589. Assessment of an Antiretroviral Therapy Policy in Patients with Human Immunodeficiency Virus at a Large Academic Medical Center

Abstract

BackgroundAccurate medication reconciliation upon hospital admission is crucial for patients with human immunodeficiency virus (HIV) to ensure continuation of appropriate antiretroviral therapy (ART). An ART policy was implemented at our institution which restricted ART ordering to infectious diseases physicians to increase appropriate ART prescribing following admission. The purpose of this study was to evaluate the effectiveness of the HIV medication restriction policy on the appropriateness of ART re-ordering upon admission.MethodsThis was a single-center, retrospective chart review conducted from July 2014 to June 2017 as a pre–post intervention study. The pre-intervention group included adult patients with HIV who received one or more doses of ART prior to implementation of the HIV medication restriction policy. The post-intervention group included adult patients with HIV who received one or more doses of ART after implementation of the policy. Exclusion criteria included patients who received ART for hepatitis B infection or prophylaxis, HIV post-exposure prophylaxis, or patients receiving a first dose of ART for occupational exposure. Home ART medication regimen and inpatient ART medication regimen were evaluated. The primary endpoint was to compare the rate of appropriate medication reconciliations completed before and after implementation of the HIV medication restriction policy. The secondary endpoint was to compare the time to restart of ART following admission.ResultsA total of 115 patients were included in this study. Appropriate medication reconciliation increased from 76% to 100% after implementation of the policy (P = 0.014). However, the mean time to re-initiation of ART increased from 7.9 hours to 14.5 hours after implementation of the policy (P = 0.01). ART regimens were restarted within 24 hours of admission in 96.7% of the pre-HIV policy group vs. 84% in the post-HIV policy group (P = 0.02).ConclusionThe mean time to re-initiation of ART increased after implementation of the HIV policy. However, restriction of ART ordering to infectious diseases physicians significantly increased the rate of appropriate medication reconciliation for patients with HIV. In light of these results, a procedure will be established to ensure the timely re-initiation of ART.Disclosures All authors: No reported disclosures.