HIV Prevention and the Role of Pharmacists

Join Ashlee as she talks with Bernadette Jakeman, an ID-HIV specialized prescribing pharmacist and associate professor at the University of New Mexico College of Pharmacy. Her expertise lies in infectious diseases and HIV, a field that she's deeply passionate about and has dedicated her career to.

Listen in as she takes us on a fascinating journey, recounting her unique trajectory in the field of pharmacy, her experiences with an HIV specialist in an outpatient setting, and the incredibly impactful work she is currently doing within the HIV community.

In this episode, the two discuss:
- Bernadette's unique pharmacy career path
- Bernadette's work within the HIV community
- How pharmacists play a role in HIV prevention
- The updated Pre-Exposure Prophylaxis guidelines

 For those keen on learning more or who work in the field, Bernadette has prepared an insightful course titled "Preparing for Tomorrow: A Pharmacist Guide to HIV Prevention". So, gear up to learn, engage, and feel empowered to discuss PrEP with patients and advocate for those who need it.

To learn more about CEimpact's By Design memberships and to gain access to Bernadette's course, click here.

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Transcript

Pharmacist's Expertise in HIV Prevention

Speaker 1 0:00

Bernadette, welcome. To Level Up, I'm really excited to have you on our show. I think that what your area of expertise is so interesting and I'm excited to get to know you more.

Speaker 2 0:13

Thank you. Thanks so much, Ashley, for having me.

Speaker 1 0:15

Yeah, why don't you share with us and the audience a little bit about your background, what type of pharmacy you practice?

Speaker 2 0:23

Sure, I'm an associate professor at the University of New Mexico College of Pharmacy and I did a PGY1 and PGY2 in infectious diseases HIV so the state of New Mexico allows for the licensing of prescribing pharmacists. So currently I'm licensed as a prescribing pharmacist clinician at the Truman Health Services Clinic at the University of New Mexico and we serve the majority of people with HIV in our state, so that's where I spend a lot of my time. Wow.

Speaker 1 0:54

Two big things. You just said you did a residency in ID, infectious disease and HIV. Did you subspecialize? I didn't even know that was a thing.

Speaker 2 1:04

So you can do infectious diseases residencies that really focus on just one of the two, but this one had a lot of bulls. That's why I picked it.

Speaker 1 1:15

That's so cool.

Speaker 2 1:17

Yeah.

Speaker 1 1:19

So you knew right out of pharmacy school that you wanted to work in the HIV community.

Speaker 2 1:25

I did. I always had an interest in HIV and infectious diseases. I loved micro. I also read a number of books on the HIV epidemic in pharmacy schools. So Tracy Kitter's Mountains Beyond.

Speaker 1 1:41

Mountains, yeah.

Speaker 2 1:43

About Paul Farmer and then Stephanie Noland's book 28, which tells 28 stories of people who have been impacted by HIV. And then when I did my APPEs in pharmacy school, I had a. Really I had an experience with a pharmacist who specialized in HIV in the outpatient clinic and she was incredibly smart and incredibly kind and everybody always came to her with the tough questions and I remember thinking that's what I want to be.

Speaker 1 2:13

That's so cool. I love that and you also so. The second thing you said was you're a prescribing pharmacist in the state of New Mexico, so I read that in your bio. I was like what is? That. Can you share a little bit more about what is exactly? Is that under your license?

Speaker 2 2:30

So it's a separate. In addition to your pharmacist license, you can get a pharmacist clinician license. So you get the license through the board of pharmacy and also get licensed with the medical board. Oh wow, Similar to prescribing a nurse practitioner, you have a VA where you have, like, a supervising physician and we do have protocols, but there's a lot of they're not necessarily algorithm driven, so there's a lot of flexibility for prescribing and I see patients my own patients in my own clinic.

Speaker 1 3:11

That's amazing. What is a day of Bernadette look like? I mean, obviously, working in academia it's always different because you have the.

Speaker 2 3:21

That's what I love about it, I know.

Speaker 1 3:23

So fun, so fun.

Speaker 2 3:25

Every day is different, but yeah, so I spend Mondays at the HIV clinic and then I also round with the Adult Infectious Diseases Consult Service at the hospital. I take students on and residents on clinical rotations, and then I'm involved with multidisciplinary clinical and research activities at Truman as well, and so that's kind of really I've been trying to get more into research that focuses on co-robidities and co-medications in the aging population of people with HIV. So that's kind of my area of interest right now. So that is so cool.

