue medications 16%: decrease dose 13%: restart medications 8%: pharmacokinetics 6%: increase dose 5%: nonformulary	–
De Maat^Citation35	Netherlands, Amsterdam NR NR N = 138 (A); 130 (B) 42.6** 87.7%/NR/NR/NR	Controlled before-after comparison to evaluate the usefulness of drug-interaction interventions by clinical pharmacist. Intervention: Arm A: medication list provided to physician. Arm B: medication list + pharmacist’s drug interaction notification + how to handle it	Scheduled outpatient visit, signed informed consent	Obtained pharmacy records and screened list of drugs for drug interactions and sent notification to physician along with advice on how to handle it Role: Central	Arm A: 36 interventions Arm B: 33 interventions Accepted: NR	Most common interactions involved: 58.5%: NVP 20.7%: BZD 14.6%: methadone 11%: SSRIs 8.5%: RTV 7.3%: d4T	There was a decrease in number of interactions between baseline and 3 months but effect similar between 2 arms
Foisy^Citation36	Canada, Edmonton 2002 2003 N = 57 NR 66.6%/NR/NR/21%	Descriptive study to portray implementation of DOT to inner-city patients and the identification and management of DRPs and outcomes during 14 months of a pharmacist position Intervention: none	NR	Obtained baseline data (medication history, illicit drug use, lab data); selected ARVs with physician; provided medication counseling and weekly patient follow-up; communicated patient progress and adherence to physician Role: Central	149 DRP identified (mean 2.6 DRP per patient) Accepted: >95%	DRP identified: 38%: adverse effects 21%: interactions 16%: initiate new medication for comorbidities 13%: adherence issues 7%: medication not indicated 5%: dose adjustment	–
Sterling^Citation37	USA, Lexington (KY) 2001 2003 N = 20 (pre); 51 (post) Pre: 40; post: 38 Pre: 90%; post: 76.4% NR/NR/NR	Historically controlled trial to examine change in number of ARV errors 1 year prior to (March 2001–March 2002) and 1 year after (April 2002–March 2003) the implementation of pharmacy admission notes Intervention: none	≥18 years, HIV diagnosis and ARV orders on admission. Exclude: HIV diagnosis during admission, length of stay <1 day, pregnant	Within 24 hours of admission, interviewed patient; conducted chart review; documented patient’s demographics, recent VL/CD4^+, diagnosis, home and inpatient medications. Evaluated patient’s medications for drug interaction, verify doses and frequencies, assess prior ARV adherence, and determine need for dose adjustments Role: Central	Pre: 1 of 27 ARV errors identified and addressed by pharmacy note. Post: 3 of 46 ARV errors detected and addressed in pharmacy admission notes. No improvement in detection of medication errors with pharmacy admission note Accepted: NR	NR	–
Heelon^Citation38	USA, Springfield (MA) 2005 2006 N = 99 (pre); 100 (post) Pre: 45; post: 45** Pre: 51%; Post: 48% NR Pre: 29%; post: 27% Pre: 18%; post: 22%	Historically controlled trial to compare duration of ARV-related error in hospitalized patients prior to (pre: 1/2005–6/2005) and after (post: 8/2005–2/2006) presence of pharmacist’s activities Intervention: none	≥18 years, admitted to hospital, on HAART Exclude: patients in pharmacist’s outpatient clinic	Intervene on ARV errors by discussing with staff or MD. Retrospectively identified ARV errors, including: incomplete regimen, incorrect dose, incorrect schedule, drug interaction, incorrect formulation, incorrect ARV, duplicate therapy Role: Central	73 ARV errors in 41 patients (17% pre versus 24% post) No significant difference in frequency or type of error pre versus post Accepted: NR	DRP identified: 45%: incomplete regimen 30%: incorrect dose 8%: incorrect schedule 7%: incorrect formulation 3%: incorrect ARV	Length of time until error corrected significantly shorter post pharmacist (84 hours pre versus 15.5 hours post; P < 0.0001). Mean (SD) number of prescribed ARVs was 3.5 (0.8) pre versus 3.7 (0.7) in the post phases
