During my undergraduate studies, I was fortunate enough to undertake a placement within Chelsea and Westminster Hospital’s large HIV service. I learnt lots about antiretrovirals, research, and the management of complex/late-stage HIV. So, when I was asked during my pre-registration training year if there was any specialty I would like to do my quality improvement project in, HIV quickly sprang to mind.
The project I devised aimed to increase pharmacists’ awareness of antiretrovirals, and the ways they could be used to prevent and treat HIV. Our trust did not have an HIV Specialist Pharmacist, although we lived in an area with HIV prevalence far higher than average and an increasing number of new diagnoses in recent years. Internal data showed that large numbers of people with HIV had been admitted to our hospital, which indicated that improving clinical knowledge and confidence around HIV could benefit both staff and the patients we serve.
I created a 30-minute teaching session and delivered this to the pharmacy department. I also created a visual summary guide about antiretrovirals and made this available on the intranet for future reference. We asked attendees to fill out an anonymous questionnaire before and after the session, to gauge how their understanding of HIV treatment had changed.
What we found was a significant knowledge gap regarding HIV. Only 24% of attendees said they had previous formal teaching about HIV, and only 8% felt they had sufficient knowledge for their role. Differences in the education and training of the attendees may explain some of this gap. For example, technicians may not have had traditional lectures in the same way pharmacists might have. Regardless, with the roles of both pharmacists and technicians expanding, it is important we feel able to understand the clinical impact of HIV and discuss patients’ treatment with confidence.
To help close this gap, the teaching session therefore was focused on basics of HIV treatment, such as combination antiretroviral therapy, viral load and CD4 counts, prognosis, and the importance of early diagnosis and engagement with treatment. It also covered the existing use of Pre-Exposure Prophylaxis (PrEP) in sexual health clinics and supply of Post Exposure Prophylaxis (PEP) from our A&E departments. It also covered patient perspectives on stigma and common myths that persist to this day, particularly around transmissibility. The questionnaire feedback following the session showed clear quantitative increases in self-rated understanding across clinical concepts and of confidence in patient consultations involving HIV.
Additionally, I received lots of feedback from colleagues that they were not aware of PrEP or that once someone has an undetectable viral load, they cannot pass on the virus through sexual contact (U=U).
I found this surprising on two levels. Firstly, I would have expected that qualified healthcare professionals would have been aware of these major breakthroughs regarding HIV. Understanding how to prevent, treat, and reduce onwards transmission of all infectious diseases is critical for ensuring population health.
And secondly, on a personal note, I thought it unusual that so many of my colleagues had not encountered these concepts already in their day-to-day lives. As a member of the LGBT+ community, this information is hard to miss – and rightly so!
Education around sexual health and wellbeing, including HIV, is present in almost all areas of the LGBT+ community. We see these messages at our pride events, in our magazines, in our bars and clubs, in our media and now have online resources at our fingertips. I found it hard to imagine this information not being as freely available to others.
This raises the question of an apparent disparity in HIV health literacy between different communities. UKHSA figures from 2020 showed that 49% of new diagnoses were in heterosexuals, and we already know that these cohorts are more likely to be diagnosed late, which is associated with poorer outcomes.
The UK has not had a national government-backed HIV campaign since the infamous ‘tombstone’ campaign of 1987. The HIV landscape of today is almost unrecognisable, but unfortunately, it seems that many people have not been kept up to date.
All healthcare professionals, including pharmacists, should welcome opportunities to educate themselves and their patients about what HIV looks like today. Whether it be signposting patients who may benefit from PrEP, helping maintain compliance for those on treatment, or even supporting NHS trusts to roll out ‘opt-out’ HIV testing – we all have a role to play in ending HIV.
By Adam Somerville, Clinical Pharmacist and PDA LGBT+ Network member
Get involved
- Follow the PDA LGBT+ Network on social media using the hashtag #PDAlgbt
- For more information about the PDA LGBT+ Network, click here.
- If you would like to get involved with the network and its activities, please email: [email protected]
Learn more
- The BMJ Best Practice – HIV infection
- British HIV Association current guidelines
- Pharmaceutical Journal – Eliminating HIV: are we on target?
- HIV drug interactions
- i-base guides
- i-base guides – ARVs
- The HIV podcast
Not yet a PDA member?
If you have not yet joined the PDA, we encourage you to join today and ask your colleagues to do the same.
Membership is FREE to pharmacy students, trainee pharmacists, and for the first three months of being newly qualified.
Read about our key member benefits here.