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Involvement of the Pharmacists
in India in the fight against
HIV/AIDS
Dr Nirmal Gurbani
Professor and Associate Dean (Pharmaceutical Management)
Indian Institute of Health Management and Research (IIHMR),
Jaipur and
Consultant, DSPRUD
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Greetings
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Acknowledgements
• Delhi Society for
Promotion of Rational
Use of Drugs
(DSPRUD)
NEW DELHI
• National AIDS Control
Organization (NACO)
Government of India
NEW DELHI
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Humanitarian Slant
• HIV/AIDS is a massive crisis in its own
• Humanitarian response is deeply concerned with
increased levels of mortality and morbidity
• HIV infection is not the end of life.
• PLHV can lead a healthy life for a long time with
appropriate medical and pharmaceutical care
• Medication with adherence enhances both quality of life
and longevity, and
• A sustainable and significant contribution can be made
towards poverty reduction as part of the Millennium
Development Goals.
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Attempts to Involve the Pharmacists in
India in the fight against HIV/AIDS
• 2000 IPA NPW theme was “Pharmacist Shouldering the
Responsibility in Fighting AIDS
• 2002 FIP-CPS supported bringing out the "Guiding
Principles for Pharmacists in Prevention & Management
of HIV/AIDS”
• Efforts to train pharmacists on these ‘Guiding Principles’
were successful at very few academic schools, and,
• By and large the Community Pharmacy did not show
much interest in this as there were very few prescriptions
with HIV/AIDS medications at their counters
• Several endorsements, including Chennai Statement on
HIV/AIDS, MCH, and TB (March 2010)
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National Aids Control Program (NACP)
NACP I
1992-1999
To slow down the spread of HIV infection
- (National AIDS Control Board constituted
- National AIDS Control Organisation
NACP II
1999-2006
Focusing on behaviour change,
- Increased decentralization and NGO involvement
- State AIDS Control Societies
- National AIDS Control Policy adopted
- National Blood Policy adopted
- ART Treatment initiated at selected states center
NACP III
2007-2012
Halt and reverse the epidemic in India over the next 5
years
- Reduce / prevent new infections
- Increase proportion of PLHA receiving care, support,
and treatment
- Strengthen capacity at district, state and national
levels
- Build strategic information management systems
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NACP III: Care, Support & Treatment
activities
• ART is now available free to all those who
need it
• Operational Guidelines for ART Centers (May
2008), the pharmacists have been assigned
specific roles and responsibilities
• Indeed, this is the first national program in
India in which PHARMACISTS are being
involved with defined roles and
responsibilities
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NACP III: Pharmacist’s Tasks • Dispense ARV and OIs medicines
• Maintain medicines stock and medicines dispensing registers
• Ensure ART center has stock of ARVs for at least 3 months
• Inform the ART Nodal Officer of the center as and when the stock
falls below the 3 month back up stock
• Ensure adequate stock of medicines required for treatment and
prophylaxis of OIs
• Advise the patients and family about importance of adherence
during each visit
• Advise the patient on possible medicines toxicities and reporting
of the same if significant
• Maintain a monthly sheet for expiry of medicines stock.
• Do Pill count and report any adverse effects of ARVs or any OIs
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Hurdles • Pharmacists could not perform the assigned
tasks at ART centers as they have not received
enough education and training during their
pre-degree / diploma curriculum to perform
required roles and responsibilities effectively
• Therefore, to empower pharmacists in fulfilling
their obligations, the NACO in late 2009,
constituted a Working Group comprising of
experts from DSPRUD and NACO for
development of a Training Module for training
of Pharmacists
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Working Group focus
• Good Store & inventory management for
uninterrupted supply quality medicines
• Good dispensing practices
• Imparting appropriate pharmaceutical
care (PI and Adherence counseling)
• Orient participation in PV program for
ensuring better safety
• WG divided topics among themselves for
proposed Training Module
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Working Group Methodology • WG divided topics among themselves for proposed
Training Module
• Chapters so written were shared among all members
for review, comments, linking up with each other;
avoid redundancy, etc.
• Draft “Training Module” was finalized for pre-test
training program in June 2010
• Based on the feedback, comments of the participants,
observers and review by country experts from
different regions, training module was further fine
tuned during second training program in September 10
• National Training Module for ART Centers Pharmacists
finalized for regular training jointly by DSPRUD NACO
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Pharmacist’s Role
• prime role in ensuring uninterrupted supply
of quality medicines
• good dispensing practices with imparting
appropriate pharmaceutical care
• imparting drug related patient information
• adherence counseling & monitoring, and
• participation in pharmacovigilence
especially on ARVs & OIs medicines
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Session Objectives
To understand the
• importance of rational use of medicines;
• adverse impact and factors influencing the
rational use of medicines;
• national guidelines for HIV/AIDS;
• useful role pharmacists can play in
promoting rational use of medicines; and
• importance of patient education
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31 January 2013 14
HOW TO PROMOTE RATIONAL USE OF
MEDICINES?
