Abstract
Immediate antiretroviral therapy (iART), defined as same-day initiation of ART or as soon as possible after diagnosis, has recently been recommended by global and national clinical care guidelines for patients newly diagnosed with human immunodeficiency virus (HIV). Based on San Francisco’s Rapid ART Program Initiative for HIV Diagnoses (RAPID) model, most iART programs in the US condense ART initiation, insurance acquisition, housing assessment, and mental health and substance use evaluation into an initial visit. However, the RAPID model does not explicitly address structural racism and homophobia, HIV-related stigma, medical mistrust, and other important factors at the time of diagnosis experienced more poignantly by African American, Latinx, men who have sex with men (MSM), and transgender patient populations. These factors negatively impact initial and subsequent HIV care engagement and exacerbate significant health disparities along the HIV care continuum. While iART has improved time to viral suppression and linkage to care rates, its association with retention in care and viral suppression, particularly in vulnerable populations, remains controversial. Considering that in the US the HIV epidemic is sharply defined by healthcare disparities, we argue that incorporating an explicit health equity approach into the RAPID model is vital to ensure those who disproportionately bear the burden of HIV are not left behind.
Highlights
Gaps in the human immunodeficiency virus (HIV) care continuum, between HIV diagnosis, linkage to HIV care, and initiation of antiretroviral therapy (ART), present a persistent global public health challenge [1]
The advent of new potent antiretrovirals, including integrase inhibitors, have resulted in regimens that are easier to tolerate, with fewer drug–drug interactions, higher barriers to resistance, and more single-dose regimen options [7]. These advances led to the exploration of rapid or immediate ART—defined as same-day, or as soon as possible after diagnosis, ART without waiting for initial bloodwork or viral resistance testing—as a potential approach to close the gap between HIV diagnosis, linkage to care, and ART initiation
This commentary argues that a health equity approach that recognizes and intervenes upon the psychosocial forces impacting the most vulnerable populations living with HIV is vital for successful immediate ART (iART) implementation and to avoid exacerbating disparities along the HIV care continuum
Summary
Gaps in the HIV care continuum, between HIV diagnosis, linkage to HIV care, and initiation of antiretroviral therapy (ART), present a persistent global public health challenge [1]. The advent of new potent antiretrovirals, including integrase inhibitors, have resulted in regimens that are easier to tolerate, with fewer drug–drug interactions, higher barriers to resistance, and more single-dose regimen options [7] These advances led to the exploration of rapid or immediate ART (iART)—defined as same-day, or as soon as possible after diagnosis, ART without waiting for initial bloodwork or viral resistance testing—as a potential approach to close the gap between HIV diagnosis, linkage to care, and ART initiation. A more thorough examination of iART’s impact, for the most vulnerable populations, is critical to meet the goals of ending the epidemic and to ensure that in addition to the universal, immediate offer of treatment, there is an appreciation of and targeted interventions for specific patient concerns This commentary argues that a health equity approach that recognizes and intervenes upon the psychosocial forces impacting the most vulnerable populations living with HIV is vital for successful iART implementation and to avoid exacerbating disparities along the HIV care continuum
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
