HIV Specialist - June 2021 - Cover3

FEATURED LITERATURE:
FEATURED LITERATURE:
Crawford ND, Myers S, Young H, Klepser D, Tung E. The Role of Pharmacies
in the HIV Prevention and Care Continuums: A Systematic Review. AIDS
Behavior. 2021 June; 25(6): 1819-1828. doi: 10.1007/s10461-020-03111-w. Epub
2021 Jan 2. PMID: 33386509.
Pharmacies are innovative access points to expand HIV care and
services. However, the scientific evidence describing and evaluating
pharmacy-based interventions is limited. This systematic review aimed
to synthesize and assess the recent literature on pharmacist roles across
the HIV prevention and care continuums and identify key research gaps/
priorities. Investigators searched studies published between January 2004
and August 2019 involving non-hospital-based U.S. pharmacy settings/
programs. Thirty-two studies underwent complete review and were organized
around the following themes: (a) HIV testing; (b) syringe access and
harm reduction; (c) post-exposure prophylaxis; (d) pre-exposure prophylaxis;
and (e) antiretroviral therapy. Findings suggest pharmacy-based HIV
testing is feasible and effective at reaching some populations believed to be
at " highest risk " (e.g., people with no prior testing history and people who
report high HIV stigma). A small number of studies have examined pharmacists'
attitudes towards selling non-prescription syringes: the majority
believe pharmacies to be important resources for people who use/inject
drugs. In one study, 59 percent indicated willingness to provide health
information and referrals.
The literature on pharmacy involvement with post-exposure and
pre-exposure prophylaxis (PrEP) is modest. Recent studies have highlighted
the benefit and feasibility of PrEP screening and same-day dispensing
although important questions (including reimbursement-related concerns)
remain. Few studies have utilized pharmacies to promote and/or
support ART adherence among people with HIV. Data suggest people who
obtain ART from HIV specialized pharmacies are more likely to obtain
refills; also, when pharmacists provide more HIV counseling, adherence
and viral load improvements are observed.
AUTHOR'S COMMENTARY
Pharmacy-based HIV testing appears to be highly feasible and acceptable
to both staff and clients, especially in settings offering other routine
prevention services (e.g. vaccinations, hypertension screenings). In comparison,
pharmacy-based syringe access services, pre- and post-exposure
prophylaxis, and ART/HIV treatment support are interventions that, while
highly promising, are less well-studied. In many U.S. areas, and through
legislative support, pharmacies have become uniquely positioned as vital
community resources that can offer prevention services for people who inject
drugs. Rigorous study design and inclusion of implementation science
frameworks are critical elements for building a sufficient evidence base to
help further raise the visibility of pharmacies in ending the HIV epidemic
and promote broader adoption and scale-up.
Massad LS, Xie X, Minkoff HL, et al. Frequency of high grade
squamous cervical lesions among women over age 65 years
living with the human immunodeficiency virus. Am J Obstet
Gynecol. 2021 May 3; S0002-9378(21)00535-4. doi: 10.1016/j.
ajog.2021.04.253. PMID: 33957115.
Current guidelines for cervical cancer screening cessation
differ by HIV status: specifically, screening in women with
HIV is recommended throughout a woman's lifetime (i.e., not
end at 65 years of age as recommended for the general population).
This analysis, utilizing data from the WIHS cohort,
attempted to determine the proportion of women reaching
age 65 years who would be eligible to end screening and the
incidence of subsequent high grade squamous intraepithelial
lesions (HSIL) among such women. Pap testing data through
September 2019 for 169 eligible participants (121 women
with HIV, 48 seronegative women) were analyzed. 2.2
percent had high grade cytologic abnormalities; no cancers
were diagnosed during follow-up. Twenty women had prior
precancer and 74 had abnormal Pap results within the prior
decade. Fourty-eight women (27 women with HIV, 21 without
HIV) met current guidelines to stop screening; their risk
of HSIL was 2.2/100 woman-years overall and did not vary by
HIV status (2.3 versus 1.8/100 woman-years, p=0.81).
AUTHOR'S COMMENTARY
Optimal cancer screening for people aging with HIV remains
an important topic of HIV medicine, and this analysis provides
data that might help guide information-sharing and
shared decision making for women with HIV who are 65+
years of age and their providers. Investigators found that
most women with HIV who reach age 65 do not meet criteria
for exiting screening. However, for those who do meet criteria,
HSIL risk is similar to the risk observed among seronegative
women. Thus, authors suggest " women living with HIV
should be offered the option of screening cessation as part of
an informed discussion of the risks and potential benefits of
screening, recognizing that the 2 percent annual HSIL risk ...
may persuade many in good health to continue screening. " It
is also worth noting that many patients have limited documentation
of prior screening/testing results (which might be
avoidable at times), often leading to challenges in confident
decision making regarding ongoing screening. HIV

HIV Specialist - June 2021

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