How pharma can support patients: HIV and Sexual Health

Jacky Law talks to a consultant physician in HIV and Sexual Health, about how pharma companies can better support patients in her field.

In the latest in a series of interviews with Doctors.net.uk members, a consultant HIV physician at a London teaching hospital highlights how pharma companies may help the care of HIV patients from a secondary to a primary care setting

Interview summary

Can you describe the biggest challenges in your therapeutic area in terms of how pharma companies might be able to help?

One area we struggle with is in attending HIV conferences to present research. The traditional support from pharma companies in terms of sponsoring physicians has declined in recent years and registration at HIV conferences is expensive. That is a big opportunity that used to be there. The companies stopped with the recession in 2008. It might be that money is tight, but it is also to do with transparency and ethics. These two elements mean that the money that we had become accustomed to has gone, and we really miss it.

Is there anything pharma can do to improve adherence rates to treatment?

I work at a large London teaching hospital and in our clinic setting the people who work in adherence are our clinical specialists and pharmacists. I know there have been some initiatives from pharma with companies such as Gilead Sciences sending text reminders to patients to take their medication. I am not aware of any other companies doing anything.

Is there a role for pharma in helping to improve education for doctors?

The companies put on a lot of education events but these tend to be after school so only a proportion of the medical community is ever going to attend. If you have kids, as I do, you won’t be able to attend, so it is only a certain type of doctor that benefits. Since having kids I haven’t been to one.

Is there a role for pharma in helping to improve education for patients?

Our education events are run by our patient forum and I don’t think they are sponsored by pharma. There is a lot of information out there for patients. They’ve got the National AIDS Trust (NAT), NAM (originally NHS AIDS Manual), the NHS and various other organisations, which all tend to be very pro-active. To be honest, it’s never occurred to me that pharma should be doing more in this respect.

How do your patients regard the industry and do any companies stand out in terms of reputation?

In answer to the second question, no, I don’t think patients know enough about the different companies to form an opinion. And in terms of the industry in general, I don’t think drugs companies come off in a good light even though the HIV drugs do save lives. A lot of people are suspicious of pharma. They think that rather than trying to find a cure they are keeping them on drugs so that they can get rich. It may be, of course, that these people who express an opinion are a self-selecting group and other patients think differently but what I tend to hear stems from a generally bad reputation.

What kind of joint working projects with the NHS would you like to see pharma companies getting involved in?

One area for joint working lies in reconfiguring patient pathways in HIV, which will inevitably change because everything is so much simpler than it was, say, eight years ago. The push is to diagnose and treat early. So increasingly we are diagnosing people with high T-cell counts when they are well and putting them on a once-a-day drug. When the new drugs come out, there is usually no resistance so it begs the question of whether they need to be seen in secondary care?

The other thing is that generics are around much more now, so treatment is much cheaper, and also GPs are open from 7.30am-7.30pm. We’re not. We are open from 9am-5pm with one late clinic a week. How can we compete with primary care? Consider the experience of one of the big HIV clinics in Dean Street, central London. It is very successful. It looks after 2,000 HIV patients and 50 percent of those will be on home delivery. They just need to see their secondary care provider once a year and get checked out. The doctors write a script and they go to their GP at six months where the practice nurse does the blood checks. If there is any abnormality they go back to their secondary care provider. If not, they go back to secondary care as usual after a year.

I know there are meetings being held between the clinical commissioning groups (CCGs) and HIV physicians to discuss new pathways of care among other things. There is probably a lot that pharma companies can teach us about this.

“One area for joint working lies in reconfiguring patient pathways in HIV, which will inevitably change because everything is so much simpler than it was, say, eight years ago”

What is the single biggest thing that you would like to see pharma doing to make your life easier?

One thing they could do is have far less pushy drug reps. I’ve stopped seeing them because they are so pushy. This could improve if we could build a better relationship with the reps. I’d like to know who they are and for them to get to know us. The only rep I know is with Janssen. I couldn’t mention any others.

As for my colleagues, there is a gap in education. I do a ‘Journal Watch’ every month for Doctors.net.uk, so I am really up to date on what is being published. But for people who don’t have to read the journals, maybe companies can give them more information they might not have known about, especially when there are a lot of new launches. We went through a phase recently where a number of new drugs came out, and we are now all waiting on one more. After that I don’t think there will be many for quite a while. So what we need is information on the newer drugs; the older ones we know about.

“I’ve stopped seeing reps because they are so pushy. This could improve if we could build a better relationship with them”

Do digital channels have a role to play in improving best practice in your therapeutic area? What kind of online resources are most valuable?

There is a fair bit of stigma about infections in this area so patients are not as open online as in other therapeutic areas. As for resources, I get good feedback from colleagues on Doctors.net.uk’s Journal Watch, so that is an important contribution. I also tweet a lot when new papers are out or an issue comes up.

That is another important channel that is used a lot from conferences. Other good sites include Aidsmap (www.aidsmap.com), which is where people go for studies but it is not as up to date as you might think. What they cover is covered very well but it is lacking in terms of breadth. The British HIV Association website (www.bhiva.org) is also very good in terms of producing a live stream of news and recent studies. Medscape (www.medscape.com/hiv) and the HIV and Hepatitis site (www.hivandhepatitis.com) are also good. They are the main ones.

Doctors.net

About the interviewee:

The interviewee is a consultant HIV physician at a London teaching hospital.

This article was co-ordinated by Doctors.net.uk, the UK’s largest and most active online professional network of doctors. It is part of the M3 network, which operates in the US, Asia and Europe with more than 1 million physician doctor members globally via its websites such as M3.com, MDLinx, Medigate and Doctors.net.uk.

Closing thought: How can pharma reps build better relationship with HIV physicians?