Pastakia^Citation39	US, Chapel Hill (NC) 2006 2006 N = 68 45** 71%/NR/78%/18%	Descriptive study to evaluate frequency and severity of ARV prescribing errors in inpatients, hospitalization and discharge errors, physician acceptance of pharmacy recommendations, risk factors associated with occurrence of errors Intervention: none	HIV+, ≥18 years, received care at ID/HIV clinic of hospital, continued ARVs upon admission	Reviewed ARVs of HIV+ inpatients, identified ARV errors, resolved errors by making recommendations to clinical team. Errors classified as: Class 1: unlikely to cause patient discomfort or clinical deterioration; Class 2: had the potential to cause moderate discomfort or clinical deterioration; Class 3: had the potential to cause severe discomfort or clinical deterioration Role: Peripheral	Initial regimen: 72% of patients had at least 1 error; 56% had at least 1 class 2/3; inpatient physician errors made up 45% of errors (all class 2/3); inpatient pharmacy errors made up 33% of errors (37% class 2/3). Initial regimen and hospitalization: 119 errors observed (82% class 2/3); 84% of patients had at least 1 error; 65% had at least 1 class 2/3 Accepted: 100%	NR	No factor (patient, provider, drug regimen characteristics) was predictor of initial inpatient ARV errors. Use of ATV was a predictor of errors during hospitalization/discharge. Risk factor predisposing patients to having >1 class 2 or 3 error was regimens requiring conversion from outpatient to hospital formulary
Horace^Citation40	USA, Augusta (GA) 2007 2009 N = 50 (descriptive); 34 (pilot) NR NR/NR/NR/NR	Descriptive study to retrospectively identify common medication-related problems for HIV+ patients and a historically controlled trial to evaluate the effect of a pharmacy monitoring services pilot program Intervention: none	NR	Followed HIV+ patients; contacted patient or family or pharmacy to obtain correct information; communicated medication errors with medicine team; intervened on medication related problems Role: Central	42 clinical care activities Accepted: 95%	Activities performed: 35%: complete home medication list; 18%: resolve drug–drug interactions; 18%: reconciled inpatient medications to home medication list	Home medication documentation improved by 24%; matching inpatient to home medications by 26%. 9% of patients had medications discontinued for >24 hours (100% had appropriate reason) versus 42% prior to pharmacist (67% had no appropriate reasons). Appropriate ARV dosing and scheduling increased by 21%
Carcelero^Citation41	Spain, Barcelona 2007 2008 N = 189 45 71%/26%/NR/NR	Descriptive study to identify and describe ARV-related errors in medication prescribing and determine degree of acceptance of pharmacist’s patient-care activities Intervention: none	HIV+, ≥18years, admitted to Hospital Clinic, prescribed ARVs	Checked for drug–drug interactions, incorrect or incomplete ARV regimens, omitted doses, incorrect doses, lack of dose reduction for renal/hepatic impairment, and incorrect schedule Role: Central	247 admissions reviewed, 60 drug-related problems identified in 41 patients (21.7%) Accepted: 92%	DRP identified: 33%: drug interaction 17%: incorrect dose 15%: dose omission 10%: omission of ARV 8.3%: prescription of alternative ARV 5%: incorrect schedule	Factors associated with increased risk of ARV problems: renal impairment, use of ATV, admission to unit other than ID unit. Majority of errors occurred at admission

