CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
The global spread of the human immunodeficiency virus (HIV) has led to the unfortunate demise of approximately 40.1 million individuals [with a range of 33.6-48.6 million] up to the present time. Despite previous declines, certain countries are now witnessing an increase in new infections (World Health Organization, 2023).
Nigeria, Africa's most populous nation, has an HIV prevalence rate of 1.4%, placing it third in terms of the number of people living with HIV aged between 15 and 49, totaling 1.9 million individuals. The lack of understanding regarding the transmission of HIV has been identified as a contributing factor to its ongoing spread (Ukaegbu et al., 2022).
HIV is a retrovirus that specifically attacks CD4 T lymphocytes, ultimately leading to their demise and causing severe immune deficiency in the infected person. When the CD4 count drops below a certain threshold, the individual's immune system becomes incapable of effectively combating opportunistic infections and tumors (Waymack and Sundareshan, 2023). Without appropriate treatment, the majority of HIV-positive patients are likely to progress to AIDS, the final stage of the disease, within a decade.
After the initial infection, patients may exhibit symptoms of primary infection within a span of two to four weeks, followed by a prolonged phase of chronic HIV infection that can persist for several decades (Brew and Garber, 2018; Capriotti, 2018). The defining characteristics of AIDS include the occurrence of opportunistic infections and tumors, which can be fatal if not treated promptly (Javadi et al., 2018; Pires et al., 2018).
Based on a thorough examination of national reports, it is evident that HIV is no longer solely a healthcare crisis but poses challenges across all sectors (South Africa Human Development Report, 2003). The disease hinders development by causing a steady decline in key indicators of human development, thereby reversing the social and economic progress that African nations strive to achieve (Zambia Human Development Report, 2007; Zimbabwe Human Development Report, 2003).
HIV/AIDS, simultaneously being both a cause and a consequence of poverty and underdevelopment, presents a significant challenge to human security and human development. Its presence undermines efforts to alleviate poverty, combat hunger, achieve universal primary education, promote gender equality, reduce child and maternal mortality, and ensure environmental sustainability (Zambia Human Development Report, 2007; Boutayeb, 2009).
The impact of HIV/AIDS goes beyond physical health, as it shortens human life, diminishes people's sense of dignity and self-esteem, leads to social exclusion, and inflicts trauma and impoverishment upon individuals, families, and entire communities. This disease has the potential to undo the progress made in human development over the past few years (Boutayeb, 2009).
As the HIV epidemic continues to evolve, new challenges arise in the realm of successful care and prevention. In response to these challenges, healthcare providers, including pharmacists, are adapting and expanding their roles to ensure optimal patient care (Smith et al., 2010; Smith et al., 2013). Over the past five decades, the role of pharmacists has undergone significant transformations. They have moved beyond their traditional duty of dispensing medications and have embraced a more active role in providing clinical services.
This expanded role now includes tasks such as patient education, direct patient care, and involvement in the management of chronic diseases through team-based care. To support these advancements, specialized training programs such as residency programs and certificate programs have played a crucial role in expanding the scope of practice for pharmacists.
The evolving role of community pharmacists highlights their unique position in improving access to care for individuals within their local communities. In addition to their primary responsibility of dispensing medications, community pharmacists now play a vital role in patient education. With additional certifications, they can also take on tasks such as prescribing and administering medications, further enhancing their impact on patient care (Bodenheimer and Sinsky, 2014).
Pharmacists have long been recognized as vital members of the healthcare team for HIV patient care, and their involvement has been linked to improved outcomes in managing individuals living with HIV. The contributions of pharmacists encompass various activities that positively impact treatment outcomes (Mgbahurike and Cecilia, 2021)
Given the significance of pharmacists' role in HIV management, this study aims to investigate their specific contributions within the context of Nigeria. The research seeks to explore and analyze the role of pharmacists in the management of individuals living with HIV in Nigeria, providing valuable insights into their impact on patient outcomes and overall HIV management.
1.2 Statement of the Problem
The role of pharmacists in HIV management has been extensively studied in various settings, predominantly in the United States, Canada, Europe, and Australia, with limited research conducted in Africa. Pharmacists have been identified as key healthcare providers who can contribute significantly to HIV care by providing information, education, and counseling to promote adherence to antiretroviral (ARV) treatment regimens.
Their roles have evolved from inpatient infectious diseases training to specialized clinical pharmacists in outpatient units, specifically trained in the treatment of people living with HIV/AIDS (PLHA) (Henderson et al., (2011); Ma et al., (2010); Heelon et al (2007); March et al (2007); Castillo et al (2004); Carcelero et al (2011); Levy et al (2004); Horberg et al (2007).
Pharmacists' primary contributions in HIV service provision include medication adherence counseling, education on dosing intervals, review of medical records to identify medication errors and opportunities for ARV adjustment, dispensing of ARV drugs, and implementation of adherence improvement strategies.
These studies have also demonstrated the positive impact of pharmacists' roles in HIV management. Their involvement has been associated with increased adherence to medication, reduced dosing frequency and pill burden, improved clinical outcomes, and decreased CD4+ cell count, viral load, and drug-related toxicities.
However, the Nigerian healthcare system has its unique characteristics and challenges, which may influence the role and effectiveness of pharmacists in HIV management. Therefore, there is a need to extensively explore the specific context of Nigeria and examine the contributions of pharmacists in HIV care within this setting.
1.3 Aim of the Study
The aim of this study is to examine the role of pharmacists in HIV management in Nigeria
1.4 Objectives of the Study
The study had the following specific objectives:
- To identify the roles of pharmacists in HIV management in Nigeria.
- To determine the impact of pharmacist interventions in HIV management in NIgeria.
- To propose recommendations for improving the role of pharmacists in HIV management.
1.5 Research Questions
- What are the roles of pharmacists in HIV management in Nigeria?
- What is the impact of pharmacist interventions in HIV management in Nigeria?
- What recommendations can be made to improve the role of pharmacists in HIV management?
1.6 Research Hypothesis
H0: Pharmacists do not play significant roles in HIV management in Nigeria.
Ha: Pharmacists play significant roles in HIV management in Nigeria.
1.7 Justification of the Study
This study is essential to understand the current role of pharmacists in HIV management in Nigeria. The findings can contribute to policy development, healthcare planning, and strategies to strengthen the pharmacist's role in HIV care. Enhancing the involvement of pharmacists can lead to improved treatment outcomes, increased patient adherence, and better overall management of HIV in Nigeria.
1.8 Scope of the Study
This study will focus specifically on the role of pharmacists in HIV management in Nigeria. It will encompass various aspects of pharmacist involvement. It is important to note that the study does not cover other healthcare professionals' roles in HIV management, but specifically focuses on the contributions and effectiveness of pharmacists in improving patient outcomes and enhancing the quality of HIV care.
