Development of a City-Wide Rapid Antiretroviral Therapy Initiation Toolkit for People Newly Diagnosed with HIV in the Southern United States

Abstract

Abstract Background Rapid antiretroviral therapy (ART) initiation, where individuals with HIV start treatment within days of diagnosis, is a key component of the United States Ending the HIV Epidemic initiative. The Memphis Metropolitan Statistical Area ranks second in the US for HIV incidence, yet only ∼60% of individuals link to treatment within one month of diagnosis. This study aimed to identify barriers and strategies for implementing rapid ART initiation in Memphis. Methods From August to December 2022, we conducted process mapping guided by the Consolidated Framework for Implementation Research to outline the steps from three HIV testing sites to ART prescription at three Ryan White-funded clinics in Memphis, Tennessee. We then used modified conjoint analyses to prioritize barriers and identify strategies for improving rapid ART implementation, focusing on the importance and feasibility of changes. Findings Prioritized barriers included intersectional stigma and a lack of access to centralized information about the rapid ART program, branding and logo development, inter- and intra-organizational networking and communication, testing and treatment resources (such as testing kits and ART starter packs), rapid ART knowledge, and organizational champions. Strategies to address these barriers were compiled into a local rapid ART toolkit. Conclusions We identified modifiable systemic barriers to rapid ART initiation in Memphis, Tennessee, a community disproportionately affected by the HIV epidemic. The strategies developed to address these barriers informed the creation of a locally relevant rapid ART toolkit for future evaluation. These methods could be applied in other high-burden areas seeking to develop local rapid ART models.