Pharmacists and HIVAIDS

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Pharmacists and HIV/AIDS
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PROJECT OVERVIEW

• An assessment of Knowledge, Attitudes, Beliefs
  and Practices among Pharmacists in four Caribbean
  Countries

Prepared by Maxine Ruddock-Small MBA.BSc
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TRIGGERS

• UWI HARPs training experience with Dentists on
  HIV/AIDS education
• Small study conducted by UWI HARP summer
  programme intern with Pharmacists in Jamaica
• Anecdotal reports from the PLWHA community
  regionally
• Plan for Scale up of ARV usage and access in the
  Caribbean

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SOME INITIAL QUESTIONS

• What is the experience of the Person Living with
  HIV who interacts with a pharmacist as one of the
  main health care workers with whom he/she
  interacts?"
• What is the level of general knowledge of HIV
  facts among Pharmacists?
• What beliefs and attitudes do Pharmacists have as
  it relates to an HIV person?

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RESEARCH QUESTION

• What is the current picture on knowledge,
  attitudes, beliefs and practices among
  Pharmacists, in order to develop evidence-based
  training programmes to support improved access
  and improved care provided by Pharmacists to
  PLWHA
• ?

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LITERATURE REVIEW

• Quantitative Study completed by Research Student
  in Jamaica
• Web-based Survey conducted by Caribbean
  Association of Pharmacists
• VERY LITTLE PUBLISHED RESEARCH DONE WITH THIS
  FOCUS

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A STUDY OF FOUR CARIBBEAN COUNTRIES

• These four countries could represent models of
  four Caribbean profiles, from small to large,
  with different degrees of development of their
  health structures.

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Countries involved

• Four Caribbean states with different types of
  access to HIV services
• St Lucia (pop. 149,000 2003 Est.)
• Localized access to HIV services
• Barbados (pop. 280,946 July 2007 Est.)
• Centralized access
• Bahamas (pop. 300,529 July 2002 Est.)
• Centralized access
• Jamaica (pop. 2,780,132 July 2007 est.)
• Widening access to HIV services

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PHARMACISTSDATA OF TARGET COUNTRIES
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GAINING ACCESS

• Approval from all relevant Ethics Committees
• Letters of request to all MINISTRIES OF HEALTH
• Letters of request for support of all Local
  Pharmacist Associations

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GAINING ACCESS

• Request to PLWHA networks
• Establishment of multi-country Planning committee
  to discuss approach in each country

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THE TEAM

• Planning committee/Resource persons
• Field Team
• Data entry officer
• Consultant data analysts

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PLANNING COMMITTEE/RESOURCE PERSONS

• Professor Brendan Bain
• Maxine Ruddock-Small
• Donnette Ramsay
• Barbara McGaw

• Donna Daniel
• Pamela Payne
• Chena Scott
• Claudette Hobbins
• Althea Bailey
• Ellen Grizzle

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FIELD TEAM

• OLIVE SCOTT
• SHELLEY MUNNINGS
• CHRISTINE OLADIMEJI
• CARI INGHAM

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DATA ENTRY ANALYSIS

• Data-Entry -MR.ANDRE FRAY
• Data Analysis- MRS. DESMALEE NEVINS
• DR. MARVIN REID

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IMPLEMENTATION STEPS

• Development of work Plan/schedule/budget
• Orientation/Training of field team
• Development of Research Instruments
• Pre-test Instrument and validate
• Conduct survey
• Conduct In-depth Interviews

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IMPLEMENTATION STEPS

• Submission of data and country reports
• Analysis of data
• Preparation of Reports on Quantitative and
  Qualitative findings
• Dissemination

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SURVEY METHODOLOGY

• Obtain List of Current Pharmacists in country
• Identify best data collection strategy for each
  country
• Purposive sampling with agreed criteria
• Administration of survey

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METHODOLOGY FOR IN-DEPTH INTERVIEWS

• Establish criteria for selection of Pharmacists
  to be interviewed
• Establish criteria for selection of PLWHA to be
  interviewed
• Develop semi-structured interview guide
• Signed permission from each interviewee

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GENERAL CRITERIA FOR PHARMACISTS TO BE INTERVIEWED

• Regulatory Body/Authority
• Pharmacy Council
• Local Pharmacist Association
• Private Sector front line
• Public Sector front line

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Objectives

• To determine the level of knowledge, attitudes,
  beliefs and practices among Pharmacists, in order
  to develop evidence-based training programmes to
  support improved access and improved care
  provided by Pharmacists to PLWHA

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QUANTITATIVE Study among Pharmacists
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Independent Factors documented

• Age group
• Gender
• Personal experience with HIV/AIDS
• Years of pharmacy registration
• Level of training
• Dispensed ARVs
• Counselled HIV/AIDS client within last 6 month
• Attended educational session on HIV/AIDS within
  the last 12 months

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Outcomes investigated

• Knowledge
• Attitude
• Emotions
• Confidentiality
• Information needs

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Statistical Techniques

• Summary statistics frequencies, means, median
• Univariate statistics ttest,ANOVA, Chi-square
• Multivariate Multiple linear regression,
  Logistic regression and multinominal regression

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Characteristics of sample
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Respondents by country
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Gender distribution
Some data missing
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Age-group distribution
Some data missing
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Years of pharmacist registration
Some data missing
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Pharmacist Training
Values are counts with (col ) ?2 108.3 df(6)
plt 0.001
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Personal experience
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Knowledge
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Drug-drug interactions
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Drug-food interactions
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Distribution of Knowledge scores
82.3
55.5
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Comparison of HIV-related knowledge

• There was a statistically significant difference
  in mean knowledge concerning HIV in general and
  concerning drug-drug and drug-food interactions
  when persons who actually dispense ARVs were
  compared with persons who did not dispense ARVs.
• On average, the former group knew more than the
  latter group.

