Philly Walgreens Specialize in HIV Outcomes

You may not know it, but your local Walgreens pharmacist could save your life with their HIV-specialized services, not only in Philadelphia, but also across the country. For the past 30 years, Walgreens has offered these specialized pharmacy services, and a new study provides evidence that they can make a huge difference by increasing adherence.

"I've been with Walgreens for almost 25 years, and we've been doing HIV work since the beginning of the epidemic," said Glen Pietrandoni, RPh, AAHIVP, an advocate for HIV/AIDS patients who oversees more than 700 Walgreens.

The first drugs like AZT came in the late '80s, and there wasn't a lot of knowledge about them at pharmacies, he said. By '96, protease inhibitors arrived, then antiretrovirals, and pharmacists decided they needed to handle these patients differently. That's when they opened the first HIV-specialized Walgreens in Chicago.

Pietrandoni said that they track data across the country for prevalence and incidence to find out which neighborhoods are hit hardest by HIV. Then they open locations in those areas, staffed with clinically trained pharmacists and staff, prescription information and the resource referrals for local AIDS service organizations.

This training is rigorous and two-fold. The American Academy of HIV Medicine mandates a robust 25 hours of clinical training that pharmacists must know, which comprises about a year's worth of information on HIV and hepatitis.

Secondly, there is stigma and cultural competency training, done by all store personnel, not just pharmacists, to know how to treat people living with HIV/AIDS. Then, there are operational things that make the program unique.

"As a company, we are invested in having the inventory available at these stores," said Pietrandoni. "People are looking for drugs, and patients' regimens get mixed up. But because we are committed to having the inventory on hand, that provides security for patients."

Pharmacists go to school for six or seven years, and emerge very knowledgeable about the disease. They are present in the community, and sometimes on hand 24 hours a day. Best of all, said Pietrandoni, people can talk to a pharmacist without having to pay a doctor's fee.

But how does this help adherence? When you visit a Walgreens pharmacy that is specialized in HIV, your pharmacist is going to be a buddy to you to be ahead of the game, to proactively know what's needed and get things ready for you before you come in.

"You might run in on your last meds, and that could catch a pharmacist off guard," said Pietrandoni. "We try to do that prep all in advance because we know a patient has to be adherent, we know what they need every month and start four or five days before to do outreach calls. If they don't come in, we call them and say 'You're due for your refill, do you need it delivered?' Anything to keep that patient engaged."

Sayuri Lio, Pharm. D, AAHIVP, is a Walgreens pharmacist that is dedicated to being an accessible resource to HIV patients with counseling and medication review/adherence and medication therapy management for comorbidity.

"I had one patient who had a lot of multiple diseases: HIV, plus high cholesterol, high blood pressure, etc. She comes here with multiple medication needs, and it's a very complicated regimen," Lio told EDGE. "One time she forgot to fulfill one of medicines, so I called her and said, 'I noticed you didn't request this medicine.' She said the doctor told her to discontinue it because it might cause kidney problems. But there is still a regimen that needs to be followed. Because I had a relationship with the doctor, I called him and he directed me to a proper regimen."

Lio said that patients can come to speak to any pharmacist, and if something doesn't match the proper regimen, they can have a conversation between the pharmacist and doctors.

"HIV health care is not just about one person, it takes a team of people, and the pharmacist is the last person who sees the patient before they take the medicine," she said. "If we don't catch this, sometimes the patient can go without the proper regimen for three months before they see their doctor again. We as pharmacists also have an impact in those patients' survival in staying adherent, preventing drug resistance and monitoring."

Pietrandoni said that this should be a model for all pharmacists to operate to address their HIV epidemic. With Walgreens across the country, they are able to help communities highly affected by HIV.

"We believe in it, and know this is the right way to do it," said Pietrandoni. "You could get a prescription filled anywhere, but to find a pharmacist that is your partner in keeping you healthy -- not just with HIV, but for your whole patient's needs -- we know how important this is."

There are many systems and technologies that go into this, said Pietrandoni, adding, "There is a big investment on the company's part, and our mission for HIV is for Walgreens' pharmacists to be part of the solution to end AIDS."