Decreased Time From Human Immunodeficiency Virus Diagnosis to Care, Antiretroviral Therapy Initiation, and Virologic Suppression during the Citywide RAPID Initiative in San Francisco

Bacon, Oliver; Chin, Jennie; Cohen, Stéphanie; Hessol, Nancy A.; Sachdev, Darpun; Coffey, Susa; Scheer, Susan; Buchbinder, Susan; Havlir, Diane V.; Hsu, Ling

doi:10.1093/cid/ciaa620

Cited by 28 publications

(34 citation statements)

References 16 publications

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“…The proportion of new cases that were linked to care and started ART within the RAPID Protocol's timelines was tracked over time, and the association between rapid ART initiation and VS was analyzed. 5 Outcomes were stratified by sex/gender, race/ethnicity, age, transmission category, and housing status to monitor inclusion and outcomes among historically underserved groups.…”

Section: Metrics and Accountabilitymentioning

confidence: 99%

“…The RAPID ART initiatives in San Francisco, both at the Ward 86 clinic and at the citywide level, have shown that immediate initiation of ART after HIV diagnosis can substantially lower time to ART initiation and result in very high rates of VS, even in disproportionately affected populations. 5,6 Based on evidence from U.S. and international rapid ART programs (which used somewhat different timelines for ART start), 1,2,5−8 immediate ART at diagnosis is now recommended by national and international guidelines. 9−11 Prior work reported early outcomes of the San Francisco Citywide RAPID ART initiative.…”

mentioning

confidence: 99%

“…9−11 Prior work reported early outcomes of the San Francisco Citywide RAPID ART initiative. 5 Here, key elements in its development and early implementation are described, with an updated synopsis of program outcomes.…”

mentioning

confidence: 99%

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Development of a Citywide Rapid Antiretroviral Therapy Initiative in San Francisco

Bacon

Coffey

Hsu

et al. 2021

American Journal of Preventive Medicine

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Introduction:Ending the HIV epidemic in the U.S. holds rapid antiretroviral therapy as a key strategy to improve the health of those with HIV and to decrease transmission. In 2015, Getting to Zero San Francisco, a multisector consortium, expanded rapid antiretroviral therapy citywide.Methods: A Getting to Zero San Francisco Rapid ART Program Initiative for HIV Diagnoses Committee (academic, community, service delivery, health department partners) designed the program, protocol, dissemination plan, and monitoring strategy. Newly diagnosed patients were linked to an HIV medical home or Rapid ART Program Initiative for HIV Diagnoses initiation hub to best deliver rapid antiretroviral therapy across a diverse patient mix, with a goal of ≤5 working days from diagnosis to care and ≤1 day from care to antiretroviral therapy. Stakeholders were trained on rapid antiretroviral therapy via Getting to Zero San Francisco meetings, in-services, public health detailing, and peer-topeer recruiting, prioritizing HIV clinics serving patients of color, Latinx ethnicity, youth, and the uninsured or publicly insured. Rapid ART Program Initiative for HIV Diagnoses−specific metrics were derived from surveillance data; stratified by sex/gender, age, race/ethnicity, and housing status; and presented at public meetings. Data were analyzed between January and April 2021.Results: From 2014 to 2018, median time from diagnosis to care decreased 71% (7 to 2 days), care to antiretroviral therapy decreased from 19 to 0 days, and diagnosis to virologic suppression decreased 51% (94 to 46 days). Improvements occurred regardless of age, race/ethnicity, sex/gender, exposure, or housing status.Conclusions: During a citywide initiative to optimize antiretroviral therapy initiation, time from HIV diagnosis to care, antiretroviral therapy, and virologic suppression decreased across all affected groups to varying degrees. The Rapid ART Program Initiative for HIV Diagnoses Committee continues to address challenges to retention and expand implementation.

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Section: Metrics and Accountabilitymentioning

confidence: 99%

mentioning

confidence: 99%

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Development of a Citywide Rapid Antiretroviral Therapy Initiative in San Francisco

Bacon

Coffey

Hsu

et al. 2021

American Journal of Preventive Medicine

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“…Follow-up of the RAPID cohort did show that 95% maintained viral suppression at 1 year [ 25 ]. However, as this approach was adopted by the entire city of San Francisco, a recent evaluation of citywide RAPID outcomes demonstrated that some groups, including Latinx patients, were more likely to initiate iART at first visit, while transgender women were least likely to initiate iART at first visit [ 26 ]. There were also emerging disparities in time to first viral suppression among people who inject drugs and African Americans [ 26 ].…”