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Multivariate Analysis-Predictors of knowledge
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Attitude
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Attitude towards HIV person
c2 16.12, plt 0.0001
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Multivariate predictor of positive attitude
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Emotions
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Feelings evoked by seeing person with diabetes
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Feelings evoked by seeing a woman with AIDS
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Feelings evoked by seeing a man with AIDS
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Feelings evoked by seeing a child with AIDS
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Confidentiality
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Who would you wish to know about an HIVve person?
Note 39 persons did not answer this question
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Should an employer know an employees HIV results?
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Predicted probability by gender in employers
rights to know categories
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Counseling Information needs
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Counseling Speaking with customers about HIV
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Sources of HIV information
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Sources of information on drugs to treat HIV
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Recommendation for herbal medicine
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Information needs
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Rank of Information needs
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QUALITATIVE Study among Pharmacists and Persons
living with HIV
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Informants by category
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Distribution of pharmacists interviewed by
country sector
Includes 1-2 Drug distribution agencies
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Themes raised with Pharmacists

• Proposed changes relating to
• Access to ARV
• Policies for pharmaceutical industry
• Perceptions about
• Their roles in counseling HIVve clients
• Feelings about PLWHA
• Training needs, content and methodology

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Themes raised with PLWHAs

• What they expect from a pharmacist
• Their experiences when they have used pharmacy
  services
• Confidentiality
• Their comfort level with various health care
  providers

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Bahamas - Pharmacists main concerns

• The need for education and training
• Desire for decentralization of services

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Barbados - Pharmacists main concern

• Distribution of Anti-retrovirals (ARV) too
  centralized
• Public pharmacies and some Government Centres
  were not privileged to provide this service.
• Suggested solution
• Increase distribution points
• (a) allow private pharmacies to supply ARVs with
  minimal stocking charges applied
• (b) allow other poly-clinics to do distribution
  or do home deliveries.

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• One pharmacist said,
• I would decentralize the delivery of
  anti-retroviral medications. Mandatory
  continuing education for pharmacists would have
  to include updates on care and treatment of
  persons living with HIV/AIDS.

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Jamaica - Pharmacists main concerns

• Increased education and training about HIV and
  its treatment
• Making Postinor a prescription item
• Need for confidential counselling at pharmacies

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St Lucia - Pharmacists main concerns

• Non-availability of ARVs at pharmacies
• Increased training to understand and be able to
  get involved in the programme
• Lines of communication between doctor and
  pharmacists alleged to be closed (according to
  one interviewee)

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Feelings towards PLWHAs

• Bahamas
• Compassion and pity
• Ways to give reassurance and help
• Concern about lifestyles
• Barbados
• Empathy especially for children
• Willing to reach out, but cautious of spread
• Curiosity about previous lifestyle and mode of
  infection
• Integration of care would help to reduce stigma

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Feelings towards PLWHAs

• Jamaica
• Sympathy dependent on patient age, gender
• Sadness due to finality of illness recognizing
  personal risks
• Integration of care would help to decrease stigma
• St Lucia
• Pity, empathy sympathy
• Integration of care essential to reduce stigma

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PLWHAs Experiences

• Long waiting time (Jamaica)
• Other clients at drug window hearing their
  business
• Very good service with respect and caring
  attitude (St Lucia and Bahamas)
• Curious, judgmental looks

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Preferences for instructions

• Oral and written instructions
• Given in privacy
• Explain the medication to you cause not
  everybody can read and write.

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Disclosure of HIV status to pharmacists

• Most persons not willing to do so unnecessarily
• Reasons for not disclosing status
• Not knowing pharmacist enough
• Not having a relationship with pharmacist
• Fear of it being discussed

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PLWHAs highest comfort levels with health workers
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Summary

• Knowledge scores were low.
• There were differences in knowledge score by
  countries.
• There were independent associations of
  pharmacist training, age, whether pharmacist
  actively dispensed ARV, and Counseled an HIV
  client with Knowledge scores.
• The data obtained in this study will be used to
  guide future interventions with pharmacists

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Summary

• Pharmacists should be exposed to training in
  counselling
• Increases sensitisation among pharmacists about
  HIV persons may improve attitudes and care
• Integration of services, with attention to
  privacy may reduce stigma for PLWHA.
• Strategies must be developed to increase the
  comfort level with PLWHA

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Acknowledgement Planning Committee/Resource
personnel

• Professor Brendan Bain
• Maxine Ruddock-Small
• Donnette Ramsay
• Barbara McGaw

• Donna Daniel
• Pamela Payne
• Chena Scott
• Claudette Hobbins
• Althea Bailey
• Ellen Grizzle

Thank You