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

Objectives: 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.

Design: 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.

Setting and participants: 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.

Outcome measures: An undetectable VL was defined as the most recent HIV VL being < 50 copies/mL or suppressed as < 200 copies/mL.

Results: 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.

Conclusions: 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.