Background

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.

Objective

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.

Methods

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).

Results

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/mm³ [95% CI 44.08, 89.57]). The strength of evidence ranged from moderate, low to very low.

Conclusion

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.

中文翻译：

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药剂师护理对 HIV/AIDS 患者临床结局的影响：系统评价和荟萃分析

背景

药剂师在人类免疫缺陷病毒 (HIV)/获得性免疫缺陷综合征 (AIDS) (PLWHA) 患者的多学科护理中发挥着重要作用。然而，阐明药剂师作为个体团队成员对 HIV 护理的影响的证据较少。

客观的

本研究旨在确定药剂师干预对提高抗逆转录病毒治疗 (ART) 依从性、病毒载量 (VL) 抑制和 PLWHA 中 CD4-T 淋巴细胞变化的影响。

方法

我们从六个数据库（Pubmed、EMBASE、ProQuest、Scopus、Cochrane 和 EBSCOhost）中确定了从开始到 2020 年 6 月的相关记录。我们纳入了评估药剂师护理活动对 PLWHA 临床结果影响的研究。使用随机效应模型以 95% 置信区间 (CI) 估计总体效应 [二分法的优势比 (OR) 和连续数据的平均差 (MD)]。推荐分级评估、制定和评价 (GRADE) 系统用于评价证据的质量。

审查方案发表在 PROSPERO (CRD42020167994) 上。

结果

涉及 3206 名 PLWHA 的 25 项研究包括药剂师以教育形式提供干预，有或没有药物护理，单独或作为跨学科团队成员。8 项研究是随机对照试验 (RCT)，而 17 项研究是非 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果 (OR: 2.70 [95%, CI 1.80, 4.05])、VL 抑制 (OR: 4.13 [95% CI 2.27, 7.50]) 和CD4-T 淋巴细胞计数升高（MD：66.83 个细胞/mm ³ [95% CI 44.08, 89.57]）。证据强度从中等、低到非常低不等。

结论

研究结果表明，药剂师护理可改善 PLWHA 患者的依从性、VL 抑制和 CD4-T 淋巴细胞改善；然而，应该指出的是，大多数研究存在很高的偏倚风险。需要更多设计更严格的研究来重申药剂师干预对 PLWHA 临床和经济结果的影响。