Effect of mobile text messages on antiretroviral medication adherence and patient retention in early HIV care: an open-label, randomized, single center study in south Florida.

BACKGROUND: People with HIV (PHIV) with limited access to health services often experience suboptimal antiretroviral therapy (ART) adherence. We investigated whether a daily text messaging intervention improves ART adherence and retention in early HIV care in PHIV in a south Florida hospital-based clinic. METHODS: ART-naïve PHIV receiving care through the clinic's Ryan White HIV/AIDS Program were enrolled and randomly assigned to the intervention or control groups with a 1:1 ratio. The intervention group received a 1-way text message daily and the control group received standard care without receiving text message reminders for 6 months. HIV RNA and CD4 cell count were measured at baseline and post-intervention. Adherence to ART was defined as a visual analog scale of ≥ 90%. Retention in care was defined as continued engagement at study end. RESULTS: 94 ART-naïve patients were randomized and 83 (85.6%) completed the study, of which 44 were in the intervention group and 39 were in the control group. At the end of the 6-month study period, adherence to ART was 84.4% in the intervention group versus 73.5% in the control group (OR, 1.9; 95% CI 0.7-5.0; p = 0.194). Retention in care significantly improved in the intervention group compared to the control group with the odds of retention increasing by 20% (OR, 1.2; 95% CI 1.1-1.5; p = 0.006). Undetectable HIV RNA (< 50 copies/mL) was 86.7% in the intervention group versus 73.5% in the control group (OR, 2.3; 95% CI 0.8-6.9; p = 0.112). A significant increase in CD4 cell count and a decrease in HIV RNA were found at study end, with no differences between the two groups. CONCLUSIONS: In this pilot study, a one-way daily text messaging intervention did not improve ART adherence over a 6-month study period, but significantly enhanced patient retention in early HIV care. Implementation of interventions to improve adherence in this population is required.

Students' versus residency programs' perceptions of a high-quality PGY1 residency applicant.

INTRODUCTION: Securing a pharmacy residency position is highly competitive, and pharmacy students must work throughout pharmacy school to ensure their applications are as competitive as possible. Several surveys asking residency programs to describe the most crucial qualities of a high-quality residency candidate have been conducted. However, no study has investigated whether congruency exists between pharmacy students' and residency programs' perceptions of these sought-after qualities. METHODS: We surveyed pharmacy students to compare their perceptions of important qualities of residency candidates for securing an interview and ultimately being ranked by residency programs. The results were compared to results of an identical previously-published survey of residency program directors. RESULTS: Student and program perceptions of important qualities of residency candidates were mostly in agreement. Students' perceptions of qualities considered for final ranking of candidates are similar among pharmacy students in professional years 1-3 (P1-P3). However, P3 students' perceptions of qualities important for interview invitations are better aligned with residency programs than P1 and P2 students. DISCUSSION: Students' and programs' perceptions of important qualities for residency candidates were well aligned on most items. However, only students perceived a letter of recommendation from the dean and North American Pharmacist Licensure Examination (NAPLEX) scores as an important factor for residency. As the pharmacy curriculum progresses, students' and residency programs' perceptions of the most important qualities used to ultimately rank candidates appear to converge; however, perceptions of important characteristics for an interview invitation were consistent over time. CONCLUSIONS: Overall, perceptions of components of a high-quality residency applicant are congruent between residency programs and students.

Patient Perceptions of Text Messaging to Improve Antiretroviral Therapy Adherence: A Qualitative Study of Patients in a Ryan White Clinic.

Evidence on the use of short message service (SMS) to improve medication adherence in people living with HIV (PLHIV) is mounting, yet qualitative research on patient perceptions regarding SMS content and utility for HIV/AIDS remains nascent. To explore the experience of receiving medication reminders via SMS among PLHIV, 45 uninsured and underinsured PLHIV nested within the intervention arm of a larger study received daily, 1-way SMS adherence reminders. Qualitative data were collected by face-to-face, structured interview and were analyzed using conventional content analysis methods. Three main themes emerged from the data: (1) reminders helping with adherence, (2) concerns about delivery modes, and (3) the need for confidentiality. Study findings offer enhanced focus on an emerging strategy in patient-centered HIV care: Equipped with greater context on the experiences of PLHIV using SMS adherence reminders, health-care providers can offer more targeted support and thereby maximize the benefits of this popular and powerful technology.

A Comparison of the Use and Quality of Antidiabetic Medication Regimens Between Non-Hispanic Black and White Adults With Uncontrolled Type 2 Diabetes in the US: NHANES 2003-2012.

