Year: 2016
Type: article
Study design: Observational Study
Abstract: Background. Adhering to daily medication regimens is essential to achieve viral suppression. Most early research in adherence focused on internal barriers, such as fear of stigmatization, inconvenience of medication, and difficulties in maintaining a scheduled regimen. Newer research has focused on external barriers to adherence, such as proximity of pharmacy and access to transportation however most of these studies have been limited by small sample size or derived from surveys and interviews with HIV patients. This study focuses on a quantitative analysis of accessibility and proximity of one's pharmacy as a barrier to adherence for urban low-income HIV patients. Methods. Retrospective chart review of 378 patients with HIV who resided in a zip code with median income below $30,000. Patients were included if they had an outpatient visit related to HIV, a prescription to antiretroviral medications, and an HIV RNA lab draw in 2012. Manual chart review determined type and location of pharmacy used. In-store pharmacy proximity was calculated in 3 ways: distance between household and pharmacy, number of transfers required via public transportation to arrive to pharmacy, and time required to arrive to pharmacy if taking public transportation. An HIV RNA of <200 copies/ml was considered suppressed. Results. Viral suppression rates were higher for patients utilizing home delivery pharmacies compared to patients using in-store pharmacies (aOR = 3.430). Furthermore, there were no significant differences in rates of viral suppression for patients that traveled to a pharmacy, regardless of the distance, time, or number of public transport lines required in the trip to the pharmacy. Conclusion. These results demonstrate that medication delivery is a viable option for providers looking to improve a patient's adherence. Infrastructure for pharmacy delivery services is established, and increasing the utilization of these services for patients struggling with medical adherence and viral suppression may help close the gap in viral suppression disparities between HIV patients of varying economic backgrounds. Disclosures. All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Authors: Nathan Pham, Ann Avery, Steven Lewis
Institutions: Case Western Reserve University, MetroHealth Medical Center
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2559633229