Pharmaceutical care effectiveness in brazilian healthcare setting: PrEP knowledge and adherence
Efetividade do cuidado farmacêutico em cenário real de saúde brasileiro: conhecimento e adesão à PrEP
Palavras-chave:
Pre-Exposure Prophylaxis, HIV, Pharmacists, Patient Medication Knowledge, Medication AdherenceResumo
PrEP is a globally effective and safe healthcare technology that substantially reduces HIV incidence. Pharmacists have played a crucial role in promoting PrEP scale-up, however, there is a lack of studies in the Brazilian context. This intervention study, conducted in Central Brazil from 2021 to 2022, assessed pharmaceutical care's effectiveness in enhancing PrEP knowledge and adherence among high-risk individuals for HIV acquisition. Over 80% of 150 participants, were predominantly male, homosexual, averaging 31.4 years old, single, and highly educated, and showed normal liver and kidney function with no HIV seroconversions. The Intervention Group (IG) displayed significant statistical differences in PrEP knowledge (p<0.001) and adherence (p<0.008) compared to the control group. The clinical pharmacist effectively resolved 27 drug-related problems with no adverse effects on participants. This study is pioneering within the Brazilian context, making a significant contribution to the advancement of scientific understanding regarding the role of pharmaceutical services in fostering PrEP utilization in Brazil.
Downloads
Referências
Anvisa. Agência Nacional de Vigilância Sanitária. (2023). Novos medicamentos e indicações [dataset]. https://www.gov.br/anvisa/pt-br/assuntos/medicamentos/novos-medicamentos-e-indicacoes/apretude-r-cabotegravir-novo-registro.
Arnold-Forster, D., Horne, R., Nutland, W., Wayal, S., Rayment, M., Rae, C., Desai, M., Clarke, A., Sullivan, A., McCormack, S., & Gafos, M. (2022). Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England. AIDS and Behavior, 26(8), 2768–2782. https://doi.org/10.1007/s10461-022-03624-6
Baeten, J. M., Donnell, D., Ndase, P., Mugo, N. R., Campbell, J. D., Wangisi, J., Tappero, J. W., Bukusi, E. A., Cohen, C. R., Katabira, E., Ronald, A., Tumwesigye, E., Were, E., Fife, K. H., Kiarie, J., Farquhar, C., John-Stewart, G., Kakia, A., Odoyo, J., Celum, C. (2012). Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women. New England Journal of Medicine, 367(5), 399–410. https://doi.org/10.1056/NEJMoa1108524
Barry, M. J., Nicholson, W. K., Silverstein, M., Chelmow, D., Coker, T. R., Davis, E. M., Donahue, K. E., Jaén, C. R., Kubik, M., Li, L., Ogedegbe, G., Rao, G., Ruiz, J. M., Stevermer, J. J., Tsevat, J., Underwood, S. M., & Wong, J. B. (2023). Preexposure Prophylaxis to Prevent Acquisition of HIV: US Preventive Services Task Force Recommendation Statement. JAMA, 330(8), 736. https://doi.org/10.1001/jama.2023.14461
Berger, V. W., Grant, W. C., & Vazquez, L. F. (2010). Sensitivity designs for preventing bias replication in randomized clinical trials. Statistical Methods in Medical Research, 19(4), 415–424. https://doi.org/10.1177/0962280209359875
Booker, C., Murphy, A. L., Isenor, J. E., Ramsey, T. D., Smith, A. J., Bishop, A., Kelly, D. V., Woodill, L., Richard, G., & John Wilby, K. (2023). Community pharmacists’ acceptance of prescribing pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV). Canadian Pharmacists Journal / Revue Des Pharmaciens Du Canada, 156(3), 137–149. https://doi.org/10.1177/17151635231152218
Brasil. Ministério da Saúde, Secretaria de Vigilância em Saúde. (2023). Painel PrEP. [dataset]. https://www.gov.br/aids/pt-br/assuntos/prevencao-combinada/prep-profilaxia-pre-exposicao/painel-prep
Brasil. Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente, Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis. (2022). Relatório de Monitoramento de Profilaxias Pré e Pós-Exposição ao HIV 2022 [dataset].
