Evaluation of a home-delivery service for HIV-infected patients attending an inner London HIV treatment centre.
Home delivery (HD) of medication is a goal of the Department of Health's Pharmacy in the Future; Implementing the NHS Plan. We evaluated the safety and effectiveness of an HD service for antiretroviral therapy (ART). Patients on ART with stable viral load (VL) <50 were identified. Comparison was made between patients using HD and those using the clinic-based pharmacy (CP). The primary endpoint was HIV virological failure (VF) (HIV VL >400 copies/mL on two consecutive occasions). Secondary endpoints included frequency of outpatient attendances (OPA) and an incidence of adverse events. Cumulative incidences (CulmIn) for each outcome event were calculated. Incidence-rate ratios (IRR) were obtained using Poisson regression. Of 1663 patients identified; 450 received HD and 1213 used CP. CuImIn of VF was =4% in those using HD and =7% in those using CP (IRR [95% confidence intervals, CI] =0.53, 0.32-0.90). HD patients had fewer OPA, less frequent blood test monitoring and less frequent abnormal liver function results (IRR [95% CI]= 0.63 [0.59-0.67] and 0.59 [0.53-0.67], 0.68 [0.65-0.71] and 0.64 [0.53-0.78], respectively). Patients deemed stable enough on social, psychological and medical grounds to receive HD of ART had a lower risk of VF, fewer OPA and no increase in adverse events when compared with patients using CP.
Harte
D
D
The Mortimer Market Centre, Department of Genitourinary Medicine, Camden PCT, London.
Hamill
M
M
Edwards
S G
SG
Copas
A J
AJ
Minton
J
J
Jones
V L
VL
Allason-Jones
E
E
Williams
I G
IG
Miller
R F
RF
D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology; D006699:Home Care Services; D006801:Humans; D008131:London; D008297:Male; D010342:Patient Acceptance of Health Care; D010593:Pharmaceutical Services; D015397:Program Evaluation; D016896:Treatment Outcome; D019037:Urban Health Services; D019562:Viral Load
D019380:Anti-HIV Agents