title: Improved antiretroviral refill adherence in HIV-focused community pharmacies.
abstract: OBJECTIVE
  To determine differences in patient characteristics, antiretroviral therapy (ART) regimen characteristics, and regimen refill adherence for human immunodeficiency virus (HIV)-focused pharmacy (HIV-P) versus traditional pharmacy (TP) users.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  California Walgreens pharmacies from May 2007 to August 2009.
  
  
  METHODS
  HIV-positive patients with greater than 30 days of antiretroviral prescription claims.
  
  
  METHODS
  Deidentified prescription records for patients filling any ART prescription at any California Walgreens pharmacy during the study period were assessed.
  
  
  METHODS
  ART regimen refill adherence (calculated by modified medication possession ratio [mMPR]) and dichotomous measure of optimal adherence of 95% or greater.
  
  
  RESULTS
  4,254 HIV-P and 11,679 TP users were included. Compared with TP users, HIV-P users traveled farther to pharmacies (5.03 vs. 1.26 miles, P < 0.01). A greater proportion of HIV-P users filled prescriptions for chronic diseases (35% vs. 30%) and received fixed-dose combination antiretroviral tablets (92% vs. 83%) (all P < 0.01). Median mMPR was higher for HIV-P users (90% vs. 77%, P < 0.0001). After adjusting for age, gender, insurance, medication use, and distance from pharmacy, use of HIV-P (odds ratio 1.90 [95% CI 1.72-2.08]) and fixed-dose combination antiretroviral tablets (3.34 [2.84-3.96]) were most strongly associated with having 95% or greater ART regimen refill adherence.
  
  
  CONCLUSIONS
  For HIV-positive patients struggling with antiretroviral adherence, clinicians may consider minimizing pill burden with combination tablets and referral to an HIV-focused pharmacy.
authors.affiliation: School of Pharmacy, University of California at San Francisco, 521 Parnassus Ave., San Francisco, CA 94143, USA. cocohobaj@pharmacy.ucsf.edu
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Cocohoba
authors.forename: Patricia
authors.initials: P
authors.lastname: Murphy
authors.forename: Glen
authors.initials: G
authors.lastname: Pietrandoni
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Guglielmo
mesh_terms: D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002140:California; D003157:Community Pharmacy Services / Q000706:statistics & numerical data*; D015897:Comorbidity; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D012189:Retrospective Studies; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents; D004338:Drug Combinations