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

Abstract

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.

Essential elements of and challenges to rapid ART implementation: a qualitative study of three programs in the United States

“…Some settings receive newly diagnosed patients as referrals from outside their system while others do not—a factor that can affect the volume of RAPID patients. Evidence suggests that, in the United States, settings with existing HIV testing programs or strong referral partnerships between testing and clinic entities may be in a position to implement a RAPID program without adding significant resources [ 11 , 17 ]. In locations with weak HIV testing and ART delivery infrastructure and limited human resources, implementation of RAPID programming may be less feasible.…”

“…Early initiation of ART confers clinical and public health benefits [ 4 – 9 ]. ART initiation on the day of diagnosis or as soon as possible after diagnosis, known as rapid or immediate ART (henceforth “RAPID”), is a safe and effective strategy to quickly reduce viral load and potentially improve engagement in care over time [ 9 – 11 ]. RAPID has been endorsed by each of the international and national health organizations charged with developing guidelines on HIV management [ 13 – 16 ].…”

Same Week: Feasibility of Rapid Antiretroviral Initiation in Brazil

“…The median TVS decreased from 77 days (2.6 months) in nonrapid starters to 55 days (1.8 months) in rapid ART starters (p = 0.03). 25 Another study conducted in Botswana suggests the feasibility, acceptability, and safety of rapid ART initiation in low-and middle-income country settings. One year after ART initiation, 1,472 of 1,627 individuals (90.5%, 95% CI 87.4-92.8) who linked in the standard ART period were in care and had a viral load of fewer than 400 copies/mL, compared with 578 of 631 (91.6%, 95% CI 88Á1-94.1) in the rapid ART period (risk ratio 1.01, 95% CI 0.92-1.11).…”

Essential Elements of and Challenges to Rapid ART Implementation: A Qualitative Study of Three Programs in the United States

“…Evidence suggests that, in the United States, settings with existing HIV testing programs or strong referral partnerships between testing and clinic entities may be in a position to implement a RAPID program without adding signi cant resources. 11,12 In locations with weak HIV testing and ART delivery infrastructure and limited human resources, implementation of RAPID programming may be less feasible.…”

“…[3][4][5][6][7][8] ART initiation on the day of diagnosis or as soon as possible after diagnosis, known as rapid or immediate ART (henceforth "RAPID"), is considered to be a safe and effective intervention to quickly reduce viral load and potentially improve engagement in care over time. [9][10][11] Yet the implementation of RAPID programming is not yet widespread. At each site, providers and staff who ran or oversaw the program facilitated identi cation of prospective key informants.…”