Greater HIV Viral Load Suppression in Patients Using an Integrated Health System Specialty Pharmacy

Abstract

Purpose

This study assessed the impact of an integrated health system specialty pharmacy (HSSP) on viral load (VL) suppression in HIV patients, compared to patients utilizing non-health system specialty pharmacies (non-HSSPs).

Methods

This was a single-center, retrospective observational cohort study of patients ≥18 years with a HIV diagnosis and an encounter in the outpatient HIV clinic at an academic medical center associated with a HSSP, at least one order for an antiretroviral (ARV) medication, and at least one HIV-1 RNA VL result between January 2018 and May 2022. Outcomes included average rate of VL suppression and socio-demographic factors associated with VL suppression. Comparison of VL suppression between groups was tested using a generalized estimating equation logistic regression.

Results

From January 2018 to May 2022, 889 patients met the inclusion criteria; 326 provided VL results while filling at the HSSP and 681 had results while filling through a non-HSSP (118 patients provided results in both groups). Of the 5295 VL results, 90.6% reflected VL suppression, with the average rate of 91.0% in the HSSP group vs 86.0% in the non-HSSP group (adjusted OR = 1.89 95% CI: [1.40, 2.56]). Sex, ethnicity, and race were not associated with VL suppression. However, VL suppression decreased significantly with Charleson Comorbidity Index 1-3; increased with age; and increased over time from VL index date.

Conclusions

HIV patients filling ARV therapy through a HSSP had a higher rate of VL suppression than those filling through non-HSSPs, highlighting the potential clinical benefit of this specialty pharmacy model.