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Background
The use of adherence measures as markers for virologic failure (VF) has been studied. Yet, there is currently no single adherence metric recommended for VF. Tenofovir diphosphate in dried blood spots have demonstrated predictability of future VF, yet their utility is investigative and not encompassing of all antiretroviral agents. Antire...
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Context 1
... results for HIV virologic failure were observed for each study year ranging from 7.3% to 8.8%. Matched pairs for 2018- 2019 and 2019-2020 were analyzed to assess differences in mean PDC based on HIV virologic suppression (Table 3). Statistically significant differences in mean PDC were observed for both the 2018-2019 matched pairs (HIV RNA >200 vs ≤200 copies/mL: 40% [95% confidence interval {CI}, 33%-46%] vs 85% [95% CI, 84%-87%], respectively; P < .0001) ...Similar publications
Antiretroviral therapies (ARTs) have revolutionized the management of human immunodeficiency virus (HIV) infection, significantly improved patient outcomes, and reduced the mortality rate and incidence of acquired immunodeficiency syndrome (AIDS). However, despite the remarkable efficacy of ART, virologic failure remains a challenge in the long-ter...
Citations
BACKGROUND: Medication adherence plays an important role for patients living with HIV and achieving the treatment goal of viral suppression. A goal adherence rate of at least 90% has been previously cited and endorsed; however, studies have demonstrated that lower rates of adherence may still lead to high rates of viral suppression. Adherence rates are increasingly being used by payers to assess pharmacy performance. OBJECTIVE: To determine if there is a difference in the odds of achieving viral suppression with a proportion of days covered (PDC) at least 90% compared with patients with lower PDC levels. Additionally, to determine if demographic factors, including age, ethnicity, sex, primary antiretroviral regimen type, payer type, primary pharmacy location, and refill assistance program enrollment, impact the odds of achieving viral suppression. METHODS: This retrospective observational study included patients who were aged 18 years or older; were diagnosed with HIV; had at least 2 occurrences of dispensed antiretrovirals between July 1, 2020, and June 30, 2021, within the health system; and had at least 1 HIV-RNA viral load recorded between these dates. PDC was calculated at the generic product identifier (GPI) level. For patients receiving multiple GPIs in this period, a weighted average PDC was calculated. A logistic regression analysis was performed, and odds ratios were calculated with 95% confidence for each demographic factor to determine correlation with viral suppression. RESULTS: 1,629 patients were included. Overall, 1,516 (93.1%) patients were virally suppressed. 106 (6.5%) patients had a PDC lower than 50% and 639 (39.2%) had a PDC of at least 90%. Of the patients with a PDC lower than 50%, 80 (75.5%) achieved viral suppression as did 617 (96.6%) patients with a PDC of at least 90%. Age and insurance type significantly impacted viral suppression. No statistically significant difference was found between the odds of achieving viral suppression until PDC was below 75%. Patients with a PDC of less than 50% or a PDC of 50% to less than 75% were less likely to achieve viral suppression than patients with a PDC of at least 90% (P < 0.001). CONCLUSIONS: Patients with adherence rates above 75% achieve similar results compared with patients with adherence rates above 90%. High population viral suppression may be achieved with as few as 39.2% of patients achieving a PDC greater than 90%. Using these results, the Pharmacy Quality Alliance and other guidance setting entities should consider lowering the at least 90% threshold as well as providing further guidance on how payers should use results and network benchmarking when creating pharmacy quality performance measures.
Background
Detection of antiretrovirals (ARV) in biological specimens is a reliable objective way to measure adherence. However, routine ARV testing is not feasible in many high-burden settings. This study explored if pharmacy data could accurately predict HIV viremia postpartum in previously virally-suppressed women.
Methods
South African women living with HIV who initiated antiretroviral therapy (ART) during pregnancy and achieved viral suppression (VS; viral load [VL]≤50 copies/mL) were followed postpartum where plasma VL was measured and ARV adherence self-reported. A portion of samples were tested for the presence of ARV using mass-spectrometry. Patient-level routine pharmacy data were used to classify if women should have drug in hand in the past seven days prior to the visit date. Logistic regressions were used to calculate associations between adherence and viral non-suppression (VNS; VL > 50) or failure (VF; VL > 1000) at the first study visit of women who had ARV measured. Data for all women were examined for associations of self-reported adherence and drug in hand with VS and VF at two, six, and 12 months postpartum.
Results
Women with no ARV detected were significantly more likely to have VNS (odds ratio [OR] = 26.4). Having no drug in hand for seven days was also predictive of VNS in these same women (OR = 7.0), and the full cohort (n = 572) at three (OR = 2.9), six (OR = 8.7) and 12 months (OR = 14.5). Similar results were seen for VF.
Conclusion
These data show that routine pharmacy data can act as a highly predictive mechanism for identifying patients at risk of VNS and VF due to non-adherence.
