Rapid Antiretroviral Therapy Program: Development and Evaluation at a Veterans Affairs Medical Center in the Southern United States.

Publisher: Mary Ann Liebert, Inc Country of Publication: United States NLM ID: 9607225 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-7449 (Electronic) Linking ISSN: 10872914 NLM ISO Abbreviation: AIDS Patient Care STDS Subsets: MEDLINE

Original Publication: Larchmont, NY : Mary Ann Liebert, Inc., c1996-

Anti-HIV Agents*/therapeutic use ; HIV Infections*/diagnosis ; HIV Infections*/drug therapy ; HIV Infections*/epidemiology ; Veterans*; CD4 Lymphocyte Count ; Female ; Humans ; Integrase Inhibitors/therapeutic use ; Male ; Retrospective Studies ; United States/epidemiology ; Viral Load

Early HIV viral suppression (VS) improves individual health outcomes and decreases onward transmission. We designed an outpatient clinic protocol to rapidly initiate antiretroviral therapy (ART) in a large Veterans Health Administration (VA) HIV clinic. A pre-post evaluation was performed using a retrospective cohort study design for new diagnoses of HIV infection from January 2012 to February 2020. Time-to-event analyses were performed using the Cox proportional hazards model with the intervention group as the main exposure adjusted for integrase inhibitor usage, baseline viral load, age, gender, and race. Most of the patients were men (historical control: 94.8%, n  = 55; Rapid Start: 94.8%, n  = 55) and Black or African American persons (historical control: 87.9%, n  = 51; Rapid Start: 82.8%, n  = 48). More patients initiated treatment with an integrase inhibitor-based regimen in the Rapid Start group (98.3%, n  = 57) compared with the historical control group (39.7%, n  = 23). Compared with controls, the Rapid Start patients were significantly more likely to achieve VS at any given time during the study period (hazard ratio 2.65; p  < 0.001). Median days (interquartile range) from diagnosis to VS decreased from 180.5 (102.5-338.5) to 62 (40-105) ( p  < 0.001), first appointment to VS decreased from 123 (68.5-237.5) to 45 (28-82) ( p  < 0.001), referral to first visit decreased from 20 (10-43) to 1 (0-3) ( p  < 0.001), and from first visit to ART dispense date decreased from 27.5 (3-50) to 0 (0-0) ( p  = 0.01). Prioritizing immediate ART initiation can compress the HIV care continuum from diagnosis to linkage to VS. Implementation of the Rapid Start Protocol should be considered at all VA facilities providing HIV care.

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Keywords: HIV; antiretroviral therapy; continuum of care; rapid ART; same-day therapy; viral suppression

0 (Anti-HIV Agents)
0 (Integrase Inhibitors)

Date Created: 20220519 Date Completed: 20220614 Latest Revision: 20230602

20240105

PMC9353996

10.1089/apc.2022.0039

35587641