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Background: Few published studies have examined the relationship between pharmacy location and retention in care or clinical outcome in people living with HIV (PLWH). Objective: The study purpose was to determine whether using an on-site/in-clinic pharmacy to obtain antiretroviral therapy increased retention in care and virologic suppression rates. Methods: PLWH attending a Ryan White outpatient clinic in an academic center were matched based on age and insurance. Rates of retention in care (≥2 medical visits/calendar year) were assessed between patients using a pharmacy on-site in the clinic versus patients use off-site pharmacy options. Virologic suppression [viral load(VL)<200 copies/mL], completing ≥2 VL, and CD4 count were compared between pharmacy types. Results: 137 on-site pharmacy patients and 274 off-site pharmacy patients met inclusion and matching criteria. 91.2% of on-site pharmacy users attended ≥2 clinic visits compared to 83.2% of off-site pharmacy users (P =.0275) and were approximately twice as likely to complete ≥2 clinic visits (odds ratio: 2.032; 1.071-3.857). A similar proportion of the on-site pharmacy group achieved virologic suppression compared to the off-site pharmacy group (92.7% vs 89.1%; P =.239, respectively). Conclusions: On-site pharmacies may provide an opportunity to positively impact retention in care and clinical outcomes for PLWH. [ABSTRACT FROM AUTHOR]

Background Data increasingly support the immunologic and public health advantages for a shortened time interval from HIV diagnosis, initiation of antiretroviral therapy (ART), and subsequent virologic suppression. Much of the current research on rapid or same-day ART has been performed in large urban centers with the infrastructure and support needed for these programs. This study assessed the time from HIV diagnosis to linkage to care (LTC), initiation of ART, and time to virologic suppression (TVS) in newly diagnosed, ART-naïve subjects at a Midwestern academic institution after structured programmatic changes to reduce TVS. Methods IRB-approved, single-center, retrospective cohort including all newly diagnosed, antiretroviral-naïve adult patients seen in the Ryan White Clinic (RWC) at the University of Toledo Medical Center with an on-site 340B pharmacy for their initial visit between January 1, 2015 and December 31, 2015 (control) and January 1, 2017 and December 31, 2017 (intervention)—see Table 1. Diagnosis of HIV and ART initiation took place in separate facilities and were the responsibility of independent entities. Exclusion criteria were previously receiving HIV care, ART-experienced, pregnant, or an active opportunistic infection. The primary outcome of time from HIV diagnosis to virologic suppression (VL < 200 copies/mL) was compared between groups. Secondary outcomes include time from diagnosis to LTC (initial clinic appointment) and time to initiation of ART. Results 72 patients were screened and 60 met inclusion criteria; 24 in the 2015 group and 36 in the 2017 group; 88% were male, 48% white. Median (IQR) time from diagnosis to viral suppression was 137 days (77–318) in 2015 vs. 78 (52–152) days in 2017 (P = 0.028). Time from diagnosis to first clinic visit remained similar (13.5 days vs. 15.5 days, P = 0.791), while time from first clinic visit to initiation of ART decreased significantly (15 vs. 0 days, P < 0.001). Additional outcomes are provided in Tables 2 and 3. Conclusion Time from first clinic visit to ART initiation was significantly shortened in this intervention and was the driving force to decreasing TVS. Additional research into barriers impacting time from diagnosis to LTC are needed to further shorten TVS. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Infection with the human immunodeficiency virus (HIV) continues to affect millions of people worldwide. Preventive measures have done little to slow the transmission of the virus. Discovery of an effective vaccine to prevent HIV could have a tremendous impact on this global pandemic. However, the complex interactions between HIV and the host immune system have limited the progress in vaccine development. Traditional vaccination strategies have shown little promise. Currently, subunit vaccines, DNA vaccines, recombinant vector vaccines, and prime-boost strategies are being evaluated in clinical trials. Although many breakthroughs have been made in HIV vaccine research, only three candidate HIV vaccines have been studied in phase III clinical trials. The current strategies being investigated in the development of preventive HIV vaccines are reviewed. [ABSTRACT FROM AUTHOR]

Several new fluoroquinolones have been marketed since the late 1990s. Fluoroquinolones are an effective treatment for most community-acquired respiratory tract infections, including acute sinusitis, acute exacerbations of chronic bronchitis and community-acquired pneumonia. However, other antibiotics, including beta-lactams, macrolides, tetracyclines and trimethoprim-sulfamethoxazole, are also effective against these respiratory infections. From a managed care perspective, it is the subtle differences between the drugs in the eradication of bacterial pathogens, adverse effects, dose regimens, compliance issues, bacterial resistance and cost that determine the best choice for the management of pneumonia, sinusitis or exacerbations of chronic bronchitis. The potential for bacterial resistance is perhaps the only significant barrier to extensive fluoroquinolone use in community-acquired respiratory tract infections. Cost-effectiveness must be balanced with quality care, both from an individual perspective and that of the greater society.