Finding Resources For Antiretroviral Stewardship

Segment Description: Daniel Chastain, PharmD, BCIDP, clinical assistant professor at the University of Georgia, discusses how antiretroviral stewardship might practically be implemented in the context that antimicrobial stewardship as a whole is often underdeveloped.

Interview Transcript (modified slightly for readability):

Chastain: I think that's one of the bigger questions that's going to come out of all this with the paper that was published, they really put an emphasis on having an individual solely doing antiretroviral stewardship. That's going to be a little bit difficult in most situations where antimicrobial stewardship as a whole is typically underdeveloped and sometimes even underfunded with FTEs [full-time equivalents].

The best way would be through a series of different things. One being an accurate way to identify these patients, whether it be through alert with ICD 9 or ICD 10 codes, or even medication specific alerts and that there's some sort of flag with a clinical decision support that lets you know a patient is being ordered or prescribed this medication.

The other thing is education, which is the simplest but most difficult of all in the perspective of making sure that the pharmacy staff and also medical staff, whether it be interns, residents or fellows, understands the importance of antiretroviral therapy, because there's a lot of individuals, a lot of prescribers who have some angst about, oh, it's an HIV medication, I'll just continue it, and we're not going to press forward in terms of making sure that these patients are compliant and that we have it.

And then lastly is formulary status.

I think that's going to be one of the more difficult ones because these medications are expensive. And they're not widely used and not used as much as say, an antimicrobial agent, amoxicillin or, or cefazolin even for that matter, and so we'll have to figure out what's the best way to transition these patients from the outpatient to the inpatient setting, but hopefully, at least this gets the conversation started in terms of pressing forward and hopefully curbing some of these errors that we've seen in HIV-infected patients.