Brasil. Ministério da Saúde. Conselho Nacional de Saúde (2004). Resolução no 338 de 06 de Maio de 2004. Aprova a Política Nacional de Assistência Farmacêutica. https://bvsms.saude.gov.br/bvs/saudelegis/cns/2004/res0338_06_05_2004.html
Brasil. Ministério da Saúde (1998). Portaria no 3.916, de 30 de Outubro de 1998. Aprova a Política Nacional de Medicamentos.
Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância, Prevenção e Controle das Infecções Sexualmente Transmissíveis, do HIV/Aids e das Hepatites Virais. (2018). Protocolo Clínico e Diretrizes Terapêuticas para Profilaxia Pré-Exposição (PrEP) de Risco à Infecção pelo HIV.
Brizzi, M., Sherman, E. M., Green, S. B., Nowicki, D. N., Drwiega, E. N., Nicol, M. R., Chastain, D. B., Sahloff, E. G., Truong, W. R., Cluck, D., Badowski, M. E., Michienzi, S. M., & Durham, S. H. (2023). Personalizing prevention: Advances in pharmacotherapy for HIV prevention. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 43(4), 305–320. https://doi.org/10.1002/phar.2796
Broekhuis, J. M., Scarsi, K. K., Sayles, H. R., Klepser, D. G., Havens, J. P., Swindells, S., & Bares, S. H. (2018). Midwest pharmacists’ familiarity, experience, and willingness to provide pre-exposure prophylaxis (PrEP) for HIV. PLOS ONE, 13(11), e0207372. https://doi.org/10.1371/journal.pone.0207372
Burns, C. M., Endres, K., Derrick, C., Cooper, A., Fabel, P., Okeke, N. L., Ahuja, D., Corneli, A., & McKellar, M. S. (2023). A survey of South Carolina pharmacists’ readiness to prescribe human immunodeficiency virus pre‐exposure prophylaxis. Journal of the American College of Clinical Pharmacy, 6(4), 329–338. https://doi.org/10.1002/jac5.1773
Cernasev, A., Barenie, R. E., Wofford, B. R., Golden, J., & Walker, C. (2023). Empowering Tennessee Pharmacists to Initiate PrEP Using Collaborative Pharmacy Practice Agreements. Clinics and Practice, 13(1), 280–287. https://doi.org/10.3390/clinpract13010025
CFF. Conselho Federal de Farmácia. (2013). Resolução no 585 de 29 de Agosto de 2013. Regulamenta as atribuições clínicas do farmacêutico e dá outras providências. https://www.cff.org.br/userfiles/file/resolucoes/585.pdf
CFF. Conselho Federal de Farmácia (2016). Serviços farmacêuticos diretamente destinados ao paciente, à família e à comunidade: Contextualização e arcabouço conceitual. https://pesquisa.bvsalud.org/portal/resource/pt/mis-41897
CFF. Conselho Federal de Farmácia (2021). Dados 2020. Farmácias e Farmacêuticos no Brasil. [Relatório]. https://www.cff.org.br/pagina.php?id=801%26menu=801%26titulo=Dados%2B2018
Correr, C. J., Melchiors, A. C., De Souza, T. T., Rotta, I., Salgado, T. M., & Fernandez-Llimos, F. (2013). A Tool to Characterize the Components of Pharmacist Interventions in Clinical Pharmacy Services: The DEPICT Project. Annals of Pharmacotherapy, 47(7–8), 946–952. https://doi.org/10.1345/aph.1S006
