Impact of a CMO-Based Pharmaceutical Care Model on 3-HIT Criteria in Older People Living with HIV: The DIS3HIT Project

Background: People living with HIV (PLWH) are increasingly affected by ageing-related issues, including multimorbidity and polypharmacy, which heighten the risk of drug-related problems. The 3-HIT phenomenon- defined as the simultaneous presence of high pharmacotherapeutic complexity, clinically relevant drug-drug interactions, and poor adherence to concomitant medication-represents a significant challenge in the care of older PLWH. Objective: To evaluate the impact of a Capacity-Motivation-Opportunity (CMO) pharmaceutical care model on reducing the prevalence of the 3-HIT criteria in PLWH aged ≥50 years and to assess pharmacotherapeutic goal achievement according to patient stratification. Methods: A prospective, multicentre intervention study was conducted in nine Spanish hospitals (March 2023-March 2024), including PLWH aged ≥50 on antiretroviral and concomitant therapy. Participants were stratified into three levels of pharmaceutical care according to the CMO model (Capacity, Motivation, Opportunity). Clinical, virological, and pharmacotherapeutic data were collected at baseline and week 24. Interventions were tailored to individual needs and stratification level. Results: Among 154 participants (mean age 62.6 years (SD: 7.47); 75.3% male), the predominance of male participants was consistent with the demographic profile of ageing PLWH cohorts in Spain. Polypharmacy was highly prevalent (96.1%), and 17.5% of participants simultaneously met all three 3-HIT criteria at baseline. After 24 weeks, 3-HIT prevalence decreased significantly to 9.4% (p