780. A Quality Improvement Initiative to Identify and Close Gaps in Rapid Initiation of Antiretroviral Therapy (ART)

Abstract

Abstract Background Treatment guidelines recommend prompt ART initiation after HIV diagnosis, but implementation barriers persist. This project aimed to identify gaps and improve clinical practices surrounding rapid ART initiation in the US. Methods Baseline surveys were completed by 130 healthcare professionals (HCPs) in 8 HIV clinics assessing knowledge and practice around ART initiation. Responses informed the development of interactive, live virtual audit-feedback sessions at 8 clinics from 5/2022 – 8/2022. Pre and post-program surveys were administered, team-based action plans developed, and HCPs completed 60- and 120-day follow-up surveys. Results Top reported challenges impeding rapid ART initiation were medication adherence for patients with unstable housing/substance use disorders (SUD) (63%), incomplete lab results (33%) and co-infections/opportunistic infections (28%). Knowledge was assessed using case vignettes. For a patient with hepatitis C and SUD, 45% of learners correctly chose to promptly start ART, which improved to 94% after the sessions (p< .001). More HCPs were confident initiating ART for patients with unstable housing/SUD (70%) and before confirmatory HIV testing (74%) after the sessions than before (38% and 39%, respectively, p< .001 each). Follow-up surveys noted a 10% increase in proportion prescribing ART within 7 days of a positive screening test (32% to 42%) along with increased ART prescribing the same day as a positive test and before additional test results, Figure 1. Action plans implemented after the sessions included coordination with off-site labs, new intake forms, and staff training. HCPs self-reported improvements including appropriate prompt ART initiation (81% and 88%), integrating new patients to avoid loss to follow-up (85% and 88%), and alignment with guidelines (88% and 91%). HCPs identified care coordination (31%) and identifying candidates for rapid ART initiation (31%) as areas of need to improve rapid ART initiation. Challenges reported included scheduling conflicts, timely lab results and coordination with case management.Figure 1.Proportion of HCPs reporting ART initiation practices occurring for >75% of their patients Conclusion Tailored implementation discussion with live audit-feedback and action planning led to measurable practice improvements. These outcomes may inform other practice-changing implementation needs. Disclosures Jonathan Colasanti, MD, MSPH, DKB MED LLC: Honoraria|Prime Education LLC: Advisor/Consultant Aadia I. Rana, MD, Merck: Grant/Research Support JEWEL SAWYER, PA-C, MSHS, AAHIVS, Janssen: Speakers Bureau|Prime Education: Speakers Bureau