Abstract
BackgroundRapid 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.MethodsWe 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.ResultsBetween 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.ConclusionOur 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.
Highlights
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
Recommendations that ART should be initiated within 7 days of HIV diagnosis have been adopted by the World Health Organization (WHO) and International AIDS Society-USA (IAS-USA) [1, 3]
Evidence provided by the PARTNER and Opposites Attract prospective, observational studies support that the risk of HIV transmission in both gay and heterosexual couples through condomless sex when HIV viral load is undetectable is effectively zero [13, 14]
Summary
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. Rapid antiretroviral therapy (ART) is a novel strategy to reduce HIV transmission and shorten time to virologic suppression. Recommendations that ART should be initiated within 7 days of HIV diagnosis have been adopted by the World Health Organization (WHO) and International AIDS Society-USA (IAS-USA) [1, 3]. The Department of Health and Human Services (DHHS) recommends the immediate initiation of ART therapy due to the significant increase in viral suppression amongst patients from the START and TEMPRANO randomized trials who began immediate ART or initiated therapy within 7 days [10]. Earlier linkage to care and treatment has proven to improve patient outcomes and decrease AIDS progression and mortality [15]
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