Is home delivery of HIV drugs just a cost-saving
ploy or are there real benefits for people on HIV therapy? Michael
Laffan investigates
Illustration: C(Aitch)
When
I first heard about home delivery of HIV medication I baulked at the idea.
I remembered when a letter from my clinic was mis-delivered to the neighbours,
and had a terrifying vision of Muriel from next door shouting down the street:
“Michael, your Aids drugs have arrived!”
But then I thought: how much easier would it be if all my pills were delivered
to my door? After all, my shopping comes from Tesco online (with a tidy donation
to UKC if you click on the Tesco banner on the PN website). But still I could
see downsides. Would it mean a trek to the sorting office if the delivery
arrived when I was out? What if I needed advice from the pharmacy? Who could
I talk to if I encountered problems? Would my confidentiality be guaranteed?
Seeking reassurance and answers, I spoke to Howard Lamb, of Applied Dispensary
Service, a division of Healthcare at Home, a company that delivers HIV drugs
to almost 3,000 people across the UK. It currently has HIV drug dispensing
contracts with 25 hospitals from Glasgow to Cornwall and wants to expand further.
How does it work?
“You must be stable on your drug regimen before you can be considered
for home delivery. Then it’s your choice whether you continue to collect
your drugs from the pharmacy or have them delivered to your home. Your drugs
can be delivered by private van or special delivery post.”
What if I’m not in when it arrives?
“Delivery days and times are flexible and include evenings and weekends,
although this is dependant on where you live. Alternatively, you can have
them delivered to a post office where you can pick them up at your own convenience.
Some people even choose to have them delivered to their workplace, but obviously
this wouldn’t suit everyone.”
Who can I talk to if I have a problem with my drugs?
“Don’t worry, you won’t have to ‘phone a friend’.
Everyone who opts for home delivery gets a card with two phone numbers: one
to speak to the pharmacist at your treatment centre about your medication;
the other to call if you have a problem with the delivery. Just remember to
keep the numbers somewhere safe. You can always call the i-Base treatment
helpline or arrange an appointment with the UKC’s health and treatment
adviser if you want impartial advice on HIV medication.”
And what about confidentiality?
“Your drugs will be delivered in plain and secure packaging, and there
will be nothing on the delivery note saying what the parcel contains. The
delivery vans are unmarked, and the delivery driver will have no idea what’s
in the package. And unlike pizza deliveries, you’re not expected to
tip. Just have an answer ready for the nosy flatmates about which book or
CD you have ordered online.”
So all in all a good idea?
“That depends on you. For many people living with HIV, regular contact
with the staff at a clinic is reassuring. For some it’s a lifeline.
Home delivery is definitely not for people experiencing problems with adherence
or severe side effects. But some who are doing well on their meds may not
want to take the time off to attend eight appointments a year. That can be
an unwelcome interruption in their lives.”
Pros and Cons
Lead HIV nurse at Chelsea and Westminster’s Victoria Clinic, Tony Kerley,
believes it empowers people to manage HIV and take control of their lives.
He told Nursing Times: “On one hand we are telling people they are fit
and well, then on the other we’re saying they have to take a lot of
time off work to attend all these clinic appointments.”
The Victoria Clinic supplements home delivery with email notification of test
results and an email support service allowing patients to ask questions or
raise concerns. This is particularly helpful for those who can’t use
the phone during working hours.
“Home delivery gives a very positive message,” says Tony. “It
says: ‘Yes, you are HIV positive. But no, you are not going to die tomorrow.
You don’t need to see a doctor every few weeks. And you can live your
life as you choose’.”
While all this sounds hugely convenient, cynics among us may suspect home
delivery is just another cost-cutting exercise to keep us away from our doctors.
There is no doubt it will relieve pressure on clinics. And it is no secret
that hospitals are fans of home delivery because drugs dispensed on hospital
premises attract 17.5 per cent VAT while those delivered to patients’
homes are zero-rated for VAT.
Across London the aim is to save more than £3 million a year from the
pan-London HIV budget. In theory, this money can then be ploughed back into
HIV treatment and care. That said, clinicians would not support home delivery
if they felt it was clinically inappropriate for stable patients. People will
continue to have their bloods taken at regular intervals and they can still
see their HIV doctor every three months or each year depending on their clinical
need.
When I was first diagnosed, I needed the security and reassurance of seeing
my consultant regularly. But now I don’t feel that need. I want to get
on with my life and save days off for doing other things, so why not?So far,
home delivery has remained a matter of choice for HIV patients. But in a cash-strapped
NHS it is not inconceivable that at some point that choice may be removed
in order to save money. Yes, HIV is a manageable condition, but very often
nurses, consultants and pharmacists are the only people we can talk to about
HIV. Having that human contact is essential, and something we should ensure
we never lose.
• www.healthcare-at-home.co.uk
• For information on HIV treatments read PN’s treatment pages
or visit:
www.i-base.org.uk
www.aidsmap.com
Home Delivery may be for you if...
• Your clinic offers it
• You are stable on your meds and have you been on the same regimen
for six months
• Have a high level of adherence
• Feel in control of your treatment
• Are happy seeing your consultant less frequently
• Have consulted with your doctor and pharmacist
• You struggle to take time off work
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