Improving medication adherence and viral load suppression in pediatric, adolescent, and young adult patients living with HIV using a specialty pharmacy.

Abstract

Background: Pediatric (age, 0-13 y), adolescent (age, 13-19 y), and young adult (age, 20-24 y) (AYA) patients living with human immunodeficiency virus (HIV) face numerous barriers to adherence to antiretroviral therapy (ART). Suboptimal adherence to ART leads to increased drug resistance, poor quality of life, and increased long-term morbidity and mortality.

Objective: This study evaluates the effects of implementing a specialty pharmacy model on adherence and virological suppression in pediatric and AYA individuals living with HIV.

Methods: Specialty pharmacy operations began at St. Jude Children's Research Hospital in July 2020. Before then, ART was dispensed to patients in a traditional hospital outpatient pharmacy model. A single-center, retrospective analysis was conducted on 38 individuals living with HIV from 1 July 2019, through 1 July 2021, to capture one year of data pre-implementation and one year of data post-implementation of the specialty pharmacy model. Proportion of days covered (PDC) was used to measure adherence. Viral loads were obtained from laboratory samples as part of routine care.

Results: The mean PDC appeared to increase after specialty pharmacy implementation (82.3% vs. 80.3%), but the change in mean did not reach statistical significance (p = 0.07). Nevertheless, of the patients who were below the 80% PDC threshold before implementation, more reached or exceeded the 80% benchmark after intervention than not (60.0% versus 40.0%) (p = 0.03). Of the patients who were already ≥80% adherent, most remained that way (82.6% versus 17.4%) (p < 0.001). Sixty percent of patients whose viral loads were > 200 copies/mL experienced undetectable viral loads after intervention (p = 0.05).

Conclusions: Specialty pharmacy services may help pediatric and AYA patients adhere to ART, which can lead to higher rates of virological suppression.