Physicians’ Notes: Caring for Patients Taking Antiretroviral Medications

These drugs are covered by the provincial High Cost Drug Program for all individuals with Alberta Health Care and are dispensed through designated pharmacies; coverage is normally limited to prescribing by authorized experts who are part of a multidisciplinary team. This team, including nurses, social workers and pharmacists, is critical in providing adherence support, addressing basic social needs, ensuring appropriate laboratory monitoring and assessing complex drug resistance and drug-drug interaction issues, all essential to achieving good health outcomes for patients, optimal benefit from use of these costly drugs and reducing transmission in the community.

Recently, increasing numbers of First Nations patients who have been lost to follow-up have been found to have been receiving antiretroviral therapy prescribed by physicians without special experience in HIV care or affiliation with the multidisciplinary team. In some cases, inappropriate or incomplete regimens have been prescribed-in one particularly concerning case, to a pregnant woman whose therapy was critical to preventing transmission to her infant-usually without appropriate laboratory and clinical monitoring or allied health worker support.

The medications appear to have been dispensed by a small number of pharmacies and billed to Non-Insured Health Benefits (NIHB) Program, Indigenous Services Canada (ISC), contrary to NIHB policy and College of Pharmacy guidance (for patients who have an Alberta Health number).

The concern of the Northern Alberta HIV Program relates to the resulting loss to follow-up and compromised care, specifically involving First Nations patients, a group where our program strives to achieve care and treatment results comparable to those of other Albertans.

We are working with NIHB (Alberta Region and National HQs) and the Alberta College of Pharmacy to find practical solutions to these problems. However, we want Alberta physicians to be aware of potentially serious unintended consequences if asked to provide a prescription for antiretroviral medication.

Under limited circumstances (e.g., a First Nations individual resident in, and receiving HIV care in another province, but who runs out of medication while visiting Alberta) a short term (<30 days) prescription to prevent treatment interruption might be reasonable. However, communication by the patient or the physician with the patient’s usual HIV care provider and/or the Northern or Southern Alberta HIV Program would be desirable, certainly before the 30 day supply runs out.

Questions? Please contact Ted Birse, Nurse Clinician for AHS’ Northern Alberta HIV Program, at ted.birse@albertahealthservices.ca.