Development of a Citywide Rapid Antiretroviral Therapy Initiative in San Francisco

Abstract

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.

Cohort Profile: The Zurich Primary HIV Infection Study

“…Specifically, for the PWH diagnosed since 2005, the median time to cART initiation was 15 days, while the PWH diagnosed since 2020 had a median time of 8 days. A similar decrease has been observed in other cohorts around the world [ 33 , 34 , 35 , 36 , 37 ]. Whilst the ZPHI demonstrated a more rapid treatment start after diagnosis than many other similar cohorts in other countries, a few cohorts with programs and initiatives targeted to optimize cART initiation observed a median time from diagnosis to cART initiation as low as 2 days [ 33 , 34 , 35 , 36 , 37 ].…”

Trends in Time Spent Viremic Among Persons Newly Diagnosed With HIV in San Francisco

“…Typically, those with acute infection (eg, CD4 counts ,200) are prioritized for ART treatment, including in San Francisco's RAPID program that stipulates acute cases begin ART within 48 hours. 33 Our findings are subject to several limitations. First, among those newly diagnosed with HIV in San Francisco during the study period, 28% were excluded from analysis because they had fewer than 2 viral loads in the 12 months after diagnosis.…”

The Capacity of HIV Care Facilities to Implement Strategies Recommended by the Ending the HIV Epidemic Initiative: The Medical Monitoring Project Facility Survey

“…26 Rapid Linkage to Care and ART Rapid linkage to care and ART initiation are key EHE strategies that lead to better outcomes for PWH. [27][28][29] Facilities reported being able to offer an appointment with an HIV care provider for patients new to the facility in a median of 5 business days. The most common barriers to seeing new patients within 1 business day were insufficient provider capacity (56%) and patient preference (50%); support for rapid enrollment among administration and staff was not reported to be a barrier.…”