Dr. Ramesh Adepu
Professor
Department of Pharmacy Practice,
JSS College of Pharmacy,Mysore
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Men
Woman
Children
: 32.2 million
: 18.0 million
: 2.8 million
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Total
: 42.5 million
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5.7 million cases
On an average 3500 Indians are contracting
HIV every day
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9 out of 10 infected women are living in developing
countries
25% - 30% of the infected patients are women and
90% of them are between 20 to 49 yrs of age
Around 500,000 infants per year acquire HIV
infection through mother to child transmission
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Social mobilization
Improving treatment of STDs using the syndromic
management approach
Work place programs
Community and home based care
Practical strategies for reducing mother to child (MTC)
transmission
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In Prevention
Treatment and care
Human legal rights
Monitoring, surveillance and research
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Promotion of safe and healthy sexual
behavior
Improve the management and control of
STIs
Reduce mother to child transmission
Provide appropriate post exposure
services
Improve voluntary testing and counseling
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Providing information to the patients
regarding disease, medication, diet and life
style modifications and assisting the patients
in clarifying the doubts and in taking suitable
decisions with respect to the management of
the disease.
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To improve the patient’s understanding about
the disease and its management
To improve the medication adherence
behaviour and improved therapeutic outcomes
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To adopt healthy lifestyles
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To improve the quality of life
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Psychological counseling and buffering effect
of social support reduces the stressors and
improves the ability of an individual to lead
normal life.
Susan S, J Mohr, N Singh et al. Quality of life in patients
with human immunodeficiency virus infection: impact of
social support, coping style and hopelessness. Int. J STD
AIDS. 1999;10:383-391
Social support is the major factor in
improving the quality of life in HIV
patients.
Murdaugh C. Health-related quality of life in HIV disease:
Achieving a balance. J Asso Nurses in AIDS Care. 1998;9:5971.
Nunes JA. Raymond SJ. Nicholas PK et al. Social support,
Quality of life, Immune function, and Health in persons living
with HIV. J Holis Nursing. 1995;13:174-198.
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Studies on adherence behavior have
observed that educational
interventional strategies have
enhanced the medication adherence
behavior in HIV/AIDS patients.
Christopher M, Gordon. Commentary Meta-Analysis of
Randomized Controlled Trials for HIV Treatment Adherence
Interventions. J Acquired Immune Deficiency Syndrome.2006;
43:36-40.
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Pharmacist’s educator role in analyzing
barriers in adherence and strategies to
overcome them in HIV-infected patients
by providing pharmaceutical care.
Cantwell-Mcnelis K, Christoper W, James. Role of
clinical Pharmacist in Outpatient HIV Clinic.
Medscape .2002; 59:447-52.
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The Study findings conclude that structured
education provided by the pharmacist to
patients living with AIDS improved their
awareness regarding the disease, coping with
disease related challenges and in turn
improved the overall quality of life scores
showing a strong association of education
with therapeutic outcomes and QoL.
Dinesh Jain, Ramesh Adepu, Nagavi B.G and S.N.Mothi,
Unpublished thesis, RGUHS
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In a randomized study conducted at a NGO
AIDS Care research center, pharmacist
provided counseling has shown a significant
improvement in adherence behavior. The
study also observed a significant increase
(p<0.01) in the number of patients, shifting
from positive screen to negative screen
scores of BMQ.
Mini, Ramesh Adepu, S.N.Mothi, T.Swami, Unpublished thesis,
RGUHS 2008
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Different modes of transmission
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Condoms usage and Safe sex practices
Use of disposable syringes
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Making a change in
the sexual practices
is an important way
to minimize the risk
of HIV transmission.
Limit the sex
partner to one
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Not to share the needles of others.
Incase of any cut with sharp instruments,
clean the area with disinfectant like soap or
Dettol and consult the doctor.
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Use of good quality condoms protects against
the transmission of disease.
Patients must be counseled regarding the
proper use of condoms such as,
How to open the condom packet,
How to unroll,
Use of the condom,
Removal and disposal of the condom.
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Counsel the patient about the name, purpose,
dose, frequency, and importance of medication
and its adherence in controlling the disease.
Brief the patient about the possible adverse
effects of anti retroviral therapy and should be
encouraged to report those adverse effects if
at all they experience the same.
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Diet should be balanced and
nutritious with plenty of fibers
and liquids.
Patients must be told not to
use raw food items and
unpasteurized milk.
They should be told to wash
fruits thoroughly and
preferably peel them, as there
may be germs on them.
To maintain personal
hygiene
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To maintain personal
hygiene, wash the
hands with soap
before and after
taking food and after
using the toilet.
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Patients should be
told to avoid alcohol,
tobacco, narcotic
drugs and situations,
which force to
indulge in to the
activities, which
worsens their
problem.
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Patients should
be encouraged to
have friends and
build their own
associations that
help them for
recreational
purposes.
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They must be
told to be away
from sick people
and check for
opportunistic
infections
especially TB.
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Patients should
be encouraged
to visit their
clinician on a
regular basis for
better care.
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The HIV positive individuals are counseled in
a private environment through integrated
counseling and testing centers.
There are now more than 4000 ICTCs which
are mainly located in government hospitals.
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A place where a person is counseled and tested for HIV,
on his own will or as advised by a medical provider.
The main functions of an ICTC include:
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Early detection of HIV
Provision of basic information on modes of transmission
and prevention of HIV/AIDS for promoting behavioural
change and reducing vulnerability
Link people with HIV prevention, care and treatment
services.
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Sex workers and their clients,
Men who have sex with men (MSM),
Transgender,
Injecting drug users (IDUS),
Truckers, migrant workers,
Spouses and children of men who are prone to
risky behavior.
Patients who have a history of risky behaviour or
have signs and symptoms suggestive of
HIV/AIDS
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Provide treatment, care and support services
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Assisting the clinician to choose rational
regimens
Providing unbiased drug information
Calculating dosing of drugs based on lab
parameters.
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By playing in an important role in procuring and
supply of anti retro virals, antibiotics, TPNs, anti TB
drugs and anti fungal drugs.
Providing information on rational use of anti
retrovirals
Encouraging HIV patients with TB to have DOTS
therapy.
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Playing an active role in support groups in
communities, patient counseling and home based
care.
Pharmacists also have a role to play in offering
advice in linking antiretroviral use, lifestyle
modifications, and nutrition
Educating the public to minimise the social stigma.
Displaying the charts,
Calendars in the pharmacy,
Displaying the messages on the leaflets given to
the patients,
Wearing a badge around the arm that he can
give information on AIDS to the patients.
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Non judgmental
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Empathetic
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Maintaining the confidentiality of the patient
details and data