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

María Roldán Galnares,1 Ramón Morillo-Verdugo,1 María de las Aguas Robustillo-Cortes,1 Manuel Vélez-Díaz-Pallarés,2 María José Company Albir,3 Beatriz Proy Vega,4 Laura Losa López,5 Laura Marín Ventura,6 María Ferris Villanueva,7 Oihana Mora Atorrasagasti,8 Esperanza Gutiérrez9 1Pharmacy Department, Hospital Universitario Virgen de Valme, Sevilla, Spain; 2Pharmacy Department, Hospital Ramón Y Cajal, Madrid, Spain; 3Pharmacy Department, Hospital General Universitario de Castellón, Castellón, Spain; 4Pharmacy Department, Hospital Mancha Centro, Alcázar de San Juan, Spain; 5Pharmacy Department, Hospital Moisés Broggi, Barcelona, Spain; 6Pharmacy Department, Hospital de Segovia, Segovia, Spain; 7Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; 8Pharmacy Department, Hospital Galdakao-Usansolo, Bizkaia, Spain; 9Pharmacy Department, Complejo Asistencial Universitario de León, León, SpainCorrespondence: María Roldán Galnares, Pharmacy Department, Hospital Universitario Virgen de Valme, Sevilla, Spain, Email mariaroldangal@gmail.comBackground: 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< 0.05), with marked improvements in adherence to concomitant medication (from 50% to 76.6%). The proportion of individuals achieving at least one pharmacotherapeutic goal increased from 58.4% at baseline to 73.8% at follow-up. The intervention was associated with sustained pharmaceutical actions, particularly regarding adherence support, treatment validation, and care coordination.Conclusion: Implementation of a structured, stratified pharmaceutical care model based on the CMO methodology significantly reduces 3-HIT prevalence in older PLWH, primarily through improved adherence to concomitant medication, while maintaining virological control. These findings support the inclusion of CMO-based approaches in clinical practice to optimise pharmacotherapy and improve outcomes in ageing HIV populations.Keywords: pharmaceutical care, HIV, medication adherence, polypharmacy, outcome assessment