Serviços clínicos farmacêuticos no tratamento de pessoas que vivem com HIV/AIDS: uma revisão de escopo

Abstract

Context: Clinical services provided by pharmacists play a crucial role in the treatment of HIV LongTerm Survivors (HLTS), contributing to antiretroviral therapy adherence, therapeutic optimization, and health outcomes. Objective: This scoping review aimed to map and describe pharmacist-led clinical services in the treatment of HLTS, identifying service locations, service classifications, main outcomes studied, and the geographical distribution of studies. Methods: The Joanna Briggs Institute (JBI) recommendations for scoping reviews were followed, adhering to the PRISMA-ScR reporting guidelines. A comprehensive literature search for studies published from 1986, without language restrictions, was conducted in the Medline/PubMed, Scopus, Web of Science, Lilacs, ProQuest, and LA Referencia databases. Eligibility criteria included studies involving HLTS on antirretroviral therapy and receiving pharmacist-led clinical services in outpatient, hospital, and home-based settings. Data extraction was performed using a standardized form, and results were presented in a descriptive narrative format, accompanied by tabular and graphical representations. Results: Out of a total of 8,864 studies initially identified, 146 were included in the final analysis. North America accounted for the largest share of studies (51.87%, n=69), followed by Europe (21.8%, n=29). Observational studies constituted 48.9% of the 146 included studies, while interventional studies, including randomized and non-randomized clinical trials, represented 42.8%. Over the past two decades, there has been a notable increase in research on pharmacist-led clinical services, with peaks in publications in 2009, 2014, and 2018. The predominant service settings were outpatient clinics (n=98), followed by hospitals (n=41) and home-based care (n=2). Studies were predominantly conducted in urban areas (n=129), with few in rural settings (n=5). The most commonly studied services were medication therapy review (68.02%, n=100), health education (61.9%, n=91), and pharmacotherapeutic follow-up (61.2%, n=90). Other services included medication reconciliation (15.6%, n=23), chronic disease management (14.9%, n=22), medication dispensing (12.9%, n=19), health screening (6.8%, n=10), and therapeutic drug monitoring (4.0%, n=6). Most services were conducted solely by pharmacists (n=96), with some studies reporting collaborations with physicians (n=30) and nurses (n=15). Discussion: This is the first scoping review to map and describe pharmacist-led clinical services in the treatment of HLTS on a global scale. It demonstrated the breadth of investigations into pharmaceutical clinical services for these patients and contributed to understanding the current landscape of pharmaceutical clinical services in HLTS care. A limitation of this scoping review was the inability to access the full text of 16 studies identified in the search, which may have impacted the comprehensiveness of the analyzed data. Conclusion: This mapping provides an overview of research in the field and contributes to identifying gaps in the approach to the topic. This mapping can guide the design of future studies—including primary research, systematic reviews, or overviews—by leveraging on the existing body of literature in specific areas.