药房类型对HIV病毒抑制的影响：一项回顾性横断面队列研究。
Impact of Pharmacy Type on HIV Viral Suppression: A Retrospective Cross-Sectional Cohort Study.
作者信息
Havens Joshua P, Sayles Harlan, Fadul Nada, Bares Sara H
机构信息
University of Nebraska Medical Center, College of Pharmacy, University of Nebraska, Omaha, Nebraska, USA.
University of Nebraska Medical Center, College of Medicine, University of Nebraska, Omaha, Nebraska, USA.
出版信息
Open Forum Infect Dis. 2020 Aug 13;7(9):ofaa351. doi: 10.1093/ofid/ofaa351. eCollection 2020 Sep.
BACKGROUND
People with HIV (PWH) use various pharmacy types beyond traditional local pharmacies. Some specialized pharmacies offer additive adherence services such as refill reminders, expedited delivery, and adherence packaging.
METHODS
This single-center, retrospective cohort study evaluated the impact of pharmacy type on the gain or loss of HIV viral suppression (VS; HIV RNA ≤50 copies/mL). Patients (≥19 years) were categorized by VS and pharmacy type: HIV-specialized (additive adherence/delivery services) vs traditional (without adherence/delivery services). Fisher exact tests examined the effect of pharmacy type on differences in VS between years, and logistic regression models identified possible predictors of gaining or losing VS.
RESULTS
During 2017-2018, no differences were observed for the gain or loss of VS across pharmacy types (VS gain vs continued viremia, = .393; VS loss vs continued VS, = .064). Predictors for the gain of VS included antiretroviral therapy adherence as percentage of days covered (PDC; adjusted odds ratio [aOR], 1.05; < .001) and Federal Poverty Level 100%-138% (FPL; aOR, 0.17; = .032). Predictors for the loss of VS included use of protease inhibitor (aOR, 2.85; = .013), ≥1 other illicit substance including tobacco (aOR, 2.96; = .024), PDC (aOR, 0.95; < .001), FPL 139%-200% (aOR, 0.09; = .031), and CD4 >200 cells/ccm (aOR, 0.19; = .013).
CONCLUSIONS
The gain or loss of VS among PWH in this retrospective cohort was not impacted by pharmacy transitions within the 2-year study period. However, PDC, FPL, illicit substance use, protease inhibitor use, and CD4 >200 cells/ccm were identified as factors associated with changes in VS.
背景
感染艾滋病毒的人（PWH）除了使用传统的当地药店外，还会使用各种类型的药房。一些专业药房提供额外的依从性服务，如续方提醒、加急配送和依从性包装。
方法
这项单中心回顾性队列研究评估了药房类型对艾滋病毒病毒抑制（VS；艾滋病毒RNA≤50拷贝/毫升）获得或丧失的影响。患者（≥19岁）按病毒抑制情况和药房类型进行分类：艾滋病毒专科药房（提供额外的依从性/配送服务）与传统药房（不提供依从性/配送服务）。Fisher精确检验用于检验药房类型对不同年份病毒抑制差异的影响，逻辑回归模型用于确定获得或丧失病毒抑制的可能预测因素。
结果
在2017 - 2018年期间，不同药房类型在病毒抑制的获得或丧失方面未观察到差异（病毒抑制获得与持续病毒血症，P = 0.393；病毒抑制丧失与持续病毒抑制，P = 0.064）。病毒抑制获得的预测因素包括抗逆转录病毒治疗的覆盖天数百分比（PDC；调整后的优势比[aOR]，1.05；P < 0.001）和联邦贫困水平100% - 138%（FPL；aOR，0.17；P = 0.032）。病毒抑制丧失的预测因素包括使用蛋白酶抑制剂（aOR，2.85；P = 0.013）、使用≥1种包括烟草在内的其他非法物质（aOR，2.96；P = 0.024）、PDC（aOR，0.95；P < 0.001）、FPL 139% - 200%（aOR，0.09；P = 0.031）以及CD4>200细胞/立方厘米（aOR，0.19；P = 0.013）。
结论
在这项回顾性队列研究中，感染艾滋病毒的人在2年研究期内病毒抑制的获得或丧失不受药房转换的影响。然而，PDC、FPL、非法物质使用、蛋白酶抑制剂使用以及CD4>200细胞/立方厘米被确定为与病毒抑制变化相关的因素。
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