Fröhlich, S. E., Dal Pizzol, T. D. S., & Mengue, S. S. (2010). Instrumento para avaliação do nível de conhecimento da prescrição na atenção primária. Revista de Saúde Pública, 44(6), 1046–1054. https://doi.org/10.1590/S0034-89102010000600009
Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., Goicochea, P., Casapía, M., Guanira-Carranza, J. V., Ramirez-Cardich, M. E., Montoya-Herrera, O., Fernández, T., Veloso, V. G., Buchbinder, S. P., Chariyalertsak, S., Schechter, M., Bekker, L.-G., Mayer, K. H., Kallás, E. G., … Glidden, D. V. (2010). Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men. New England Journal of Medicine, 363(27), 2587–2599. https://doi.org/10.1056/NEJMoa1011205
Greenwell, K., Fugit, R., Nicholson, L., & Wright, J. (2023). A Retrospective Comparison of HIV Pre-exposure Prophylaxis (PrEP) Outcomes Between a Pharmacist-led Telehealth Clinic and In-person Clinic in a Veteran Population. AIDS and Behavior. https://doi.org/10.1007/s10461-023-04084-2
Grinsztejn, B., Hoagland, B., Moreira, R. I., Kallas, E. G., Madruga, J. V., Goulart, S., Leite, I. C., Freitas, L., Martins, L. M. S., Torres, T. S., Vasconcelos, R., De Boni, R. B., Anderson, P. L., Liu, A., Luz, P. M., Veloso, V. G., Adão, V. M., Alencastro, P. R., Amaral, A. P., Zuccaro, N. (2018). Retention, engagement, and adherence to pre-exposure prophylaxis for men who have sex with men and transgender women in PrEP Brasil: 48 week results of a demonstration study. The Lancet HIV, 5(3), e136–e145. https://doi.org/10.1016/S2352-3018(18)30008-0
Hoagland, B. (2016). Conhecimento, interesse, decisão sobre o uso e adesão precoce à profilaxia pré-exposição (PrEP) entre homens que fazem sexo com homens (HSH) e mulheres transexuais (Trans) participantes no estudo PrEP Brasil. https://www.arca.fiocruz.br/handle/icict/26509
Hoagland, B., Moreira, R. I., De Boni, R. B., Kallas, E. G., Madruga, J. V., Vasconcelos, R., Goulart, S., Torres, T. S., Marins, L. M. S., Anderson, P. L., Luz, P. M., Costa Leite, I. D., Liu, A. Y., Veloso, V. G., Grinsztejn, B., & for the PrEP Brasil Study Team. (2017). High pre-exposure prophylaxis uptake and early adherence among men who have sex with men and transgender women at risk for HIV Infection: The PrEP Brasil demonstration project. Journal of the International AIDS Society, 20(1), 21472. https://doi.org/10.7448/IAS.20.1.21472
Horne, R., Weinman, J., Barber, N., Elliott, R., & Morgan, M. (2005). Concordance, adherence, and compliance in medicine taking. National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO).
