Specialty pharmacy services compared with community-based pharmacy services on HIV viral load

Area of Science:

• Infectious Diseases
• Pharmacology
• Public Health

Background:

• Antiretroviral therapy (ART) with viral load (VL) suppression prevents sexual transmission of human immunodeficiency virus (HIV).
• Decreased ART adherence and medication access barriers can impede treatment success for HIV prevention.
• Specialty pharmacy services (SPS) may improve ART access, but their impact versus community pharmacies is not well-defined.

Purpose of the Study:

• To compare the impact of specialty pharmacy services (SPS) versus community-based pharmacies on medication adherence, measured by viral load (VL) suppression in people with HIV (PWH).

Main Methods:

• Retrospective cohort study analyzing medical records of PWH enrolled in the Ryan White HIV/AIDS Program (RWHAP).
• Compared VL suppression rates between patients using SPS and community pharmacies.
• Collected demographic data and determined pharmacy type via prescription refill history.

Main Results:

• Of 1452 PWH analyzed, 91.3% achieved viral load suppression (<200 copies/mL) and 83.3% had undetectable VL (<50 copies/mL).
• PWH using SPS were more likely to have suppressed (AOR 1.469) and undetectable VL (AOR 1.396) compared to those using community pharmacies, after adjusting for demographics.

Conclusions:

• Specialty pharmacy services showed a modest, statistically significant association with improved VL suppression in PWH within the RWHAP program.
• Further research is needed to assess the efficacy of mail-order pharmacy services without dedicated specialty support for maintaining virologic control.