Medication Management Programs
A person diagnosed with HIV is prescribed antiretroviral therapy (ART), which involves taking a combination of HIV medications each day as prescribed. Though these medications are not able to eliminate the virus, they work by controlling the virus so that there are very low levels of the virus in the body. An HIV-positive individual can live a long, healthy life when adhering to an ART drug regimen.
The Ryan White AIDS Drug Assistance Program (ADAP) is administered in states and U.S. territories as a mechanism to assist low-income individuals in obtaining these medications each month. The National Alliance of State & Territorial AIDS Directors (NASTAD) estimates that ADAP serves over 140,000 people who are living with HIV/AIDS each year by funding medications and helping provide health insurance. ADAP funds can be used to help with acquiring health insurance and for providing medication adherence monitoring for individuals who qualify for services.
Although there are certain requirements that need to be met in order to participate in ADAP, each program can decide how to implement the program based on the community's needs. NASTAD offers technical assistance to ADAPs around the country to help meet these needs. Since ART is essential to managing the progression of HIV/AIDS, approximately 80% of people who are living with HIV/AIDS and participate in ADAPs reach viral suppression.
Rural organizations have implemented several different strategies in an effort to improve medication adherence for people living with HIV/AIDS. For example, offering mailed medication programs can be one option to help support medication needs. These programs offer increased privacy for people who do not feel comfortable visiting a pharmacy in-person, often because of concerns about stigma, or if a person cannot travel to a clinic to pick up the medication. Medications can be mailed directly to a person's home or to another location, like a community-based organization or clinic, where they can be held for pick-up.
Another model proposed by the National Institutes of Health to improve HIV medication adherence in communities is a pharmacist-delivered Medication Therapy Management (MTM) program for people living with HIV/AIDS. The program uses community pharmacies to coordinate medication adherence, which is a novel way of including local pharmacists, who are generally more accessible than other healthcare providers, in the care coordination process. In MTM, community pharmacists, who have already formed relationships with local HIV healthcare providers, facilitate regular contact with patients and help consolidate prescriptions, which can sometimes come from several different providers. In this way, the program allows pharmacists to more directly monitor a patient's medication adherence.
Examples of Medication Management Programs:
- Curant Health Systems in Alabama provides Enhanced Pharmacy Services, which combines pharmacy and clinical services to improve HIV self-management. Some of the specific services offered include prescription refill reminder calls, free home delivery of medications, synchronization of medication, and Medication Therapy Management (MTM). An internal study of these services conducted by Curant Health Systems showed an increase in positive health outcomes for participants who were living with HIV/AIDS.
- The Ursuline Sisters HIV/AIDS Ministry works with clients to improve and monitor medication adherence. One mechanism Ursuline Sisters uses is HIV medication delivery. People can request to have their medication mailed to them if transportation to a pharmacy or clinic is difficult to obtain. People can also choose to pick up medications directly from the organization if they have concerns about privacy at home.
- The Telehealth Alliance of Oregon provides HIV pharmacy specialist care to people living in rural Oregon. This is done through a collaboration with HIV healthcare specialists and the active involvement of pharmacists in the patient's medication regimen. Pharmacists in this model routinely check up on patients' medication treatments, consult with patients on best practices, order necessary labs, and serve as an additional resource for patients.
Considerations for Implementation
According to the Centers for Disease Control and Prevention, the current estimate for the cost of lifetime treatment for one person living with HIV is nearly $400,000. Antiretroviral therapy (ART) continues to be one of the biggest expenses for people living with HIV/AIDS and can cost hundreds of dollars each month. ART can be unaffordable for people who live on a low income, especially if they are uninsured and unable to qualify for Medicaid, making medication adherence even more challenging. The Ryan White ADAP program provides funding to offset co-pays and deductibles for medications, but not all people qualify for these funds. Specific ART drug costs can also vary greatly across different regions of the country.
Limited access to transportation can also interfere with medication adherence, as it may be difficult for people to access the medication they need or obtain a prescription from their provider. Organizations have found various ways to address these challenges, such as providing transportation for clients, offering gas cards, or offering to deliver medications to the home instead. Any mechanisms that can ease barriers to obtaining medication may improve adherence to treatment. If programs choose to implement a mailed medication model, it is important to use discreet packaging to maintain confidentiality.
Resources to Learn More
Evidence-Based Interventions and Best Practices for HIV Prevention: Medication Adherence Chapter
A review of medication adherence programs and best practices for HIV prevention. This chapter of the compendium includes 12 evidence-based medication adherence programs that have been evaluated in the U.S. since April 2015.
Organization(s): Centers for Disease Control and Prevention
Dose Every Day
A training toolkit for providers to help HIV patients with medication adherence. Includes four evidence-based strategies for improving patient adherence: HEART, SMART Couples, Peer Support, and Partnership for Health for Medication Adherence. Providers also have access to consumer handouts, posters, a program monitoring guide, and even a new mobile application which they can share with patients to help manage medications.
Organization(s): Centers for Disease Control and Prevention
Retention in Care and Medication Adherence:
Current Challenges to Antiretroviral Therapy Success
Describes challenges to HIV care retention and medication adherence for people living with HIV/AIDS. Outlines the barriers to treatment success and describes some of the evidence-based recommendations for improving treatment adherence.
Author(s): Holtzman, C.W., Brady, K.A., & Yehia, B.R.
Citation: Drugs, 75(5), 445-454
& AIDS Drug Assistance Programs
Describes the AIDS Drug Assistance Program (ADAP) and how the program helps clients who are living with HIV/AIDS to acquire HIV medications as well as health insurance. Lists current resources related to ADAPs and describes technical assistance which is offered by NASTAD to help programs achieve the best patient outcomes.
Organization(s): National Alliance of State & Territorial AIDS Directors (NASTAD)