Division of Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Health Analytics, Research, and Reporting, Walgreen Company, Deerfield, Illinois.
Clin Infect Dis. 2020 Feb 14;70(5):789-797. doi: 10.1093/cid/ciz276.
Human immunodeficiency virus (HIV) viral suppression (VS) decreases morbidity, mortality, and transmission risk.
The Patient-centered HIV Care Model integrated community-based pharmacists with HIV medical providers and required them to share patient clinical information, identify therapy-related problems, and develop therapy-related action plans.Proportions adherent to antiretroviral therapy (proportion of days covered [PDC] ≥90%) and virally suppressed (HIV RNA <200 copies/mL), before and after model implementation, were compared. Factors associated with postimplementation VS were determined using multivariable logistic regression; participant demographics, baseline viral load, and PDC were explanatory variables. PDC was modified to account for time to last viral load in the year postimplementation, and stratified as <50%, 50% to <80%, 80% to <90%, and ≥90%.
The 765 enrolled participants were 43% non-Hispanic black, 73% male, with a median age of 48 years; 421 and 649 were included in the adherence and VS analyses, respectively. Overall, proportions adherent to therapy remained unchanged. However, VS improved a relative 15% (75% to 86%, P < .001). Higher PDC (adjusted odds ratio [AOR], 1.74 per 1-level increase in PDC category [95% confidence interval {CI}, 1.30-2.34]) and baseline VS (AOR, 7.69 [95% CI, 3.96-15.7]) were associated with postimplementation VS. Although non-Hispanic black persons (AOR, 0.29 [95% CI, .12-.62]) had lower odds of suppression, VS improved a relative 23% (63% to 78%, P < .001).
Integrated care models between community-based pharmacists and primary medical providers may identify and address HIV therapy-related problems and improve VS among persons with HIV.
人类免疫缺陷病毒（HIV）病毒抑制（VS）可降低发病率、死亡率和传播风险。
以患者为中心的 HIV 护理模式将社区药师与 HIV 医疗服务提供者整合在一起，要求他们共享患者临床信息，识别与治疗相关的问题，并制定与治疗相关的行动计划。在实施模型前后，比较患者对抗逆转录病毒治疗（药物覆盖率比例[PDC]≥90%）和病毒抑制（HIV RNA<200 拷贝/mL）的依从性比例。使用多变量逻辑回归确定与实施后 VS 相关的因素；参与者的人口统计学特征、基线病毒载量和 PDC 为解释变量。PDC 进行了修改，以考虑实施后一年最后一次病毒载量的时间，并分层为<50%、50%至<80%、80%至<90%和≥90%。
765 名纳入的参与者中，43%是非西班牙裔黑人，73%是男性，中位年龄为 48 岁；分别有 421 名和 649 名参与者纳入了依从性和 VS 分析。总体而言，治疗依从性比例保持不变。然而，VS 相对提高了 15%（75%至 86%，P<0.001）。更高的 PDC（调整后的优势比[OR]，PDC 类别每增加 1 级增加 1.74[95%置信区间{CI}，1.30-2.34]）和基线 VS（OR，7.69[95% CI，3.96-15.7]）与实施后 VS 相关。尽管非西班牙裔黑人（OR，0.29[95% CI，0.12-0.62]）的抑制可能性较低，但 VS 相对提高了 23%（63%至 78%，P<0.001）。
社区药师与初级医疗服务提供者之间的综合护理模式可以发现和解决 HIV 治疗相关问题，并提高 HIV 感染者的 VS。
