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I’m 7 weeks into my APPE longitudinal ambulatory care rotation at an HIV clinic. It is one afternoon a week. Before clinic every week, I spend a lot of time reading through my patients’ charts to understand their medical history. Luckily, the HIV and Opportunistic Infection guidelines are extremely thorough and up to date and are great resources when determining what interventions should be made for the patients. During the first week, I saw the patients with my preceptor. Now, I present my plan to my preceptor before seeing a patient, I see the patients on my own, and my preceptor comes in at the end to ensure the patient was fully taken care of.

Most of my patients are referred to see a pharmacist because of trouble with adherence.  We assess adherence barriers because they are different for each patient. Adherence barriers I’ve encountered varied from difficulty swallowing medications, not liking the taste of medications, forgetfulness, illiteracy, side effects, and frustration. We work with the patient to come up with a regimen that works for them. We show them what the pills look like to ensure they can swallow them. We also determine the regimen based on their virus’ mutations, their kidney function, and drug interactions. We fill pill boxes for most of our patients every week or two.  Since we see our patients so often, we also communicate with their primary care provider to help manage their blood pressure, dyslipidemia, and other comorbidities.

            I’ve found that little things such as filling a pill box or managing a side effect goes a long way with this population. Many patients were having a lot of trouble managing their disease and a little extra help to find a regimen that worked for them made a huge difference. It is very rewarding when I see their viral load decrease and their CD4 count increase.