1272. Impact of Rapid Initiation of Antiretroviral Therapy on Retention in Care in the Southern United States

Abstract

Background Rapid initiation of antiretroviral therapy (ART) is now a well-established approach for reducing time to viral suppression in persons newly-diagnosed with HIV. However, there is limited data examining the effect of rapid initiation of ART on retention in care—which is also crucial to reducing transmission—especially in the disparate populations of the southern United States. The goal of this study is to determine if rapid start ART increases retention in HIV care in this region. Methods This was a prospective population-based cohort study of newly-diagnosed HIV patients who established care at the 550 Clinic from July 2021 to April 2022. The intervention was utilizing a team to facilitate warm hand-offs of newly diagnosed patients to clinic, in contrast with standard of care, a faxed referral. All patients were enrolled in one of two arms: rapid prospective (ART initiated within 7 days of diagnosis) or non-rapid prospective (ART started > 7 days of diagnosis). Data was also matched to a retrospective arm from historical data. Patients were followed at a visit 4-8 weeks from initiation then again in 8-12 weeks. Descriptive statistics were done to compare demographics, clinical characteristics and time to follow-up visit by study arm. Results Of the 105 patients enrolled, 41 were in the rapid prospective arm, 35 in the non-rapid prospective arm, and 29 in the retrospective arm. The median age was 31 years, 83% were male, 35% African American, and 12% Hispanic. In the rapid arm, time from initiation to first kept follow-up was significantly less compared to the non-rapid arm (44 days vs 70 days, p < 0.001). From baseline to third visit, there was a 93% increase in the CD4 count among the rapid arm vs a 58% increase among the non-rapid arm. Additionally, 80% of rapid participants had an undetectable viral load by visit 3 vs 66.7% of non-rapid participants. Conclusion Results showed that addition of a warm hand-off and rapid initiation of ART improves linkage to care and increases adherence to follow-ups, as well as rates of viral suppression. This intervention was effective in improving outcomes, even among the medically vulnerable populations seen in the southern US. This data can therefore contribute to closing gaps in data on regional HIV care where ethnic minorities experience healthcare disparities. Disclosures Bailey Benidir, PharmD, AAHIVP, Gilead Sciences, Inc.: Grant/Research Support Forest W. Arnold, DO, MSc, Gilead Sciences, Inc.: Grant/Research Support.