Notes:

* Estimated based on end of recruitment year plus maximum length of follow-up;

** median age.

Abbreviations: ADR, adverse drug reaction; ARV, antiretroviral; ATV, atazanavir; AZT, zidovudine; BL, Black; BZD, benzodiazepine; CI, confidence interval; Cost avoidance, (acquisition cost of drug regimen at time of evaluation – acquisition cost of recommended drug regimen) × duration of treatment while patient in hospital; d4T, stavudine; DOT, directly observed therapy; DRP, drug-related problem; GA, Georgia; HAART, highly active antiretroviral therapy; ID, infectious diseases; IL, Illinois; KY, Kentucky; MA, Massachusetts; MD, Maryland; MSM, men who have sex with men; NC, North Carolina; NR, not reported; NSS, not statistically significant; NVP, nevirapine; PCP, pneumocystis carinii pneumonia; RI, Rhode Island; RR, relative risk; RTV, ritonavir; SD, standard deviation; SSRI, selective serotonin reuptake inhibitor; VL, viral load; WH, White.

OstropNJGillMJAntiretroviral medication adherence and persistence with respect to adherence tool usageAIDS Patient Care STDs200014735135810935052

 PubMed Web of Science ®Google Scholar

McPherson-BakerSMalowRMPenedoFJonesDLSchneidermanNKlimasNGEnhancing adherence to combination antiretroviral therapy in non-adherent HIV-positive menAIDS Care200012439940411091772

 PubMed Web of Science ®Google Scholar

MathewsWCMar-TangMBallardCPrevalence, predictors, and outcomes of early adherence after starting or changing antiretroviral therapyAIDS Patient Care STDs200216415717212015870

 PubMed Web of Science ®Google Scholar

SmithSRRubleinJCMarcusCBrockTPChesneyMAA medication self-management program to improve adherence to HIV therapy regimensPatient Educ Couns200350218719912781934

 PubMed Web of Science ®Google Scholar

CastilloEPalepuABeardsellAOutpatient pharmacy care and HIV viral load response among patients on HAARTAIDS Care200416444645715203413

 PubMed Web of Science ®Google Scholar

LevyRWRaynerCRFairleyCKfor Melbourne Adherence GroupMultidisciplinary HIV adherence intervention: a randomized studyAIDS Patient Care STDs2004181272873515659884

 PubMed Web of Science ®Google Scholar

GrossRZhangYGrossbergRMedication refill logistics and refill adherence in HIVPharmaco epidemiol Drug Saf20051411789793

 Web of Science ®Google Scholar

RathbunRCFarmerKCStephensJRLockhartSMImpact of an adherence clinic on behavioral outcomes and virologic response in treatment of HIV infection: a prospective, randomized, controlled pilot studyClin Ther200527219920915811483

 PubMed Web of Science ®Google Scholar

FrickPTapiaKGrantPNovotnyMKerzeeJThe effect of a multidisciplinary program on HAART adherenceAIDS Patient Care STDs200620751152416839250

 PubMed Web of Science ®Google Scholar

VisnegarwalaFRodriguez-BarradassMCGravissEACaprioMNykyforchynMLaufmanLCommunity outreach with weekly delivery of anti-retroviral drugs compared to cognitive-behavioural health care team-based approach to improve adherence among indigent women newly starting HAARTAIDS Care200618433233816809110

 PubMed Web of Science ®Google Scholar

MarchKMakMLouieSGEffects of pharmacists’ interventions on patient outcomes in an HIV primary care clinicAm J Health Syst Pharm200764242574257818056946

 PubMed Web of Science ®Google Scholar

HorbergMAHurleyLBSilverbergMJKinsmanCJQuesenberryCPEffect of clinical pharmacists on utilization of and clinical response to antiretroviral therapyJ Acquir Immune Defic Syndr200744553153917224844

 PubMed Web of Science ®Google Scholar

HirschJDRosenquistABestBMMillerTAGilmerTPEvaluation of the first year of a pilot program in community pharmacy: HIV/AIDS medication therapy management for Medi-Cal beneficiariesJ Manag Care Pharm2009151324119125548

 PubMed Web of Science ®Google Scholar

PirkleCMBoileauCNguyenVKImpact of a modified directly administered antiretroviral treatment intervention on virological outcome in HIV-infected patients treated in Burkina Faso and MaliHIV Med200910315215619245536

 PubMed Web of Science ®Google Scholar

KrummenacherICavassiniMBugnonOSpirigRSchneiderMPfor Swiss HIV Cohort StudyAntiretroviral adherence program in HIV patients: a feasibility study in the Swiss HIV Cohort StudyPharm World Sci2010326776786 Epub September 23, 201020862544

