PurposeThis 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).MethodsThis 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.ResultsFrom 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.ConclusionsHIV 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.
Keywords: HIV; clinical outcomes; disease management; integrated health system specialty pharmacy; specialty pharmacy.