Shifting antiretroviral drug distribution from Outpatient Clinics to Hospital Pharmacies in Italy. Evolution of ART delivery methods and impact on treatment adherence.

OBJECTIVES

This retrospective observational study assesses adherence to antiretroviral therapy before and after the transition to pharmacy-based treatment dispensation.

METHODS

Two 14-month periods were identified: before (P1) and after (P2) the transition to pharmacy-based provision of antiretrovirals. P2 also coincided with the SARS-CoV-2 pandemic. Adherence was assessed using a mathematical index to estimate the delay in refilling medication (delay index Di).

RESULTS

1,266 people with HIV were included. Higher values of Di were found to be associated with P2 (ß 0.17, 95%CI 0.04-0.07), primarily driven by a significant delay in the initial months of the SARSCoV-2 pandemic in Italy, with Di +0.051 ± 0.13 from March to May 2020 vs. Di +0.048 ±0.12 in the rest of P2. Higher Di was also associated with multi-tablet regimens (ß 0.06, 95%CI 0.006-0.03), whereas switching regimens was associated with lower Di (ß -0.06, 95%CI -0.07-0.04). The odds of HIV RNA>50 copies/mL were higher with higher Di (OR 2.78; 95%CI 1.14-6.75), but lower in P2 compared to P1 (OR 0.38; 95%CI 0.27-0.53).

CONCLUSIONS

Despite an apparent adherence decline due to delays in treatment refills during the first months of the SARS-CoV-2 pandemic, the transition to pharmacy-based antiretrovirals supply was associated with lower frequency of uncontrolled HIV replication.