Specialty Pharmacy Services Compared to Community-Based Pharmacy Services on HIV Viral Load.

Abstract

Background: People with human immunodeficiency virus (PWH) on antiretroviral therapy (ART) with viral load (VL) suppression eliminate the risk of sexual transmission. Many factors including decreased ART adherence and/or medication access barriers decrease the success of treatment as an HIV prevention strategy. ART access may be enhanced with specialty pharmacy services, but the impact compared to community-based practices is variably reported.

Objectives: Compare the impact of specialty vs community pharmacies on medication adherence via VL assessment.

Methods: This retrospective cohort medical record study investigated whether the use of specialty pharmacies compared to community-based practices significantly improves VL suppression. Patients included were enrolled in the Ryan White HIV/AIDS Program (May 31, 2022-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. 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.

Results: 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 specialty pharmacy services were more likely to have a suppressed (AOR 1.469 95% CI 1.007-2.142) and undetectable VL (AOR 1.396, 95% CI 1.051-1.854), respectively, compared to the use of community-based practices.

Conclusions: The use of specialty compared to community-based pharmacies had a significant, yet modest association with VL suppression in PWH enrolled in Ryan White HIV/AIDS services in this single-academic medical center retrospective analysis. Further studies are needed to determine if mail order services, specifically, without specialty service support, are sufficient for high rates of virologic control.