Timothy J. Howze*, Christian J. Phillips, Susan D. Carr, Tiffany M. Nason and Nehali D. Patel
Background: Adherence to oral Antiret Roviral Therapy (ART) can be challenging for children and youth living with HIV. While demographic factors have been identified as influencing adherence, limited research has explored whether the mode of HIV transmission—vertically (perinatally) vs. horizontally (behaviorally or through other means)—affects adherence outcomes. Objective: To evaluate the impact of HIV mode of transmission and use of a specialty pharmacy on adherence to oral ART among patients under 24 years of age. Methods: A single-center, retrospective cohort analysis was conducted on 38 patients aged 2 to 23 years living with HIV, spanning the period from July 1, 2019, to July 1, 2021. This timeframe was selected to capture one year of data prior to and one year following the implementation of a specialty pharmacy model. Prior to July 2020, oral ART was dispensed through a traditional hospital outpatient pharmacy. In July 2020, all patients were transitioned to receive ART through specialty pharmacy services. Patients were grouped by mode of HIV transmission: vertically acquired (n=20) and horizontally acquired (n=18). Adherence was assessed using the Proportion of Days Covered (PDC). HIV viral load data were obtained from routine laboratory monitoring as part of standard clinical care. All statistical analysis was performed with R (Version 4.4.2). Results: Mean PDC increased after enrollment in specialty pharmacy services for both vertically (85.4% vs. 83.4%, P=0.09) and horizontally (78.8% vs. 76.8%, P=0.08) acquired patients, but the changes were not statistically significant. Mean viral loads decreased for all patients in the horizontal group with 88.9% having undetectable viral loads (<200 copies/mL) (p<0.001). Mean viral loads increased for patients in the vertical group with only 10.0% having undetectable viral load (p<0.001) over the two-year period. Conclusion: Children and youth living with HIV may adhere better to ART when using a specialty pharmacy compared to a traditional outpatient pharmacy. Finally, the higher viral loads observed in patients with vertically acquired HIV, despite higher adherence, may suggest more complex treatment challenges in this population, potentially due to earlier ART exposure or other clinical factors.
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