Q&A: How HIV Care Has Allowed Pharmacists to Practice at the Top of Their Licenses

With advancements in HIV care and ongoing collaboration amongst providers in this space, pharmacists have since separated themselves as a premier resource for patients living with AIDS. From pharmacist-friendly consultations to medications that have made the HIV virus undetectable, there are now more tools than ever in the HIV space that allow pharmacists to work at the top of their license.

“One of the really lovely things about California pharmacy law is they leave it very open for pharmacist collaboration with other providers under collaborative practice agreements. It's a very much ‘the world is your oyster’ type of situation, which is really lovely,” said Jay Holloway, PharmD, AAHIVP, Pharmacist with the AIDS Healthcare Foundation (AHF).

"I think at our workplace, we're operating with pharmacists at the top of our capability as providers," said Holloway. | image credit: H_Ko / stock.adobe.com

In part 2 of our interview series with Holloway, we discussed issues and challenges within the HIV space, and how pharmacists have stepped in as vital providers for people living with HIV.

READ MORE: Specialty Pharmacist Transforms HIV Care Outside of the Pharmacy

Drug Topics: Where do you think your specific focus area of HIV in the pharmacy is lacking? Do you have any insights on how the industry can be improved?

It has been talked about many times before that, while we do have the technology and we do have the medications to successfully manage HIV, there are definite major disparities in access to care for historically marginalized and oppressed groups. There are disparities of access to care by race; by economic class; by gender modality, such as cisgender or transgender individuals. Also, a big thing that I think should be addressed more is that there is major stigma to getting tested, to finding out your status, to accessing PrEP (pre-exposure prophylaxis). In some states, there are also laws that criminalize people living with HIV if they don't disclose their status, which can make a person more liable if they know their status versus if they don't know their status and accidentally pass it on to a partner. When addressing marginalized groups, we also need to be looking at systemic inequalities and not just things that are directly affecting the patients getting the meds, but also barriers to getting their food, getting their housing, getting adequate medical care, feeling safe.

That pivots into one of the things where we'll have patients who are unhoused, for example, and they're living with HIV. They need to make sure to take their medications daily or come in for their every 2-month appointment in order to stay undetectable. But when we're getting patients to be adherent, we also need to be cognizant of the fact that, if a person is struggling with day-to-day survival, they're not going to be prioritizing taking a medication that down the line will prevent them from complications in the future. Yes, it's important to take the ARVs (antiretrovirals), but if a person is like, “Well, I don't know where I'm going to sleep tonight or where I'm going to eat tonight.” We need to focus to also address that need as well.

Drug Topics: From your perspective, how do you think pharmacists are viewed within the HIV space? Do you feel like you and your peers receive the recognition you deserve?

One of the things I really love about working with AHF is that there is major collaboration between the pharmacists and the clinic providers. We have pharmacists at the clinics themselves that are doing medication consultations for patients. Every new patient, we do something called an initial assessment, where we go over the medications with them. We record their allergies, any existing medications they're on, their most previous labs. That enables us to see patients where they are and talk about them with the meds, assess their initial levels of understanding about their condition. One of the really nice things is I get time to know my patients a lot more closely. They can tell me about, “I have been struggling with depression since my new diagnosis,” or “I am dealing with these issues at home,” or “I need specific confidentiality needs in order to make sure that my status isn't disclosed.” That's really nice. I think at our workplace, we're operating with pharmacists at the top of our capability as providers.

Additionally, one of the things I have really liked is how my pharmacy peers at my location, which is East LA, have been very supportive of initiatives that I have wanted to develop. In California, under SB 159, we're able to furnish PrEP through our pharmacies. People come in when a tester is available, they do a rapid test, and then we get them started. We've been wanting to talk about expanding those pharmacy services because one of the really lovely things about California pharmacy law is they leave it very open for pharmacist collaboration with other providers under collaborative practice agreements. It's a very much “the world is your oyster” type of situation, which is really lovely.

READ MORE: HIV Resource Center

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