Patient adherence (the degree to which patients follow their therapeutic regimen as prescribed within a set period of time) and persistence (the time to treatment discontinuation, with a permissible gap) with drug therapy are essential components of HIV/AIDS treatment. Select community pharmacies offer specialized services for HIV/AIDS patients to help combat some of the barriers to adherence and persistence. We assessed adherence and persistence with antiretroviral therapy (ART) for patients using HIV-specialized pharmacies in nine cities from seven states compared to traditional community pharmacy users over a 1-year period. Data were limited to one pharmacy chain. Propensity scoring was used to obtain 1:1 matches for ''Specialized'' and ''Traditional'' pharmacy users based on age, gender, number of prescription-inferred chronic conditions (obtained by mapping a patient's prescriptions to the Medi-Span Drug Indications Database), and presence of prescription anxiety and/or depression medication, resulting in 7064 patients in each group. Proportion of days covered (PDC) was used to measure adherence. Specialized pharmacy users had a significantly greater mean (74.1% versus 69.2%, p < 0.0001) and median (90.3% versus 86.3%, p < 0.0001) PDC. A greater percentage of patients in the Specialized group were able to obtain a PDC of 95% or better (39.3% versus 35.5%). Patients in the Specialized group were significantly more persistent ( p = 0.0117). Community pharmacies specialized in HIV services may be effective avenues for helping patients achieve greater adherence and persistence with ART. Given the value of specialized community pharmacies, payers should consider implementing policies to encourage the use of such pharmacies for filling ART.

Objective To determine differences in patient characteristics, antiretroviral therapy (ART) regimen characteristics, and regimen refill adherence for HIV-focused pharmacy (HIV-P) versus traditional pharmacy (TP) users. Design Retrospective cohort study Setting California Walgreens pharmacies, May 2007 – August 2009 Participants HIV-positive (HIV+) patients with greater than 30 days of antiretroviral prescription claims. Main outcome measures Modified medication possession ratio (mMPR) to calculate regimen refill adherence, and dichotomous measure of optimal adherence ≥ 95%. Results 4254 HIV-P and 11679 TP users were included. Compared to TP users, HIV-P users traveled farther to pharmacies (5.03 vs. 1.26 miles), filled more chronic disease medications (35% vs. 30%), and received more fixed-dose combination tablets (92% vs. 83%); all p < 0.01. Median mMPR was higher for HIV-P users (90% vs. 77%, p < 0.0001). After adjustment for age, gender, insurance, medication use, and distance from pharmacy, use of HIV-P (OR= 2.18, 95% CI 1.88–2.52) and use of fixed-dose combination antiretroviral tablets (OR=2.43, 95% CI 1.83–3.22) were factors most strongly associated with having ≥ 95% regimen refill adherence. Conclusion For HIV+ patients struggling with antiretroviral adherence, clinicians could consider minimizing pill burden with combination tablets and referral to an HIV-focused pharmacy.

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