• Use of well tested tools for promoting RUM.
• Selection and use of essential medicines,
chosen on basis of efficacy, safety and cost.
• Developing standard treatment protocols
and selecting medicines based on evidence.
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31 January 2013 15
HOW TO PROMOTE RATIONAL USE OF
MEDICINES? ----
• Ensuring availability, accessibility and
affordability of essential medicines.
• Ensure that standard protocols are adhered to.
• Ensure that medicines are dispensed and
administered appropriately and patients are
educated.
• Patients consume medicines as prescribed.
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31 January 2013 16
RATIONAL USE OF MEDICINES ----
• NACO Programme on ARV Therapy is an
excellent example of promoting RUM.
• Essential medicines have been identified,
made available at ART Centres.
• Standard Treatment Protocols are developed.
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31 January 2013 17
RATIONAL USE OF MEDICINES ----
• Treatment Protocols have been implemented.
• NACP – III in addition to above on educating
pharmacists and other health professionals to
strengthen family and community care and most
important ensuring adherence to treatment
prescribed
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31 January 2013 18
ROLE OF PHARMACISTS IN PROMOTING
RATIONAL USE OF MEDICINE
• A pharmacist is a crucial link between patient
and other health-care professionals.
• Pharmacists are first contact with community.
• Community by and large has tremendous faith in
pharmacists and find them easily accessible.
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31 January 2013 19
ROLE OF PHARMACISTS………….
• Strengthen effective drug management.
• Overcoming chronic shortage of essential
medicines.
• Combating problem with fake and inferior quality
medicines.
• Educate public on compliance and better use of
medicines.
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31 January 2013 20
ROLE OF PHARMACISTS…………
• Active participation of pharmacist in ARV therapy programme in other countries resulted into better patient outcome.
• Pharmacists working in ART Centers can participate in better and regular supply of ARV medicines.
• Follow good dispensing practices on safe use of ARV medicines.
• Participate in pharmacovigilance programme.
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31 January 2013 21
DRUG STOCK MANAGEMENT
• An effective inventory management will ensure
availability of ARV medicines at all times at ART
Centres.
• Can be achieved by determining quantity
needed, placing order at appropriate time,
receiving and checking medicines, storing
properly and monitoring consumption.
• Stock medicines for three months.
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31 January 2013 22
DRUG STOCK MANAGEMENT ---
• Maintaining accurate record for medicines
received and dispensed.
• Handling of near expiry medicines.
• Training of fellow colleagues.
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31 January 2013 23
GOOD DISPENSING PRACTICES AND
IMPARTING APPROPRIATE
PHARMACEUTICAL CARE
• Imparting knowledge to patients at time of
dispensing improves treatment adherence and
patient outcome.
• ARV medicines have low safety profile, chances
of discontinuance of therapy are more.
• Pharmacist should educate patient on dose,
duration of treatment of each medicines
prescribed.
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31 January 2013 24
GOOD DISPENSING PRACTICES AND
IMPARTING APPROPRIATE
PHARMACEUTICAL CARE ---
• Should educate about ADR commonly
encountered.
• Educate about Drug-Drug Interactions.
• Educate about prevention of HIV/AIDS and
Opportunistic Infections.
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31 January 2013 25
PARTICIPATION IN
PHARMACOVIGILANCE PROGRAMME
• Participate in ADR monitoring.
• While counseling, if they observe any adverse
effect in patient, it should be reported.
• Data generated on ADRs when used further
improves patient outcome.
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31 January 2013 26
KEY RESPONSIBILITIES IN ART
CENTRES
• Facilitate receipt of medicines and Medicine
Stock Management at ART Centre.
• Ensure centre has stock of ARV medicines for at
least 3 months.
• Inform ART SMO / In-charge MO / Nodal Officer
as and when stock falls below 3 month backup
stock.
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31 January 2013 27
KEY RESPONSIBILITIES ………….
• Dispense medicines for OI and ARV
medicines.
• Maintain Medicine Stock and Medicine
Dispensing Registers and generate “Daily
Due List” for medicine collection for next
working day.
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31 January 2013 28
KEY RESPONSIBILITIES…………..
• Handover completed list “Daily Due List” of
each day after completion medicine dispensing
for particular day, to Counselor for contacting
MIS cases.
• Advise patient and family about importance of
adherence during each visit.
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31 January 2013 29
KEY RESPONSIBILITIES…………..
• Advise patient on possible adverse reaction
to ARV and OI medicines and also explain
importance of reporting ADR to pharmacist /
doctor during each visit.
• Maintain a monthly sheet for expiry of
medicines stock.
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31 January 2013 30
KEY RESPONSIBILITIES…………..
• Do pill count and provide necessary data to
data manager related to medicines for
preparation of Monthly reports.
• Facilitate and monitor supply of ARV
medicines to LACS as per number of patients
linked out.