Wednesday, October 26, 2016

HIV Alphabet Soup - From ABC to ZDV

Posted by James Shen at Wednesday, October 26, 2016

I was fortunate enough to spend my 3rd rotation in Chicago, IL for an HIV/AIDs community specialty rotation. There is a steep learning curve for this rotation, especially considering the brief amount of time spent covering HIV/AIDs during school. Making sense of the ~300 page DHHS guidelines, and memorizing every detail about each of the various HIV drugs took up way more time than I would like to admit. However, at the end of the rotation, I can definitely say that I had the knowledge, skills, and confidence to be able to counsel and manage a patient’s HIV/AIDs diagnosis and drug regimen.

Typical Weekly Activities
Rotation ran from 9am to 5pm each day. On Mondays, Wednesdays, and Thursdays, we were at a Walgreens located inside the Howard Brown Health Center, which is a clinic that serves a large volume of LGBTQ and underinsured patients. It is an incredibly high volume store, and it can be very overwhelming for someone who has not worked in a community setting before. On my very first day when I walked in, before I even got a chance to introduce myself to my preceptor, I was already asked to administer a Hepatitis B shot to a patient that had just come in! Other than that, our activities at Walgreens varied; we would usually start off the day by preparing patient pillboxes, making calls to patients that were newly started on therapies, and calling patients about ADAP (AIDs Drug Assistance Program) packages. From there, we would meet up with our preceptor to have some topic discussion, ranging from drug mechanism of actions, to STDs, to HIV epidemiology… whatever the topic was, you can be sure to be questioned about every minute detail until you understood it inside and out. We also participated in a large MTM (medication therapy management) project, which means we helped conduct MTM interviews with multiple patients that came in each day. This entailed performing a complete work up of the patient (looking at lab values, vaccination records, drug interactions, etc.) and then talking/counseling the patient about any concerns he or she had. Finally, by the last 1-2 weeks, we were performing typical pharmacist duties, which included verifying orders, checking technician work, counseling patients at the window, etc. The patient population and drug regimens seen at this site are very unique, and each day was definitely something new and exciting.

On Tuesdays and Fridays, we went to Mercy Hospital where we served in one of the clinics alongside with nurses, PAs, doctors, and other hospital staff. This was definitely a unique component of this rotation, as we were able to see patients one on one and counsel them about their HIV regimens and other drug-related concerns. A typical counseling session could involve readiness assessments (whether or not a patient is ready to begin HIV therapy), medication adherence assessments (whether or not a patient is taking their medications appropriately), and initial therapy counseling (helping patients choose a therapy that is right for them). For example, I personally helped a patient make a switch from an outdated HIV regimen to a newer more tolerable regimen simply by educating him on his options, counseling him on the side effects, and helping him choose a regimen that would best fit into his lifestyle. These clinic days were my favorite part of this rotation, and it provides a unique clinical experience that I think other community rotations do not offer.

Other projects
While you are kept busy with the daily day-to-day topic discussions and activities of rotation, we also had side projects that supplemented our experience on this rotation. For example, we helped create an inservice presentation to the psychology residents and externs at Mercy Hospital, where we presented about the pros and cons of various HIV regimens, as well as the differences between PrEP and PEP therapy. Additionally, we helped construct a database for Hepatitis C patients who had visited the clinic, which included information on their labs, treatment regimens, genotypes, etc.

Final thoughts

This was definitely one of my most rewarding rotations, and I feel like I came away with a new wealth of knowledge. The diverse patient population lends to an experience that is very unique, and I was able to learn more about HIV/AIDs then I ever imagined. On top of all of that, Chicago is an absolutely great city to explore and live in for a month. During my free time, I was able to attend a free airshow along the lake, visit Navy Pier, see the Bean at Millennium Park, explore the Field Museum of Natural History, walk through the expansive Chicago Botanic Gardens, ride down the Chicago River on an architectural boat tour, eat a lot of great food at the multitude of restauraunts, and much, much more! I would highly recommend this rotation to anyone looking for a unique community experience. Attached are just a few of many pictures of my experiences.

Chicago Air and Water Show

Chicago Botanic Gardens

 Architectural boat tour

Underneath the bean!

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