Assessing the impact of pharmacist-led antiretroviral stewardship In community hospitals on antiretroviral-related...

Antiretroviral stewardship programs have been recommended by several organizations, including the Infectious Diseases Society of America, to minimize medication errors that may adversely affect people living with human immunodeficiency virus (HIV). To date, the role of antiretroviral stewardship has largely been studied in tertiary or quaternary care medical centers with dedicated infectious diseases pharmacists, complex patient populations, and robust clinical laboratory services. Thus, limited data are available in lower-acuity community hospital settings. The purpose of this study was to evaluate the impact of pharmacist-led antiretroviral stewardship on antiretroviral therapy (ART)-related medication error rates in community hospital settings.

This was a multicenter retrospective chart review of patients receiving ART during admission to 6 community hospitals of a large health system between May and July 2024. ART-related medication errors were defined as incomplete ART regimens, inappropriate or absent opportunistic infection (OI) prophylaxis, incorrect dose adjustments due to renal function, or unaddressed drug-drug interactions (DDIs). Patients were excluded if they were receiving ART for pregnancy, neonates, hepatitis B, pre-exposure prophylaxis, or post-exposure prophylaxis, had a length of stay under 48 hours, or died within 48 hours of admission.

Of 247 patients who received ART during the study period, 94 were excluded based on the predefined criteria, with 153 patients included in the final analysis. The mean age was 52 years, and 68% (n = 104) of patients were male. CD4+ T cell counts below 200 cells/mm³ were observed in 37% (n = 57) of patients, and 77% (n = 118) were on a single-pill regimen. Pharmacist interventions occurred in 67 patients (44%), with OI prophylaxis (n = 10) being the most frequent intervention. The rate of ART-related medication errors was significantly lower in the pharmacist intervention group (7.5%, n = 5) than in the nonintervention group (23%, n = 20; P = 0.009). In the pharmacist intervention group, unaddressed DDIs (n = 3) were the most common error, whereas in the nonintervention group errors most frequently included inappropriate or absent OI prophylaxis (n = 9), incomplete ART optimization (n = 6), unaddressed DDIs (n = 5), and incorrect renal dose adjustment (n = 2).

In community hospital settings, ART-related medication error rates were significantly lower among patients who received pharmacist-led intervention, supporting the role of antiretroviral stewardship in improving medication safety in hospitalized persons with HIV.