PURPOSE: The purpose of this study was to determine the use of clinical guideline-recommended antidiabetic therapies among whites and blacks with uncontrolled type 2 diabetes. METHODS: A secondary data analysis based on NHANES 2003-2012 cohort data including non-Hispanic black and white adults with uncontrolled (A1C ≥6.5%) type 2 diabetes. RESULTS: Blacks were more likely to have the highest levels of A1C compared to whites (A1C >9% = 29.8% vs 16.2%). There was no statistical difference in the use of recommended regimens across racial group (blacks 60.5% vs whites 66.0%). Blacks and whites who were most uncontrolled were least likely to be on recommended regimens (A1C 6.5%-7.4%: 78.5%, A1C 7.5%-9%: 57.2%; and A1C >9%: 54.1%). This pattern was most pronounced among blacks compared to whites but was not statistically different. Use of recommended therapies decreased 29.0 percentage points for blacks and 20.1 percentage points among whites from an A1C level of 6.5% to 7.4% to >9%, respectively. The total proportion of blacks and whites on intensified non-insulin triple or insulin-based therapies were 38.9% and 41.8%, respectively. CONCLUSIONS: Even though blacks were more likely than whites to have the highest A1C, no significant differences were found in the use of clinical-guideline recommended regimens or other regimen use outcomes. Along with lifestyle modification, further intensification of antidiabetic regimens may help improve glycemic control and other disparities between blacks and whites.

Differences in the Use and Quality of Antidiabetic Therapies in Mexican American and Non-Hispanic Whites With Uncontrolled Type 2 Diabetes in the US: NHANES 2003-2012.

PURPOSE: The purpose of this study was to determine the use of clinical guideline-recommended antidiabetic therapies among Mexican Americans (MA) and non-Hispanic whites with uncontrolled type 2 diabetes. METHODS: A secondary data analysis based on the National Health and Nutrition Examination Survey (NHANES) 2003-2012 cohort data including MA and non-Hispanic white adults with uncontrolled (A1C ≥6.5%) type 2 diabetes. RESULTS: There was no difference in the use of recommended regimens across race/ethnic group (MA, 63.6% vs whites, 65.7%); however, MA were less likely to have regimens intensified to non-insulin triple therapies (7.3% vs 11.3%) or insulin-based therapies (23.7% vs 30.5%) and were more likely to be on no medications (17.2% vs 10.4%). Mexican Americans and whites who were most uncontrolled were least likely to be on recommended regimens (A1C 6.5%-7.4%, 83.0%; A1C 7.5%-9%, 60.6%; and A1C >9%, 50.4%). This pattern was most pronounced among MA compared to whites. Use of recommended therapies decreased 50.5 percentage points for MA and 20.1 percentage points among whites from an A1C level of 6.5% to 7.4% to >9%, respectively. CONCLUSIONS: The quality of antidiabetic therapies of MA and whites with type 2 diabetes who are most uncontrolled need improvement. Intensifying pharmacotherapies among MA may help improve glycemic control disparities. The innovative outcome used in this report may be useful in quality of care studies in the future.

Pharmacist testers in multidisciplinary health care team expand HIV point-of-care testing program.

Knowledge of HIV serostatus is the first step to accessing treatment, reducing transmission, and mitigating public health challenges. We describe the expansion of an HIV point-of-care testing (POCT) program within a health care system utilizing pharmacists as testers. The testing program's expansion is detailed and its impact assessed. The POCT program was evaluated by comparing the number of traditional HIV venipuncture tests to the number of POCTs performed across the health system as well as comparing the number of POCTs performed by clinical pharmacists to the number of tests at other POCT locations. Although pharmacists' contributions to HIV prevention are well documented, pharmacists' involvement in HIV testing initiatives is still nascent. Our POCT program demonstrates an effective HIV testing initiative driven by pharmacists and other health care providers.

Baseline-transmitted V106V/I/M non-nucleoside reverse transcriptase inhibitor resistance in HIV-1 subtype B infection.

We report a case in which an antiretroviral therapy (ART)-naïve patient diagnosed with HIV-1 subtype B presented with baseline genotype and phenotype resistance tests, confirming a V106V/I/M nucleoside resistance mutation. The V106V/I/M mutation represents a mixture of virus strains conferring resistance to the non-nucleoside reverse transcriptase inhibitor antiretrovirals efavirenz and nevirapine. V106M mutation is not often observed as a primary resistance mutation in patients infected with HIV-1 subtype B. The patient responded well to an ART regimen consisting of tenofovir-emtricitabine and raltegravir, achieving and maintaining an undetectable HIV RNA.