COVID-19疫情的意外影响:抗逆转录病毒治疗(ART)提供政策的调整改善了艾滋病毒感染者(PLWH)的依从性。

Q2 Medicine Infezioni in Medicina Pub Date : 2023-01-01 DOI:10.53854/liim-3102-8
Francesco Maria Fusco, Nadia Sangiovanni, Nunzia Papa, Valentina Mattera Iacono, Nunzia Cuomo, Rosaria Viglietti, Orsola Tambaro, Francesco Borrelli, Raffaella Pisapia, Maria Aurora Carleo, Viviana Rizzo, Micaela Spatarella, Vincenzo Esposito, Vincenzo Sangiovanni
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引用次数: 0

摘要

背景:坚持抗逆转录病毒治疗(ART)对艾滋病毒感染者(PLWH)至关重要。在意大利,抗逆转录病毒治疗由医院药房提供,由医院医生开具可更新的处方。重新包装的测量(为了遵守治疗而实际收集的抗逆转录病毒治疗包的比率)是评估依从性的有效工具。在2019冠状病毒病疫情期间,意大利那不勒斯“D. Cotugno”医院调整了抗逆转录病毒治疗的提供政策,以减少患者获得治疗的人数。我们分析了与2018-2019年相比,这些变化对2020年1月至8月ART补药的影响。方法:“D. Cotugno”医院是一所单专科传染病医院,收治约2500名艾滋病患者。自2020年2月以来,该医院几乎全部用于治疗COVID-19患者。除艾滋病毒/艾滋病患者外,所有门诊活动均被中断。在这项初步研究中,我们纳入了至少自2017年以来已经接受治疗的所有艾滋病患者,这些患者被分配到三个专门针对艾滋病毒的医疗部门之一。药包再填充率由医院药房登记处获得,人口学和临床数据来自临床数据库。在新冠肺炎疫情期间,采取了许多措施,以提高医护人员就医的安全性。其中,药品处方有效期从4个月增加到6个月,收集包数从2个增加到4个,采用多月调剂策略。如果实际收集了至少95%的抗逆转录病毒药物,则可重新包装;如果分别收集了75%-94%或低于75%的抗逆转录病毒药物,则为部分和不充分。与前两年同期相比,在2019冠状病毒病第一年(2020年3月至2021年2月)测量了包装重新填充的情况。结果:共纳入594例PLWH。与2018-2020年相比,最佳补药的PLWH在2020-21年显著增加(62%对55%,p 0.013)。讨论:由于COVID-19,我们原本预计抗逆转录病毒治疗的交付会减少。令人惊讶的是,情况正好相反。药丸补充率的增加可能是由于不同的原因,但我们假设配送政策的调整,允许收集更多的包裹,在很大程度上促成了这一结果。本研究表明,多月配药政策可能有助于改善PLWH的依从性。
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Unexpected effects of COVID-19 outbreak: adaption of Anti-Retroviral Therapy (ART) delivery policies improved adherence in a population of People Living With HIV (PLWH).

Background: Adherence to Anti-Retroviral Therapy (ART) is crucial for People Living With HIV (PLWH). In Italy, ART is delivered by Hospital Pharmacies, on a renewable prescription from the hospital physician. The measurement of package-refill (the rate of ART packages actually collected out of those to be collected in order to comply with therapy) is an effective tool to evaluate the adherence.During COVID-19 outbreak, at "D. Cotugno" hospital in Naples, Italy, the ART delivery policies have been adapted, in order to reduce the number of patients' access. We analysed the impact of these changes on the pill-refill of ART in January-August 2020, compared with 2018-2019.

Methods: "D. Cotugno" hospital is a mono-specialistic Infectious Diseases hospital, caring for about 2500 PLWH. Since February 2020, the hospital was almost entirely dedicated to COVID-19 patients. All out-patient activities were interrupted, except for those dedicated to HIV/AIDS patients.In this preliminary study we included all patients assigned to one of the three Medical Divisions dedicated to HIV, who were already under treatment since at least 2017. Rate of package-refill was obtained by the Hospital Pharmacy registry, demographic and clinical data were derived from clinical database.During COVID-19, many measures were adopted in order to increase safety of PLWH attending to hospital. Among these, medical prescription validity increased from 4 to 6 months, and number of packages to be collected increased from 2 to 4, adopting a multi-month dispensing strategy.Package-refill is adequate if at least 95% of ART have been actually collected; partial and inadequate if 75%-94% or less than 75% of ART, respectively, have been collected. Package-refill was measured during the first year of COVID-19 (March 2020 - February 2021), compared to the same period in the two years before.

Results: A total of 594 PLWH were included. PLWH with optimal pill-refill significantly increased in 2020-21 compared to 2018-2020 (62% vs 55%, p 0.013).

Discussion: Due to COVID-19, we would have expected a reduction in ART deliveries. Surprisingly, the opposite occurred. The increase of pill-refill rates may be due to different reasons, but we hypothesized that the adaption of delivery policies, with a higher number of packages allowed to be collected, strongly contributed to this result. This study suggests that multi-month dispensing policies may contribute to the improvement of adherence among PLWH.

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来源期刊
Infezioni in Medicina
Infezioni in Medicina Medicine-Infectious Diseases
CiteScore
8.40
自引率
0.00%
发文量
62
期刊介绍: The Journal publishes original papers, in Italian or in English, on topics concerning aetiopathogenesis, prevention, epidemiology, diagnosis, clinical features and therapy of infections, whose acceptance is subject to the referee’s assessment. The Journal is of interest not only to infectious disease specialists, microbiologists and pharmacologists, but also to internal medicine specialists, paediatricians, pneumologists, and to surgeons as well. The Editorial Board includes experts in each of the above mentioned fields.
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