by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer
February 25, 2020
Byrd KK et al. for the Patient-centered HIV Care Model Team. Adherence and Viral Suppression among Participants of the Patient-centered Human Immunodeficiency Virus (HIV) Care Model Project: A Collaboration Between Community-based Pharmacists and HIV Clinical Providers. Clin Infect Dis 2020; 70(5):789–97.
Sustained viral suppression with combination antiretroviral therapy (ART) remains the goal for persons living with HIV. Consistent medication adherence is the key to staying “undetectable.” This paper reports data from the “Patient-centered HIV Care Model” (PCHCM) which is a collaborative effort of the CDC, the Walgreen Company, and the Texas Health Science College of Pharmacy. The three objectives of PCHCM are achieving improvements in retention in care, adherence to ART, and rates of viral suppression. The PCHCM demonstration project served 765 adult HIV patients at 10 U.S. clinical sites. The medical sites collaborated with a community-based HIV-specialized retail pharmacy. This model of care required the clinics to share patient data with the pharmacists who then provided medication management for these patients. Within the cohort, 73% were male, 43% were non-Hispanic black, and the mean age was 48 years. They calculated the number of patients who were adherent to ART using a claims-based metric known as proportion of days covered (PDC). The PDC quantifies the number of days per month that a patient has medication available based on data from pharmacy fulfillment records. Adherence to ART was calculated before and after model implementation and defined as a PDC ≥ 90%. The authors also determined the percentage of those virally suppressed before and after implementation of the program. During approximately two years of the study, 649 patients met inclusion for viral suppression and 421 for ART adherence. There was no measurable difference in overall adherence based on PDCs but viral suppression improved from 75% to 86%. Sustained viral suppression (2 values < 200 copies/mL over 12 months) improved from 65% to 80%. The largest improvement in viral suppression was in patients aged 25 to 34 years – a population that is typically the most difficult to retain in care. The percentage of patients who had a VL > 1500 copies/mL at baseline also decreased significantly from 19% to 10%. The group with the lowest PDC (<50%) improved from 28% to 62%.
Models of care which integrate medical providers, social workers, mental health providers and pharmacists can identify and help address HIV therapy-related problems. Although there was no overall measured improvement in adherence in this study based on PDC, viral suppression improved a relative 15%, which likely reflects collaborative efforts to optimize ARV treatment. The Academy has historically supported such collaboration and continues to do so – recognizing the important role pharmacists play in HIV care which can be community-based, as in this study, or integrated as part of the on-site clinical team.
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