Section: The Rapid Model Expansion Of Iart and Health Disparitiementioning

confidence: 99%

“…However, as this approach was adopted by the entire city of San Francisco, a recent evaluation of citywide RAPID outcomes demonstrated that some groups, including Latinx patients, were more likely to initiate iART at first visit, while transgender women were least likely to initiate iART at first visit [ 26 ]. There were also emerging disparities in time to first viral suppression among people who inject drugs and African Americans [ 26 ]. The signal of emerging disparities highlighted by this study calls for an evaluation of what key elements need to be added to the RAPID model to better serve the most vulnerable populations with HIV.…”

Section: The Rapid Model Expansion Of Iart and Health Disparitiementioning

confidence: 99%

Immediate Antiretroviral Therapy: The Need for a Health Equity Approach

Mgbako

Sobieszczyk

Olender

et al. 2020

IJERPH

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Immediate antiretroviral therapy (iART), defined as same-day initiation of ART or as soon as possible after diagnosis, has recently been recommended by global and national clinical care guidelines for patients newly diagnosed with human immunodeficiency virus (HIV). Based on San Francisco’s Rapid ART Program Initiative for HIV Diagnoses (RAPID) model, most iART programs in the US condense ART initiation, insurance acquisition, housing assessment, and mental health and substance use evaluation into an initial visit. However, the RAPID model does not explicitly address structural racism and homophobia, HIV-related stigma, medical mistrust, and other important factors at the time of diagnosis experienced more poignantly by African American, Latinx, men who have sex with men (MSM), and transgender patient populations. These factors negatively impact initial and subsequent HIV care engagement and exacerbate significant health disparities along the HIV care continuum. While iART has improved time to viral suppression and linkage to care rates, its association with retention in care and viral suppression, particularly in vulnerable populations, remains controversial. Considering that in the US the HIV epidemic is sharply defined by healthcare disparities, we argue that incorporating an explicit health equity approach into the RAPID model is vital to ensure those who disproportionately bear the burden of HIV are not left behind.

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Long‐term outcomes of rapid antiretroviral NNRTI‐based initiation among Thai youth living with HIV: a national registry database study

et al. 2023

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Introduction The Thai National AIDS programme (NAP) treatment guidelines have recommended rapid antiretroviral therapy (ART) initiation, regardless of CD4 count since 2014. We assessed treatment outcomes among youth living with HIV (YLHIV), initiating first‐line ART and assessed the association between virological failure (VF) and timing of ART initiation. Methods We retrospectively reviewed data for YLHIV aged 15–24 years, initiating non‐nucleoside reverse transcriptase inhibitor‐based ART from 2014 to 2019, through the NAP database. We classified the timing of ART into three groups based on duration from HIV‐positive diagnosis or system registration to ART initiation: (1) <1 month (rapid ART); (2) 1–3 months (intermediate ART); and (3) >3 months (delayed ART). VF was defined as viral load (VL) ≥ 1000 copies/ml after at least 6 months of first‐line ART. Factors associated with VF were analysed using generalized estimating equations. Results Of 19,825 YLHIV who started ART, 78% were male. Median (interquartile range, IQR) age was 21 (20–23) years and CD4 count was 338 (187–498) cells/mm3. After registration, 12,216 (62%) started rapid ART, 4272 (22%) intermediate ART and 3337 (17%) delayed ART. The proportion of YLHIV starting ART <30 days significantly increased from 43% to 57% from 2014–2016 to 2017–2019 (p < 0.001). The median duration of first‐line therapy was 2 (IQR 1–3) years and 89% started with efavirenz‐based regimens. Attrition outcomes showed that 325 (2%) died (0.73 [95% CI 0.65–0.81] per 100 person‐years [PY]) and 1762 (9%) were loss to follow‐up (3.96 [95% CI 3.78–4.15] per 100 PY). Of 17,512 (88%) who had VL checked from 6 to 12 months after starting treatment, 80% achieved VL <200 copies/ml. Overall, 2512 experienced VF 5.87 (95% CI 5.65–6.11) per 100 PY). In a multivariate model, the adjusted incidence rate ratio for VF was 1.47 (95% CI 1.33–1.63, p < 0.001) in the delayed ART group and 1.14 (95% CI 1.03–1.25, p< 0.001) in the intermediate ART group, compared to YLHIV in the rapid ART group. Conclusions Rapid ART initiation after diagnosis was associated with significantly reduced risks of VF and death in YLHIV, supporting the implementation of rapid ART for optimizing health outcomes.

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Decreased Time From Human Immunodeficiency Virus Diagnosis to Care, Antiretroviral Therapy Initiation, and Virologic Suppression during the Citywide RAPID Initiative in San Francisco

Cited by 28 publications

References 16 publications

Development of a Citywide Rapid Antiretroviral Therapy Initiative in San Francisco

Development of a Citywide Rapid Antiretroviral Therapy Initiative in San Francisco

Immediate Antiretroviral Therapy: The Need for a Health Equity Approach

Long‐term outcomes of rapid antiretroviral NNRTI‐based initiation among Thai youth living with HIV: a national registry database study

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