Investigators with the University of Buffalo's School of Pharmacy and Pharmaceutical Sciences found that the 25 patients who received their program's adherence intervention had significantly better viral outcomes when compared with 38 patients who did not go through the program.

Both groups were similar at baseline, but the intervention group's 48-week data showed viral loads that were undetectable in 84 percent of participants. Comparison group viral loads were undetectable in 37 percent of patients, said Lori Esch, PharmD, clinical assistant professor at UB. However, the antiretroviral regimens were not standardized between the intervention and comparison groups, and that may have given the intervention group an advantage.

Esch described how the program works:

• Specially trained pharmacists, pharmacy residents, and nurse educators collaborate with physicians in treating patients, and meet one-on-one with patients to discuss their disease before they have been prescribed medications, Esch said. Educators assess the patient's levels of commitment and interest in his or her health. They help patients understand HIV terminology and basic issues involved in antiretroviral treatment. Through this patient-provider dialogue, pharmacists can understand the patient's lifestyle, concerns, and potential adherence barriers, such as issues with confidentiality, pill burden, pill time and commitments, Esch said.

• Patients make repeated visits until they are ready to begin a medication program. When patients decide they are ready to start medications, the team works with them on selecting a time to start the drugs, because some patients might want to put off their drug regimen until after a particular life event.

• The provider team comes up with a plan for the patient's treatment regimen. Patients are included in the planning, and pharmacists work with physicians to select an optimal antiretroviral regimen for each patient. Back at the clinic, patients are shown "what the pills look like, how they should be stored, and what each side effect could be," Esch said. Pharmacists discuss how patients should handle side effects and give patients tools, such as beepers, charts with stickers, and alarm watches, to help them remember to take their medications and fit their regimens into their daily activities.

• Ongoing team support is provided. Generally, within three days of the patients' last pharmacy visit, the pharmacist will call the patients to see how they are doing with the regimen. Then patients are brought back in for a pharmacy visit two weeks into the new regimen; pharmacists talk about adherence and make sure patients can handle any problems. "We provide intensive support over the first couple of weeks," Esch said. Patients are given emergency telephone numbers to call whenever they need help. Also, nurse educators may visit patients, and social workers will be involved in assisting patients with any potential barriers, such as substance abuse issues, domestic violence, child care, financial and other issues, Esch said.

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