IBGE, T. B. I. of G. and S. (2023). Censo 2022. [dataset]. https://censo2022.ibge.gov.br/panorama/?utm_source=ibge&utm_medium=home&utm_campaign=portal
Jalil, E. M., Torres, T. S., Luz, P. M., Monteiro, L., Moreira, R. I., De Castro, C. R. V., Leite, I. D. C., Cunha, M., De Cássia Elias Estrela, R., Ramos, M., Hoagland, B., Wagner Cardoso, S., Anderson, P., Veloso, V. G., Wilson, E., Grinsztejn, B., & for the PrEParadas Study Team. (2022). Low PrEP adherence despite high retention among transgender women in Brazil: The PrEParadas study. Journal of the International AIDS Society, 25(3), e25896. https://doi.org/10.1002/jia2.25896
Karabatsos, V., Mantas, S., & Lord, L. (2023). Introduction and Impact of a Human Immunodeficiency Virus Education Package on the Knowledge and Confidence of Pharmacists. Journal of Pharmacy Practice, 08971900231182779. https://doi.org/10.1177/08971900231182779
Kennedy, C. E., Yeh, P. T., Atkins, K., Ferguson, L., Baggaley, R., & Narasimhan, M. (2022). PrEP distribution in pharmacies: A systematic review. BMJ Open, 12(2), e054121. https://doi.org/10.1136/bmjopen-2021-054121
Kibengo, F. M., Ruzagira, E., Katende, D., Bwanika, A. N., Bahemuka, U., Haberer, J. E., Bangsberg, D. R., Barin, B., Rooney, J. F., Mark, D., Chetty, P., Fast, P., Kamali, A., & Priddy, F. H. (2013). Safety, Adherence and Acceptability of Intermittent Tenofovir/Emtricitabine as HIV Pre-Exposure Prophylaxis (PrEP) among HIV-Uninfected Ugandan Volunteers Living in HIV-Serodiscordant Relationships: A Randomized, Clinical Trial. PLoS ONE, 8(9), e74314. https://doi.org/10.1371/journal.pone.0074314
Luz, P. M., Benzaken, A., Alencar, T. M. D., Pimenta, C., Veloso, V. G., & Grinsztejn, B. (2018). PrEP adopted by the brazilian national health system: What is the size of the demand? Medicine, 97(1S), S75–S77. https://doi.org/10.1097/MD.0000000000010602
MacDonald, C. B., Murphy, A. L., Isenor, J. E., Ramsey, T. D., Furlotte, K., Smith, A. J., Bishop, A., Kelly, D. V., Woodill, L., Booker, C., & Wilby, K. J. (2023). Target users’ acceptance of a pharmacist-led prescribing service for pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV). Canadian Pharmacists Journal / Revue Des Pharmaciens Du Canada, 156(4), 194–203. https://doi.org/10.1177/17151635231177027
Marins, L. M. S., Torres, T. S., Leite, I. D. C., Moreira, R. I., Luz, P. M., Hoagland, B., Kallas, E. G., Madruga, J. V., Liu, A. Y., Anderson, P. L., Grinsztejn, B., & Veloso, V. G. (2019). Performance of HIV pre-exposure prophylaxis indirect adherence measures among men who have sex with men and transgender women: Results from the PrEP Brasil Study. PLOS ONE, 14(8), e0221281. https://doi.org/10.1371/journal.pone.0221281
McCormack, S., Dunn, D. T., Desai, M., Dolling, D. I., Gafos, M., Gilson, R., Sullivan, A. K., Clarke, A., Reeves, I., Schembri, G., Mackie, N., Bowman, C., Lacey, C. J., Apea, V., Brady, M., Fox, J., Taylor, S., Antonucci, S., Khoo, S. H., … Gill, O. N. (2016). Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): Effectiveness results from the pilot phase of a pragmatic open-label randomised trial. The Lancet, 387(10013), 53–60. https://doi.org/10.1016/S0140-6736(15)00056-2
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2010). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. International Journal of Surgery, 8(5), 336–341. https://doi.org/10.1016/j.ijsu.2010.02.007
Morisky, D. E., Green, L. W., & Levine, D. M. (1986). Concurrent and Predictive Validity of a Self-reported Measure of Medication Adherence: Medical Care, 24(1), 67–74. https://doi.org/10.1097/00005650-198601000-00007
