Medication refill logistics and refill adherence in HIV

Purpose: Strict adherence to antiretroviral therapy is instrumental in viral suppression and treatment success. The relation between pharmacy-based factors and treatment adherence has been underexplored. We aimed to determine whether different medication refill mechanisms were associated with differences in antiretroviral refill adherence. Methods: We conducted a retrospective cohort study of 110 HIV-infected subjects on standard antiretroviral regimens for ≥3 months cared for at the Philadelphia Veterans' Affairs Medical Center HIV clinic. The primary outcome was a pharmacy-based measure of antiretroviral refill adherence over the 3 months of treatment immediately prior to the study date. Results: The group obtaining refills at the pharmacy had lower adherence [80% (interquartile range (IQR), 69-99%)] than the group obtaining refills via pill organizers dispensed by a pharmacist [99% (IQR, 97-100%), p=0.003] and the group obtaining refills via mail order [91% (IQR, 79-100%); p=0.04]. Conclusions: Mail ordering and pharmacists dispensing refills in pill organizers may each be effective strategies for improving medication adherence, although they target different barriers and differ in their degree of intensity. Each should be considered for adherence interventions in HIV and further studied in other disease and treatment settings.