Harnessing Pharmacy Claims to Strengthen the HIV Care Continuum: Results from the AdhereP4 Program

Antiretroviral nonadherence hinders HIV RNA suppression and care engagement. The AdhereP4 program evaluated an interdisciplinary collaboration leveraging pharmacy claims data to identify people with HIV (PWH) nonadherent to antiretrovirals and provide clinical interventions.

AdhereP4 was a collaboration of three pharmacies, two HIV clinics, and the state health department in Maryland, USA.

Pharmacy claims data identified PWH with a ≥30-day antiretroviral access gap during November 2020-September 2022. Eligible individuals received pharmacy and/or clinic interventions, categorized as: full (direct communication), soft (indirect contact), and no (unreachable) intervention. Outcomes included adherence, HIV RNA, and retention and relinkage to care. Pre- and post-intervention outcomes were summarized descriptively. Logistic regression assessed associations between intervention type and outcomes, adjusting for demographic and clinical variables.

Among 1,702 eligible patients, 48% received full and 25% soft interventions. Mean HIV RNA changed by -0.3, -0.2, and +0.1 log10 copies/mL in the full, soft, and no intervention groups, respectively. Adherent individuals (proportion of days covered ≥80%) increased by 16% (full), 20% (soft), and 11% (no intervention). Odds ratios for retention were 1.17 (95% CI: 0.65-2.14; p=0.12) and 0.64 (95% CI: 0.33-1.23; p=0.06) for the full and soft intervention groups, respectively, versus no intervention. Odds ratios for relinkage were 0.77 (95% CI: 0.20-3.01; p=0.24) and 1.89 (95% CI: 0.48-7.44; p=0.12), respectively.

Pharmacy claims data can identify adherence gaps to target adherence interventions to those at risk for virological failure. An interdisciplinary approach addressing barriers to care is needed to improve HIV outcomes.