Speaker 1 4:04

I'm so fascinated by what you do. It's so unique. It takes such a special person to do what you do and I'm just kind of I don't know. Every week I get to do these shows and I think I'm the lucky person. I'm the lucky one that just gets to interview you and learn more about you, because we pull so many different faculty members inside CE Impact and we have such an incredible wheelhouse of experts and when I meet someone like you, it just shows to me how unique pharmacy can really be. Last month I talked to a veterinary pharmacist. She works with animals every day in the veterinary clinic and then I'm speaking with you and you work in the HIV population. So I think it's amazing. What was your life like during COVID?

Speaker 2 4:59

Actually it was very similar to what it is now, except so patient care we did more like phone visits, depending upon what patient preference was, but I was still in the hospital, still in the clinic. A lot of our classes went online though, so that was a little bit different. We had to pivot pretty quick, but otherwise, like clinically, it was very similar.

Speaker 1 5:27

And did anything change from your practice post COVID? What was the shift?

Speaker 2 5:35

I mean, there's the day-to-day stuff and how we do like we do a lot more Zoom visits now a lot more. Zoom visits now just because it's for patients. Sometimes it's really difficult to get into clinic if they have issues with transportation and things. So that's one really nice thing. I think that's come out of that, as we're using, taking advantage of those technologies a lot more.

Speaker 1 6:00

That's so cool, that's awesome. We brought Bernadette here for our listeners because she is going to be leading and hosting our webinar. On November 14th called I don't want to mess this up Preparing for Tomorrow, a Pharmacist Guide to HIV Prevention, and when Josh and Kathy and our team were talking about some of the discussions we were having with our guests or with our experts, I was so intrigued with this concept because, quite frankly, I was in pharmacy school 11 years ago and before we started recording, I told Bernadette I said don't judge me, I think this prep was something that came out after I graduated pharmacy school and it's the first time I'm hearing that there are not the first time, but one of the first times I'm hearing that there are targeted patients, that or specific patient population that we can have medication for, to give them to prevent getting HIV. It's just, I mean, that's a miracle to me and I was so impressed that that's your specialty. So talk to us a little bit about the bullet points and some of the objectives of that presentation.

Speaker 2 7:25

Yeah, so it's really exciting to be able to talk to pharmacists about prep, because it's definitely, you know, it's one of the tools in our tool ROCS to fight HIV and it's we use medications that we typically treat HIV with. So we use Truvada Descovy and we've got this new injectable.

Speaker 1 7:45

Yeah.

Pharmacists' Role in HIV Prevention

Speaker 2 7:46

Formed for prep, so I'll go over that as well. And it's yeah, it's really exciting to be able to offer this to patients, and I think pharmacists are in a great spot to do that Because, you know, a lot of times they're on the front lines. They can provide that info to the patients, and I think that's the issue a lot of times, you know, people aren't aware that this is an option. So I think that's great. Pharmacists can start that conversation in their communities, hopefully.

Speaker 1 8:19

So do you think the vision of this is to help provide education to pharmacists, to help identify the patients that are at risk?

Speaker 2 8:30

Yeah, and I think honestly, you know, with the updated guidelines for PREP it's recommended for adults and adolescents over 35 kilograms without HIV who are at risk for getting HIV. So that's a lot of people in our communities and that can be risk of acquiring HIV through sex or through injection, drug use and the guidelines you know are recommending it for, basically, you know, all sexually active adults and adolescents patients that are requesting PREP or want to learn more about it. You know those patients should be offered and have that discussion about you know if it's right for them. There's some screening things like you know, things that we're looking for, you know. So if patients have had a partner where they don't know the status, have those discussions about PREP and see if that would be appropriate. So I'll go through that in the podcast and the CE.

Speaker 2 9:35

Learning how to identify Webcast.

Speaker 1 9:36

Sorry, yeah, that's okay, it's all the webinar webcasts. I mean, you know, whatever we all, it's all ways of different platforms of learning.

Speaker 2 9:45

I think the big thing is that the guidelines have changed to really try to offer this to more patients, just because we really do want to see the new cases of HIV drop. So being able to provide this on a bigger scale is really the goal.

Speaker 1 10:03

Do you think this is this part of specialty medication realm? Is this? Are they specialty meds considered?

