Out of sight, but not out of mind:
Auburn’s Kelly Hester dedicated to helping those with HIV/AIDS
December 18, 2019
AUBURN, Alabama – For more than 15 years, the Harrison School of Pharmacy’s Dr. Kelly Hester has provided tireless care and innovative clinical services to a population not normally seen.
For those living with the human immunodeficiency virus, or HIV, the virus that causes acquired immunodeficiency syndrome, or AIDS, the complex disease can be a physical and emotional strain. To help those in need, Hester works with the Copeland Care Clinic in Montgomery, Alabama, and Unity Wellness Center in Opelika, Alabama. Both are Ryan White clinics that receive federal funding to provide HIV medical care to indigent patients living with HIV. The clinics are separate, but collectively care for approximately 2,000 people living with HIV in 28 counties in central Alabama.
In addition, many of the patients seen also receive comprehensive medical care for other problems, such as hypertension and diabetes, if they do not have an established primary care provider.
“My role in these clinics is to provide collaborative comprehensive medication management to the extent possible to ensure evidence-based therapy is prescribed and utilized by the patient,” said Hester, an associate clinical professor in the Department of Pharmacy Practice. “The focus is safe and effective antiretroviral therapy to control their HIV infection. Interactions with patients serves to confirm adherence and appropriate use of these medications as well as to provide education on ways to avoid drug-related problems with their therapy.”
The clinics, which also include approximately four physicians and five nurse practitioners, also provide education on the goals of therapy, long-term expectations of living with HIV and special considerations for women during pregnancy. Hester also fields questions from regional hospital pharmacists regarding antiretroviral therapy during hospitalization.
Hester is a two-time Auburn alumna, earning her Bachelor of Science in pharmacy before completing her Doctor of Pharmacy from the Harrison School of Pharmacy in 1996. She went on to complete a residency program at Wake Forest University Baptist Medical Center where she had the opportunity to complete a rotation at an HIV clinic.
“That experience opened my eyes to the complexity of treating HIV at that time with quickly emerging resistance, strict adherence requirements and real mortality outcomes with ineffective therapy,” said Hester. “With no cure for HIV, recurrent opportunistic infections for many, poor quality of life due to intolerability of the medications and tremendous pill burden with some patients taking close to 30 pills per day, I equated it to having a cancer diagnosis but with the addition of significant stigma.”
Dealing with patients that were extremely ill, combined with the challenges of treatment and the social isolation, motivated her to learn more and find opportunities to get more involved.
“It has been exceptionally rewarding to see the shift from an infection associated with a death sentence to one that we can treat chronically like blood pressure,” said Hester. “The medical advancements in HIV medicine and drug development have directly impacted the morbidity and mortality with HIV infection.”
In treating HIV and AIDS, a pharmacist has a critical role on the health care team. While advancements have transformed a cocktail of several drugs to what is now a single tablet, the pharmacist helps address or prevent medication errors that may arise from drug interactions, encouraging medication adherence and controlling the virus through education and dispensing efforts.
“Pharmacists can play a role in impacting appropriate use of therapy, medication reconciliation, adherence and addressing drug-drug interactions,” said Hester. “Additionally, medication errors occur with transitions of care into the hospital for medical care. Therefore, antiretroviral stewardship programs are being developed in conjunction with the larger antimicrobial stewardship efforts to improve outcomes related to this.”
With the stigma of the disease, pharmacists also play a role in supporting good mental health and providing other pharmacy services on a case-by-case basis.
“The challenges currently facing these patients largely remains stigma and mental health problems such as depression and anxiety which may affect their medication adherence. The stigma may also impact their feelings about coming to their medical appointments for fear of being seen by someone they know,” said Hester. “It is also estimated that more than 70 percent of patients living with HIV will be over the age of 50 by 2030, so the development of age-related medical illnesses and associated medications with polypharmacy are also challenging adherence in the older patients we are treating.”
Living up to Auburn’s land-grant mission, Hester feels these outreach programs are vital to helping Alabamians deal with a disease that is severely affecting those in the state. According to the Centers for Disease Control and Prevention, the Deep South accounted for more than half of the country’s nearly 40,000 new HIV diagnoses in 2017, with 23 percent of diagnoses occurring in suburban and rural areas. The Deep South also has the highest death rates in the United States due to HIV infection.
“Outreach services aimed to those with HIV infection in Alabama are important because we live geographically in the area of greatest burden in the southeastern United States,” said Hester. “Patients living in rural areas and of lower socioeconomic status are those largely affected. Testing and treating is critical to the goal of ending the epidemic.”
About the Harrison School of Pharmacy
Auburn University’s Harrison School of Pharmacy is ranked among the top 20 percent of all pharmacy schools in the United States, according to U.S. News & World Report. Fully accredited by the Accreditation Council for Pharmacy Education (ACPE), the School offers doctoral degrees in pharmacy (Pharm.D.) and pharmaceutical sciences (Ph.D.) while also offering a master’s in pharmaceutical sciences. The School’s commitment to world-class scholarship and interdisciplinary research speaks to Auburn’s overarching Carnegie R1 designation that places Auburn among the top 100 doctoral research universities in the nation. For more information about the School, please call 334.844.8348 or visit http://pharmacy.auburn.edu.
Last Updated: December 18, 2019