Implementing a Rapid Antiretroviral Therapy Program Using Starter Packs for Emergency Department Patients Diagnosed With HIV Infection

Abstract

Background Emergency departments (ED) have been identified as essential partners in the national plan to end the HIV epidemic (EHE). The initiation of rapid antiretroviral therapy (ART) may be an important strategy to minimize treatment barriers faced by many ED patients diagnosed with HIV. Methods We describe the implementation and outcomes of a protocol to provide rapid ART using starter packs for eligible ED patients testing HIV antigen/antibody (Ag/Ab) reactive. Eligible patients were not pregnant, unlikely to have a false positive Ag/Ab test, discharged home, ART naive, had acceptable liver and renal function, lacked symptoms of an opportunistic infection, and judged to be a good candidate. Results During the 1-year study period, 10,606 HIV tests were performed and 106 patients were HIV Ag/Ab reactive and assessed for ED rapid ART eligibility. Thirty-one patients (29.2%) were eligible for ED rapid ART, 26 patients were offered (24.5%), and 25 accepted and were provided starter packs, for an overall ED rapid ART treatment rate of 23.6%. Two patients receiving ED rapid ART were confirmed to be HIV negative. Patients provided ED rapid ART were more likely to follow up by 30 days (82.6% vs. 50.0%, p=0.01) compared with patients not provided ED rapid ART. The 6-month incidence of the immune reconstitution inflammatory syndrome was 4.3% among the 23 HIV positive patients receiving ED rapid ART. Conclusion The initiation of ED rapid ART for patients testing HIV Ag/Ab reactive is feasible, well accepted, safe, and may be an important facilitator of linkage to care.