Clinical Outcomes in Human Immunodeficiency Virus (HIV)-Positive Individuals Using an On-Site Outpatient Pharmacy Compared to Off-Site Pharmacy Options

Abstract

Background. Current literature is conflicting regarding the impact of pharmacy location on outcomes in HIV-infected individuals. The objective of this study is to evaluate viral load (VL) suppression in HIV-infected individuals receiving their prescriptions from an on-site pharmacy (ON-Rx) versus an off-site pharmacy (OFF-Rx). Methods. This retrospective cohort study identified eligible patients from 2014 to 2015. The UTMC Ryan White Clinic has an in-clinic outpatient pharmacy (ON-Rx) serving clinic patients. The primary endpoint was achievement of VL <40 copies/mL at the final VL measurement during 2015. Secondary endpoints included utilization of healthcare services and retention in care. Results. Five hundred twenty-seven and 148 patients utilized an OFF-Rx or ONRx for their prescription medications, receptively. Differences in baseline characteristics were observed for median age (ON-Rx 50 years versus OFF-Rx 46 years), income bracket, and medical insurance between the treatment groups (all p < 0.001). Patients using the ON-Rx were more likely to have VL suppression, maintain 2 clinic visits, and obtain 2 VL laboratories and 2 CD4 tests (Figure 1). There was no difference in the rate of sexually transmitted infection screening (syphilis 96.6% versus 95.4%, gonorrhea 69.6% versus 67.9%, chlamydia 69.6% versus 68.1%; all p > 0.05), cervical cancer screening (41.7% versus 50.4%, p = .357), or utilization of other healthcare services (table 1) for the ON-Rx versus OFF-Rx groups, respectively. Conclusion. Patients utilizing an ON-Rx had increased rates of VL suppression and retention in care, which are key components in the HIV Care Cascade.