Fusco Francesco Maria, Sangiovanni Nadia, Papa Nunzia, Mattera Iacono Valentina, Cuomo Nunzia, Viglietti Rosaria, Tambaro Orsola, Borrelli Francesco, Pisapia Raffaella, Carleo Maria Aurora, Rizzo Viviana, Spatarella Micaela, Esposito Vincenzo, Sangiovanni Vincenzo
Infectious Diseases Unit, "D. Cotugno" Hospital, AORN dei Colli, Naples, Italy.
Infez Med. 2023 Jun 1;31(2):204-208. doi: 10.53854/liim-3102-8. eCollection 2023.
BACKGROUND: Adherence to Anti-Retroviral Therapy (ART) is crucial for People Living With HIV (PLWH). In Italy, ART is delivered by Hospital Pharmacies, on a renewable prescription from the hospital physician. The measurement of package-refill (the rate of ART packages actually collected out of those to be collected in order to comply with therapy) is an effective tool to evaluate the adherence.During COVID-19 outbreak, at "D. Cotugno" hospital in Naples, Italy, the ART delivery policies have been adapted, in order to reduce the number of patients' access. We analysed the impact of these changes on the pill-refill of ART in January-August 2020, compared with 2018-2019. METHODS: "D. Cotugno" hospital is a mono-specialistic Infectious Diseases hospital, caring for about 2500 PLWH. Since February 2020, the hospital was almost entirely dedicated to COVID-19 patients. All out-patient activities were interrupted, except for those dedicated to HIV/AIDS patients.In this preliminary study we included all patients assigned to one of the three Medical Divisions dedicated to HIV, who were already under treatment since at least 2017. Rate of package-refill was obtained by the Hospital Pharmacy registry, demographic and clinical data were derived from clinical database.During COVID-19, many measures were adopted in order to increase safety of PLWH attending to hospital. Among these, medical prescription validity increased from 4 to 6 months, and number of packages to be collected increased from 2 to 4, adopting a multi-month dispensing strategy.Package-refill is adequate if at least 95% of ART have been actually collected; partial and inadequate if 75%-94% or less than 75% of ART, respectively, have been collected. Package-refill was measured during the first year of COVID-19 (March 2020 - February 2021), compared to the same period in the two years before. RESULTS: A total of 594 PLWH were included. PLWH with optimal pill-refill significantly increased in 2020-21 compared to 2018-2020 (62% vs 55%, p 0.013). DISCUSSION: Due to COVID-19, we would have expected a reduction in ART deliveries. Surprisingly, the opposite occurred. The increase of pill-refill rates may be due to different reasons, but we hypothesized that the adaption of delivery policies, with a higher number of packages allowed to be collected, strongly contributed to this result. This study suggests that multi-month dispensing policies may contribute to the improvement of adherence among PLWH.
背景：坚持抗逆转录病毒疗法（ART）对艾滋病病毒感染者（PLWH）至关重要。在意大利，ART由医院药房根据医院医生开具的可续签处方提供。包装 refill率（为遵守治疗规定实际领取的ART包装数量占应领取数量的比例）是评估依从性的有效工具。在新冠疫情期间，意大利那不勒斯的“D. Cotugno”医院调整了ART发放政策，以减少患者就诊次数。我们分析了2020年1月至8月这些变化对ART药物 refill的影响，并与2018年至2019年进行了比较。 方法：“D. Cotugno”医院是一家单一专科传染病医院，为约2500名PLWH提供治疗。自2020年2月起，该医院几乎全部用于治疗新冠患者。除了针对艾滋病毒/艾滋病患者的活动外，所有门诊活动均中断。在这项初步研究中，我们纳入了所有分配到三个专门治疗艾滋病毒的医疗科室之一且至少自2017年起就已接受治疗的患者。包装 refill率通过医院药房登记处获得，人口统计学和临床数据来自临床数据库。在新冠疫情期间，为提高到医院就诊的PLWH的安全性采取了多项措施。其中包括将医疗处方有效期从4个月延长至6个月，并采用多月配药策略，使应领取的包装数量从2个增加到4个。如果至少95%的ART实际被领取，则包装 refill情况良好；如果分别有75%-94%或少于75%的ART被领取，则为部分 refill和 refill不足。将新冠疫情第一年（2020年3月至2021年2月）的包装 refill情况与前两年同期进行了比较。 结果：共纳入594名PLWH。与2018 - 2020年相比，2020 - 2021年药物 refill情况最佳的PLWH显著增加（62%对55%，p = 0.013）。 讨论：由于新冠疫情，我们原本预计ART发放量会减少。令人惊讶的是，情况恰恰相反。药物 refill率的提高可能有不同原因，但我们推测发放政策的调整，即允许领取的包装数量增加对此结果起到了很大作用。这项研究表明，多月配药政策可能有助于提高PLWH的依从性。
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