There are many barriers to adherence to antiretroviral medications, including pharmacy accessibility. Few studies have evaluated the impact of pharmacy distance or use of mail order pharmacy services on HIV viral load suppression relative to use of an ‘in-person’ pharmacy. The purpose of our study is to determine if there is a difference in viral suppression rates among patients who utilize mail order pharmacy services versus an in-person pharmacy for filling antiretroviral prescriptions. Our study also looked at the effect of distance and travel time to viral suppression for patients who use in-person pharmacy services.
This was a single center, retrospective cohort study of adult HIV positive patients who received care between 2006 and 2015 at an urban HIV care clinic. We collected patient demographic information, ART regimen, home address, pharmacy address, and laboratory values. For patients who utilized retail pharmacies, patients’ home addresses and the location of the pharmacy were geocoded using ESRI’s StreetMap Premium geocoding service. We calculated patients’ travel distance to pharmacy and travel time to pharmacy along a street network in a private vehicle. Chi squared tests and logistic regression were used to determine the association between in-person or mail order pharmacy services and distance to pharmacy and viral suppression (viral load ≤ 200 copies/mL).
There were 214 patients in the mail order group and 214 patients included the in-person pharmacy group. Baseline characteristics were similar between the groups, with the exception of more people who inject drugs in the mail order group (6.1% versus 1.8%, p=0.05). No difference in viral load suppression was observed between groups (21.7% versus 20.2%, p=0.679). There was no difference in viral suppression depending on the distance (1.46 miles away in viral suppressed patients versus 1.36 miles, p=0.75) or travel time to pharmacy (7 minutes versus 6.6 minutes, p=0.75) for the in-person pharmacy group. Factors found to be significantly associated with suppressed viral loads were older age, white race, and higher CD4 counts.
Conclusion: Viral suppression was not associated with pharmacy type, distance to pharmacy, or travel time to pharmacy.
N. N. Pettit, None
J. P. Ridgway, None
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