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Hi, my name is Jennifer Cocohoba, I'm a health sciences associate clinical professor in the
Department of Clinical Pharmacy here at the UCSF School of Pharmacy. And I am a *** clinical
pharmacist. I did my pre-pharmacy requirements at the University of California at Los Angeles
- go Bruins - and then did my School of Pharmacy requirements here at UCSF.
During my fourth year clinical rotations there was one patient in particular that really
kind of made me realize the importance of having good *** pharmacy care, and this was
a young 25-year-old woman, she didn't realize that she was actually *** infected, and was
suffering from a very bad opportunistic infection called "*** pneumonia." So when she rolled
into San Francisco General Hospital, she was very ill. She needed a chest tube, they were
giving her very high does heavy antibiotics, and she was essentially miserable. And she
was just as tough as they come; really just kind of trying to control her emotions and
control herself around her confusion around the disease, her anxieties around her treatment.
One day I realized that she was in the hospital and it was her birthday. So we had gone down
to the gift store and gotten her some small token - kind of a stuffed animal, or something
- and presented it to her as a tiny little birthday present to try to make her hospital
stay a little bit easier or better. So this very stoic, young lady - chest tube hanging
out of her side - actually stood up from her bed and hugged every single team member that
was on the *** consult team. And I think it also struck me that she was a young woman
of color, not much older than myself, and that had either of our choices been different
she could have been me, and I could have been her.
At the UCSF Women's *** Program, headed by Dr. Eddy Machtinger, I run a treatment adherence
program. Adhering to *** antiretroviral therapy is very important to keeping an *** positive
person healthy, because antiretroviral really strengthen the immune system against opportunistic
infections and other illnesses that can cause morbidity and mortality. However, even though
antiretroviral, it seems like an easy question, that you should just take your pills. Taking
antiretroviral is often ladened with more social implications than taking say a medication
for hypertension, or for diabetes.
One of the main reasons that it's most difficult to adhere to *** medicines is oftentimes our
patients come and are told that they need to start taking antiretroviral therapy, yet
they don't feel sick. So it's sometimes hard to find a reason to take a medication when
you don't feel sick and you know the medicines are going to give you side effects - nausea,
diarrhea, fuzzy thinking - and these can get in the way of having a normal every day life
for some patients.
So there are a lot of hesitation amongst the *** positive community, or people living with
***/AIDS, around taking *** medications. And part of my job is to help them learn a little
bit more about antiretroviral so they can make an informed decision on whether or not
they're going to take them, when they're going to take them, and which kind they're going
to take.
One of my favorite roles in the Treatment Adherence Program is simply to be a source
of support when someone has made the big decision to start their antiretroviral, to really be
there for them, to listen to them about their side effects, to help facilitate their meetings
with their doctors, and even to help them choose a new set of antiretroviral when the
fist one, or the second one, or maybe even the third one, hasn't worked well for them.
My interest in *** antiretroviral adherence has also grown into a research program. Because
adherence is so complex, finding interventions to help people adhere to their medicines better
is also something that we don't have the magic answer to. If we could somehow get people
to take their medications on a more regular basis, the hope would be that people would
be a lot healthier, and this includes people with ***, as well as people with other diseases.
So my research focus is on a specific niche, which is how community pharmacists - the people
that patients with chronic disease often see most frequently, every month, to pick up their
antiretroviral refill, or their other medication refill - how community pharmacists can help
get their patients to take their medications better.
The integration of pharmacists into the care of *** positive patients really showcases
the expertise of pharmacists. The current roles that *** pharmacists play with the patients
and with their providers, include things like providing drug information to the patients,
helping patients decipher clinical trials about new medicines, or even participate in
clinical trials for a new *** medicines, they help providers and patient unravel complex
drug interactions, provide adherence counseling, and do some simple things such as providing
adherence reminder devices, or packaging medicines in medisets, just help patients take their
medicines better.
I think the role for *** pharmacists is constantly expanding into areas we can't even think of
right now. So the *** pharmacists really displays pharmacists practicing at the highest level
of their license to make sure that there is safe and effective use of *** medicines for
patients, and really that pharmacist on the *** team, this serves as a great model for
interdisciplinary care for pharmacists and other disease states in other healthcare settings.