Mugo, P. M., Micheni, M., Shangala, J., Hussein, M. H., Graham, S. M., Rinke De Wit, T. F., & Sanders, E. J. (2017). Uptake and Acceptability of Oral HIV Self-Testing among Community Pharmacy Clients in Kenya: A Feasibility Study. PLOS ONE, 12(1), e0170868. https://doi.org/10.1371/journal.pone.0170868
Mugwanya, K. K., & Baeten, J. M. (2016). Safety of oral tenofovir disoproxil fumarate-based pre-exposure prophylaxis for HIV prevention. Expert Opinion on Drug Safety, 15(2), 265–273. https://doi.org/10.1517/14740338.2016.1128412
PCNE, P. C. N. E. A. (2020). The PCNE Classification V 9.1. https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf
Player, M. S., Cooper, N. A., Perkins, S., & Diaz, V. A. (2022). Evaluation of a telemedicine pilot program for the provision of HIV pre-exposure prophylaxis in the Southeastern United States. AIDS Care, 34(12), 1499–1505. https://doi.org/10.1080/09540121.2021.2018567
Pratt, M. C., Hill, S. V., Elopre, L., Simpson, T., Lanzi, R., & Matthews, L. T. (2022). PrEP Prescription for Black Adolescent Girls and Young Women in Alabama: Findings from a Survey of Healthcare Providers. Journal of the International Association of Providers of AIDS Care (JIAPAC), 21, 232595822211279. https://doi.org/10.1177/23259582221127936
Refugio, O. N., Kimble, M. M., Silva, C. L., Lykens, J. E., Bannister, C., & Klausner, J. D. (2019). Brief Report: PrEPTECH: A Telehealth-Based Initiation Program for HIV Pre-exposure Prophylaxis in Young Men of Color Who Have Sex With Men. A Pilot Study of Feasibility. JAIDS Journal of Acquired Immune Deficiency Syndromes, 80(1), 40–45. https://doi.org/10.1097/QAI.0000000000001873
Sidebottom, D., Ekström, A. M., & Strömdahl, S. (2018). A systematic review of adherence to oral pre-exposure prophylaxis for HIV – how can we improve uptake and adherence? BMC Infectious Diseases, 18(1), 581. https://doi.org/10.1186/s12879-018-3463-4
The Lancet Hiv. (2019). New PrEP formulation approved…but only for some. The Lancet HIV, 6(11), e723. https://doi.org/10.1016/S2352-3018(19)30350-9
Torres, T. S., Bastos, L. S., Kamel, L., Bezerra, D. R. B., Fernandes, N. M., Moreira, R. I., Garner, A., Veloso, V. G., Grinsztejn, B., & De Boni, R. B. (2020). Do men who have sex with men who report alcohol and illicit drug use before/during sex (chemsex) present moderate/high risk for substance use disorders? Drug and Alcohol Dependence, 209, 107908. https://doi.org/10.1016/j.drugalcdep.2020.107908
Unaids, P. C. das N. U. sobre H. (2023). O caminho que põe fim à AIDS: Relatório Global do UNAIDS 2023. Genebra: Programa Conjunto das Nações Unidas sobre HIV/AIDS; 2023. Licença: CC BY-NC-SA 3.0 IGO. https://unaids.org.br/wp-content/uploads/2023/07/JC3082_GAU2023-ExecSumm_v2_embargoed_PT_VF_Revisada-EA.pdf
Veloso, V. G., Cáceres, C. F., Hoagland, B., Moreira, R. I., Vega-Ramírez, H., Konda, K. A., Leite, I. C., Bautista-Arredondo, S., Vinícius De Lacerda, M., Valdez Madruga, J., Farias, A., Lima, J. N., Zonta, R., Lauria, L., Tamayo, C. V. O., Flores, H. J. S., Santa Cruz, Y. M. C., Aguayo, R. M. M., Cunha, M., Campos, K. (2023). Same-day initiation of oral pre-exposure prophylaxis among gay, bisexual, and other cisgender men who have sex with men and transgender women in Brazil, Mexico, and Peru (ImPrEP): A prospective, single-arm, open-label, multicentre implementation study. The Lancet HIV, 10(2), e84–e96. https://doi.org/10.1016/S2352-3018(22)00331-9
Wilson, E. C., Jalil, E. M., Castro, C., Martinez Fernandez, N., Kamel, L., & Grinsztejn, B. (2019). Barriers and facilitators to PrEP for transwomen in Brazil. Global Public Health, 14(2), 300–308. https://doi.org/10.1080/17441692.2018.1505933
