Pedersen Laura L, Fulco Patricia, Pryor Rachel, Bearman Gonzalo
J Am Pharm Assoc (2003). 2025 Jan-Feb;65(1):102307. doi: 10.1016/j.japh.2024.102307. Epub 2024 Dec 4.
People with human immunodeficiency virus (HIV) (PWH) on antiretroviral therapy (ART) with viral load (VL) suppression eliminate the risk of sexual transmission. Many factors including decreased ART adherence and medication access barriers decrease the success of treatment as an HIV prevention strategy. ART access may be enhanced with specialty pharmacy services (SPS), but the impact compared with community-based practices is variably reported. This study aimed to compare the impact of specialty vs community pharmacies on medication adherence via VL assessment.
This retrospective cohort medical record study investigated whether the use of specialty pharmacies compared with community-based practices improves VL suppression. A record review was performed to collect the most recent HIV VL Demographic data collected included age range, race, ethnicity, and patient-reported gender identity. Pharmacy type was determined via review of prescription refill history linked to the medical record.
Patients included were enrolled in the Ryan White HIV/AIDS Program (RWHAP) (May 31, 2022, to May 30, 2023) at an HIV/infectious diseases academic medical center clinic.
An undetectable VL was defined as the most recent HIV VL being < 50 copies/mL or suppressed as < 200 copies/mL.
A total of 1631 PWH were eligible, 179 were excluded, and 1452 were included in the analysis; 91.3% were virologically suppressed (n = 1326) with an undetectable VL in 83.3% (n = 1210). When adjusting for age, self-reported gender identity, race, and ethnicity, PWH using SPS were more likely to have a suppressed (adjusted odds ratio [AOR] 1.469 [95% CI 1.007-2.142]) and undetectable VL (AOR 1.396 [95% CI 1.051-1.854]), respectively, than the use of community-based practices.
The use of specialty compared with community-based pharmacies had a statistically significant, yet modest association with VL suppression in PWH enrolled in RWHAP services in this single academic medical center retrospective analysis. Further studies are needed to determine whether mail-order services, specifically those without specialty service support, are sufficient for high rates of virologic control.
接受抗逆转录病毒疗法（ART）且病毒载量（VL）得到抑制的人类免疫缺陷病毒（HIV）感染者（PWH）可消除性传播风险。包括ART依从性下降和药物获取障碍在内的许多因素会降低作为HIV预防策略的治疗成功率。专科药房服务（SPS）可能会提高ART的可及性，但与基于社区的做法相比，其影响的报道不一。本研究旨在通过VL评估比较专科药房与社区药房对药物依从性的影响。
这项回顾性队列病历研究调查了与基于社区的做法相比，使用专科药房是否能提高VL抑制率。进行记录审查以收集最新的HIV VL。收集的人口统计学数据包括年龄范围、种族、族裔和患者报告的性别认同。通过审查与病历相关的处方 refill 历史来确定药房类型。
纳入的患者参加了HIV/传染病学术医疗中心诊所的瑞安·怀特HIV/AIDS项目（RWHAP）（2022年5月31日至2023年5月30日）。
无法检测到的VL定义为最近的HIV VL < 50拷贝/mL或抑制为< 200拷贝/mL。
共有1631名PWH符合条件，179名被排除，1452名纳入分析；91.3%（n = 1326）病毒学得到抑制，83.3%（n = 1210）的VL无法检测到。在调整年龄、自我报告的性别认同、种族和族裔后，使用SPS的PWH相比基于社区的做法，更有可能分别出现抑制的VL（调整后的优势比[AOR] 1.469 [95% CI 1.007 - 2.142]）和无法检测到的VL（AOR 1.396 [95% CI 1.051 - 1.854]）。
在这个单一学术医疗中心的回顾性分析中，与基于社区的药房相比，专科药房的使用与参加RWHAP服务的PWH的VL抑制存在统计学上显著但适度的关联。需要进一步研究以确定邮购服务，特别是那些没有专科服务支持的服务，是否足以实现高病毒学控制率。
