Telehealth-enabled pill swallowing training for a pediatric patient living with HIV: A multidisciplinary approach.

BACKGROUND

This case report aims to describe the implementation of a telehealth-based, multidisciplinary intervention designed to support pill swallowing in a pediatric patient with HIV preparing to transition from liquid to tablet-based antiretroviral therapy (ART). The objective was to overcome geographic and access-related barriers to in-person behavioral training by leveraging virtual care, interdisciplinary collaboration, and the use of compounded placebo tablets. This approach sought to demonstrate how specialty pharmacists and behavioral health professionals can work together to ensure medication readiness, promote adherence, and facilitate safe transitions to more sustainable ART regimens in pediatric patients-particularly those in rural or underserved settings.

CASE SUMMARY: A pediatric patient with vertically acquired HIV who was residing in a rural community was preparing to transition from liquid ART to a fixed-dose combination tablet. Transportation barriers rendered in-person training infeasible. The care team, comprising a specialty pharmacist, clinical psychologist, and compounding pharmacy staff, designed a remote intervention. Placebo tablets matching the target medication were mailed to the patient's home. A telehealth session was conducted by using the Epic electronic medical record platform, and real-time, behavioral coaching and pharmacist-led guidance were provided. The patient successfully swallowed 2 placebo tablets during the telehealth session, indicating readiness for the transition. At the next clinic visit, the patient initiated the new fixed-dose combination ART without complications. Follow-up confirmed continued adherence to pill formulation and no reported adverse effects.

PRACTICE IMPLICATIONS: This case highlights the value of telehealth in overcoming pill swallowing training barriers in pediatric HIV care. Interdisciplinary collaboration, particularly involving specialty pharmacists and behavioral health providers, can provide equitable, patient-centered solutions for families in underserved areas. The use of compounded placebo tablets in virtual training represents a practical and scalable strategy to support medication transitions in pediatric populations.