Implementation of a Rapid Entry Program Decreases Time to Viral Suppression Among Vulnerable Persons Living With HIV in the Southern United States

Colasanti, Jonathan; Sumitani, Jeri; Mehta, C. Christina; Zhang, Yiran; Nguyen, Minh Ly; Rı́o, Carlos del; Armstrong, Wendy S.

doi:10.1093/ofid/ofy104

Cited by 79 publications

(77 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…An analysis of San Francisco city-wide data conducted after RAPID initiation of ARTwas promoted as standard practice in the city through the Getting to Zero (GTZ) initiative [12] showed that the median time from HIV diagnosis to first virologic suppression was shortened by more than 50% in 2016 compared with 2013 (from 134 to 61 days) [13,14]. Demonstration projects from clinics in New Orleans, Louisiana and Atlanta, Georgia, USA similarly found that implementation of immediate ART programs led to earlier linkage to care and shorter time to virologic suppression than in historical controls [15,16].…”

Section: Introductionmentioning

confidence: 99%

RAPID antiretroviral therapy

Coffey

Bacchetti

Sachdev

et al. 2019

Aids

View full text Add to dashboard Cite

Objective: Little is known about long-term viral suppression rates for patients who start antiretroviral therapy (ART) soon after diagnosis. We describe virologic outcomes from the San Francisco-based Ward 86 Rapid ART Program for Individuals with an HIV Diagnosis (RAPID) ART program. Design: Retrospective review of clinic-based cohort. Methods: In 2013, Ward 86 adopted immediate ART at the first visit after HIV diagnosis. Patients were referred from testing sites, offered same or next-day intakes, and received multidisciplinary evaluation, support, and insurance enrollment/optimization. Patients were provided ART starter packs and close follow-up. Demographics and labs were extracted from medical records. Subsequent viral loads were obtained from public health surveillance data. Kaplan-Meier curves summarized distribution of times to first viral suppression; viral suppression rates at last viral load recorded were calculated. Results: Of 225 patients referred to RAPID ART from 2013 to 2017, 216 (96%) were started on immediate-ART: median age 30; 7.9% women; 11.6% African-American, 26.9% Hispanic, 36.6% white; 51.4% with substance use; 48.1% with mental health diagnoses; 30.6% unstably housed; baseline median CD4 + cell count 441 cells/μl median viral load 37011. By 1 year after intake, 95.8% achieved viral suppression to less than 200 cells/μl at least once. Over a median follow-up time of 1.09 years (0-3.92), 14.7% of patients had viral rebound, but most (78%) resuppressed. Viral suppression rates were 92.1% at last recorded viral load.

show abstract

Section: Introductionmentioning

confidence: 99%

RAPID antiretroviral therapy

Coffey

Bacchetti

Sachdev

et al. 2019

Aids

View full text Add to dashboard Cite

show abstract

“…In a retrospective study, Hoenigl et al showed that among newly diagnosed patients with HIV in San Diego, CA, those who initiated same-day ART were more likely to be virologically suppressed at 12 weeks [ 27 ]. Colasanti et al also showed a reduction in median time to viral suppression for iART patients at a clinic in Atlanta, GA [ 28 ]. Rodriguez et al showed nearly all iART patients remained virally suppressed at 1 year in a Miami, FL, clinic [ 29 ].…”

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

View full text Add to dashboard Cite

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.

show abstract

“…Rapid ART has been adopted in many cities throughout the United States and typically involves the provision of antiretroviral medications within 7 days of a new diagnosis. Rapid ART, ideally within 24-h of diagnosis, is proving to be crucial in efforts to speed virologic suppression and reduce HIV transmission [1][2][3][4][5][6][7]. Our national plan: "Ending the HIV Epidemic: A Plan for America" aims to improve quality of life for people living with HIV (PLWH) through early diagnosis and rapid and effective treatment to achieve and maintain viral suppression [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Recent demonstration projects in large metropolitan areas such as Atlanta (ATL), New Orleans (NO), San Francisco (SF) and Washington D.C. (DC) have demonstrated that rapid ART initiation is a promising strategy for earlier virologic suppression in clinical settings [6,7,16]. Each of these cities benefitted from citywide and statewide initiatives to end HIV that promote faster linkage, greater access to care, expedited clinic intake and increased fiscal resources for rapid initiation.…”

Section: Introductionmentioning

confidence: 99%

“…Each of these cities benefitted from citywide and statewide initiatives to end HIV that promote faster linkage, greater access to care, expedited clinic intake and increased fiscal resources for rapid initiation. Median time to virologic suppression following ART initiation in ATL, NO, and SF was 57 days, 30 days, and 43 days, respectively [1,6,7]. The Fast Forward (FF) pilot program in DC did not see a significant difference between time from diagnosis to viral suppression between individuals who were in the FF group compared to standard of care (SOC) (80.6% vs. 74.2%) [16].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Rapid Antiretroviral Therapy (ART) Initiation at a Community-Based Clinic in Jackson, MS

et al. 2020

View full text Add to dashboard Cite

Background Rapid antiretroviral therapy (ART), ideally initiated within twenty-four hours of diagnosis, may be crucial in efforts to increase virologic suppression and reduce HIV transmission. Recent studies, including demonstration projects in large metropolitan areas such as Atlanta, Georgia; New Orleans, Louisiana; San Francisco, California; and Washington D.C., have demonstrated that rapid ART initiation is a novel tool for expediting viral suppression in clinical settings. Here we present an evaluation of the impact of a rapid ART initiation program in a community-based clinic in Jackson, MS. Methods We conducted a retrospective chart review of patients who were diagnosed with HIV at Open Arms Healthcare Center or were linked to the clinic for HIV care by the Mississippi State Department of Health Disease Intervention Specialists from January 1, 2016 to December 31, 2018. Initial viral load, CD4+ T cell count, issuance of an electronic prescription (e-script), subsequent viral loads until suppressed and patient demographics were collected for each individual seen in clinic during the review period. Viral suppression was defined as a viral load less than 200 copies/mL. Rapid ART initiation was defined as receiving an e-script for antiretrovirals within seven days of diagnosis. Results Between January 1, 2016 and December 31, 2018, 70 individuals were diagnosed with HIV and presented to Open Arms Healthcare Center, of which 63 (90%) completed an initial HIV counseling visit. Twenty-seven percent of patients were provided with an e-script for ART within 7 days of diagnosis. The median time to linkage to care for this sample was 12 days and 5.5 days for rapid ART starters (p < 0.001). Median time from diagnosis to viral suppression was 55 days for rapid ART starters (p = 0.03), a 22 day decrease from standard time to viral suppression. Conclusion Our results provide a similar level of evidence that rapid ART initiation is effective in decreasing time to viral suppression. Evidence from this evaluation supports the use of rapid ART initiation after an initial HIV diagnosis, including same-day treatment.

show abstract

Implementation of a Rapid Entry Program Decreases Time to Viral Suppression Among Vulnerable Persons Living With HIV in the Southern United States

Cited by 79 publications

References 17 publications

RAPID antiretroviral therapy

RAPID antiretroviral therapy

Immediate Antiretroviral Therapy: The Need for a Health Equity Approach

Rapid Antiretroviral Therapy (ART) Initiation at a Community-Based Clinic in Jackson, MS

Contact Info

Product

Resources

About