A patient-centered care model significantly improved viral suppression rates, researchers reported in Clinical Infectious Diseases. This was especially true among African-American participants, whose viral suppression rate rose by 23%, from 63% to 78% of people in that group.
This was a demonstration project in which community pharmacists and HIV medical providers shared clinical information, identified treatment-related problems, and developed plans to overcome them. It was conducted at 10 project sites across the U.S., with 26 to 107 enrollees at each site, for a total of 765 participants, 43% of whom are African American. Adherence data – based on a Proportion of Days Covered (PDC) measure, i.e., whether prescriptions had been filled -- were analyzed for 421 people and viral suppression data for 649 persons.
Although the overall percentage of people who were adherent didn't change significantly, people who began the study with an especially low level of adherence (less than 50% PDC) did improve by a great deal -- from a mean of 28% PDC to a mean of 62%. Viral suppression increased from 75% overall at baseline to 86% overall at the end of the demonstration project, with particularly high gains seen among people with private insurance (up 31%), adults aged 25-34 (up 26%), African Americans (up 23%), and Ryan White care recipients (up 23%).
Participating pharmacists had received HIV-specific, as well as cultural competency training. They reviewed medication regimens and worked with clinicians to optimize treatment plans. This strategy may have resulted in more effective antiretroviral regimens, which in turn could explain the findings, study authors hypothesized. Improved retention in care among study participants could also have contributed to the results, they added.