Speaker 2 10:10

Yes, so they are specialty meds, but I think there is a big push. Obviously there are HIV medications, but as far as PREP goes, they're really there's a push to try to get this really incorporated into basic primary care so that this is offered not by HIV specialist but really by primary care providers. That would be ideal so that everybody's having that conversation as part of their like annual, you know discussion with their physician or provider.

Speaker 1 10:43

Do the studies? I'm just curious, like how that looks on a day to day basis. Do they the studies show that when someone is, when a patient is identified as high risk and when they're actually prescribed the medications and they get, they fill them? What is the adherence rate typically?

Speaker 2 11:03

Yeah, so it varies depending on what studies you look at, but definitely PrEP works better with better adherence, and I'll talk about that as well during the webinar. But we also do have other options too, where maybe, if adherence is a concern, like now with the long-acting injective- yeah option for patients where maybe adherence might be a concern. So yeah, so we've got, and I think there's just going to be more options in the future too. So it's really exciting.

Speaker 1 11:35

That's amazing. I mean, it's hard for me to conceptualize wrapping my head around this of. This is the next level of pharmacy and HIV prevention. It's so fascinating to me that it's almost like how are we going to do this? But I think with the right tools and training from clinicians like yourself, educating pharmacists in the community, it's shown. Evidence has shown that it's working.

Speaker 2 12:02

Correct. Yes, so PrEP, as long as patients are taking it is effective in preventing HIV. So it's, yeah, very, very exciting, very important tool in preventing HIV.

Speaker 1 12:15

Amongst many other prevention mechanisms.

Speaker 2 12:17

Yeah, and we'll talk about that too in the webinar about the different, different ways that we can try to prevent HIV.

Speaker 1 12:24

So, bernadette, I brought you on today obviously to learn more about you, and you have done a fantastic job at that, but tell us a little bit more about specific takeaways. When someone attends the webinar, what are the biggest things that you want our attendees to walk away with? That is a great question If you, if it went as perfect as possible and someone attending your presentation, and they walked out saying, oh my gosh, this was fantastic. I learned one, two and three. What would it be?

Speaker 2 12:57

Yeah, I think you know being able to feel comfortable, knowing you know how to have those discussions with patients because we also go over that as well, because sometimes these can be uncomfortable topics. But having pharmacists feel empowered to have that discussion with patients, being comfortable and recommending different regimens for different types of patients, because some are approved in in women, some are not.

Speaker 1 13:22

Okay.

Speaker 2 13:23

We'll talk about you know which ones are approved in which patients and, yeah, I think just being being able to to advocate for prep and patients who it might benefit them.

Speaker 1 13:39

Yeah, I remember feeling in in pharmacy school and in my residency training. I loved infectious disease. It was one of my favorite topics, maybe because one of my favorite faculty and professors was teaching it, but I just remember feeling walking away with from my HIV Therapeutics and just saying, oh my gosh, I'm so overwhelmed. So I think any form of HIV CE training up to date, especially if you're working in a community, a high risk community, is so important and I went through the slides right before we got on the call and I do have to say it's pretty digestible. So for those of you who are looking for an update on just kind of overall update on HIV, Bernadette's is a great job of kind of giving you the details of what's going on in the current population but also tools and techniques on and medication that you can encourage your patients to take, especially if they're obviously part of the prep high risk patient population. So I'm excited for this.

Speaker 2 14:38

And I think you know, like moving forward, we're going to have other options as well, but I think right now it's it's really. You know, people can feel overwhelmed sometimes with HIV medications, but this is a very limited Right. We it's, it's, I think it's. It'll be easy for people to to feel like they walked, you know, walked away from this and and we're able to manageable. Yeah.

Speaker 1 15:02

Right.

Speaker 2 15:03

Yeah, so it's. You know, we've just got a few options right now and and they're great options, so it'll be wonderful to talk to everybody about those.

Speaker 1 15:14

All right. Well, it was really nice meeting you. I think this was perfect. I think it's a good little segue, a little bit of an intro of what we're going to be talking about on our live webinar. I love getting to meet you. I love getting to meet all of our guests who are coming into our by design model and just a few takeaways of what's to be expected next week. Thanks for coming on, bernadette, appreciate your time.

Speaker 2 15:38

Yeah.

Speaker 1 15:40

Good job.