PDF(Pubmed)
Abstract：
UNASSIGNED: Rapid initiation of antiretroviral therapy (rapid ART) improves clinical outcomes in people with HIV and is endorsed by clinical guidelines. However, logistical challenges limit widespread implementation. We describe an innovative rapid ART model led by pharmacists and its impact on clinical outcomes, including time to viral suppression (TVS).
UNASSIGNED: On 1 January 2019, we implemented Pharmacist-Driven Rapid ART (PHARM-D RAPID ART), including rapid ART initiation by pharmacists. Our retrospective cohort study compared TVS, using a Cox proportional hazards model, and clinical outcomes among individuals with a new HIV diagnosis before (1 January 2017 to 31 December 2017) and after (1 January 2019 to 31 December 2019) implementation.
UNASSIGNED: A total of 108 individuals were included. TVS was significantly shorter (P < .001) for the PHARM-D RAPID ART group (n = 51) compared with the preimplementation group (n = 57) (median: 30 days and 66 days, respectively). Those in the PHARM-D RAPID ART group were significantly more likely to achieve VS at any given time during the study period (adjusted hazard ratio: 3.47 [95% confidence interval, 2.25-5.33]). A total of 94.1% (48/51) of patients in the PHARM-D RAPID ART group were retained in care at 1 year. With a median follow-up of 2.4 years in the PHARM-D RAPID ART group, 98% remained suppressed at last recorded viral load.
UNASSIGNED: A pharmacist-driven model for rapid ART delivery decreases TVS with high rates of retention in care and durable VS. This model could improve clinical outcomes and increase program feasibility and sustainability.
UNASSIGNED: On 1 January 2019, we implemented Pharmacist-Driven Rapid ART (PHARM-D RAPID ART), including rapid ART initiation by pharmacists. Our retrospective cohort study compared TVS, using a Cox proportional hazards model, and clinical outcomes among individuals with a new HIV diagnosis before (1 January 2017 to 31 December 2017) and after (1 January 2019 to 31 December 2019) implementation.
UNASSIGNED: A total of 108 individuals were included. TVS was significantly shorter (P < .001) for the PHARM-D RAPID ART group (n = 51) compared with the preimplementation group (n = 57) (median: 30 days and 66 days, respectively). Those in the PHARM-D RAPID ART group were significantly more likely to achieve VS at any given time during the study period (adjusted hazard ratio: 3.47 [95% confidence interval, 2.25-5.33]). A total of 94.1% (48/51) of patients in the PHARM-D RAPID ART group were retained in care at 1 year. With a median follow-up of 2.4 years in the PHARM-D RAPID ART group, 98% remained suppressed at last recorded viral load.
UNASSIGNED: A pharmacist-driven model for rapid ART delivery decreases TVS with high rates of retention in care and durable VS. This model could improve clinical outcomes and increase program feasibility and sustainability.
摘要：
■快速启动抗逆转录病毒治疗（快速ART）可改善HIV感染者的临床结局，并得到临床指南的认可。然而,后勤挑战限制了广泛的实施。我们描述了由药剂师领导的创新快速ART模型及其对临床结果的影响，包括病毒抑制时间（TVS）。
■2019年1月1日，我们实施了药剂师驱动的快速ART（PHARM-DRAPIDART），包括药剂师的快速ART启动。我们的回顾性队列研究比较了TVS，使用Cox比例风险模型，在实施前(2017年1月1日至2017年12月31日)和实施后(2019年1月1日至2019年12月31日)接受新HIV诊断的个体的临床结局.
■共包括108个人。与实施前组（n=57）相比，PHARM-DRAPIDART组（n=51）的TVS显着缩短（P<.001）（中位数：30天和66天，分别)。在研究期间的任何给定时间，PHARM-DRAPIDART组中的人更有可能达到VS（调整后的风险比：3.47[95％置信区间，2.25-5.33]).在PHARM-DRAPIDART组中，共有94.1％（48/51）的患者在1年内被保留在护理中。PHARM-DRAPIDART组的中位随访时间为2.4年，在最后记录的病毒载量时，仍有98％被抑制。
■药剂师驱动的快速ART交付模型降低了TVS，在护理和持久的VS中保留率高。该模型可以改善临床结果，提高项目的可行性和可持续性。
■2019年1月1日，我们实施了药剂师驱动的快速ART（PHARM-DRAPIDART），包括药剂师的快速ART启动。我们的回顾性队列研究比较了TVS，使用Cox比例风险模型，在实施前(2017年1月1日至2017年12月31日)和实施后(2019年1月1日至2019年12月31日)接受新HIV诊断的个体的临床结局.
■共包括108个人。与实施前组（n=57）相比，PHARM-DRAPIDART组（n=51）的TVS显着缩短（P<.001）（中位数：30天和66天，分别)。在研究期间的任何给定时间，PHARM-DRAPIDART组中的人更有可能达到VS（调整后的风险比：3.47[95％置信区间，2.25-5.33]).在PHARM-DRAPIDART组中，共有94.1％（48/51）的患者在1年内被保留在护理中。PHARM-DRAPIDART组的中位随访时间为2.4年，在最后记录的病毒载量时，仍有98％被抑制。
■药剂师驱动的快速ART交付模型降低了TVS，在护理和持久的VS中保留率高。该模型可以改善临床结果，提高项目的可行性和可持续性。