 PubMedGoogle Scholar

MaAChenDMChauFMSaberiPImproving adherence and clinical outcomes through an HIV pharmacist’s interventionsAIDS Care201022101189119420640958

 PubMed Web of Science ®Google Scholar

HirschJDGonzalesMRosenquistAMillerTAGilmerTPBestBMAntiretroviral therapy adherence, medication use, and health care costs during 3 years of a community pharmacy medication therapy management program for Medi-Cal beneficiaries with HIV/AIDSJournal Manag Care Pharm2011173213223

 Web of Science ®Google Scholar

KrummenacherICavassiniMBugnonOSchneiderMPAn interdisciplinary HIV-adherence program combining motivational interviewing and electronic antiretroviral drug monitoringAIDS Care201123555056121271406

 PubMed Web of Science ®Google Scholar

HendersonKCHindmanJJohnsonSCValuckRJKiserJJAssessing the effectiveness of pharmacy-based adherence interventions on antiretroviral adherence in persons with HIVAIDS Patient Care STDs2011254221228 Epub Feburary 16, 201121323566

 PubMed Web of Science ®Google Scholar

WaljiNBeardsellABrownGPharmacists’ activities in monitoring zidovudine therapy in an AIDS clinicCan J Hosp Pharm1992451293210117360

 PubMedGoogle Scholar

GeletkoSMSegarraMCopelandDATeagueACPharmaceutical care for hospitalized HIV-infected patients compared to infectious diseases consult patients without HIV infectionBMJ Pharmacotherapy1996214557

 Google Scholar

BozekPSPerdueBEBar-DinMWeidlePJEffect of pharmacist interventions on medication use and cost in hospitalized patients with or without HIV infectionAm J Health Syst Pharm19985511115111559626378

 PubMed Web of Science ®Google Scholar

GareyKWTeichnerPPharmacist intervention program for hospitalized patients with HIV infectionAm J Health Syst Pharm200057242283228411146973

 PubMed Web of Science ®Google Scholar

GeletkoSMPoulakosMNPharmaceutical services in an HIV clinicAm J Health Syst Pharm200259870971311977854

 PubMed Web of Science ®Google Scholar

Segarra-NewnhamMPreventing medication errors with a pharmacy admission note for HIV-positive patientsHosp Pharm20023713437

 Google Scholar

De MaatMMRDe BoerAKoksCHWEvaluation of clinical pharmacist interventions on drug interactions in outpatient pharmaceutical HIV-careJ Clin Pharm Ther200429212113015068400

 PubMed Web of Science ®Google Scholar

FoisyMMAkaiPSPharmaceutical care for HIV patients on directly observed therapyAnn Pharmacother2004384550556 Epub Feburary 27, 200414990778

 PubMed Web of Science ®Google Scholar

SterlingESRomanelliFMartinCAHovenADSmithKMImpact of a pharmacy-initiated HIV admission note on medication errors within an academic hospitalHosp Pharm20054010874881

 Google Scholar

HeelonMSkiestDTeresoGEffect of a clinical pharmacist’s interventions on duration of antiretroviral-related errors in hospitalized patientsAm J Health Syst Pharm200764192064206817893418

 PubMed Web of Science ®Google Scholar

PastakiaSDCorbettAHRaaschRHNapravnikSCorrellTAFrequency of HIV-related medication errors and associated risk factors in hospitalized patientsAnn Pharmacother200842449149718349307

 PubMed Web of Science ®Google Scholar

HoraceAPhilipsMIdentification and prevention of antiretroviral medication errors at an academic medical centerHosp Pharm20104512927933

 Google Scholar

CarceleroETusetMMartinMinterventions by the clinical pharmacist in hospitalized HIV-infected patientsHIV Med201112849449910.1111/j.1468–1293.2011.00915.x Epub March 13, 201121395966

 PubMed Web of Science ®Google Scholar