A Qualitative Study of the Experience of Immediate Antiretroviral Therapy Among Urban Persons With Newly Diagnosed Human Immunodeficiency Virus

Abstract

Background Guidelines recommend immediate antiretroviral therapy (ART) at or shortly after HIV diagnosis, yet little is known about how people living with HIV (PLWH) experience this treatment strategy, including racial/ethnic minorities, cis/trans women, and those with housing instability. Methods To assess the acceptability of immediate ART offer among urban PLWH, understand how this approach affects the lived experience of HIV diagnosis, and explore reasons for declining immediate ART, we conducted a cross-sectional qualitative study using semi-structured interviews with individuals who had been offered immediate ART after HIV diagnosis at a safety-net HIV clinic in San Francisco and a federally qualified health center in Chicago. Interviews were analyzed using thematic analysis. Results Among 40 participants with age range 19-52, 27% cis/trans women or gender-queer, 85% racial/ethnic minority, and 45% homeless/unstably housed, we identified three major themes: 1) individuals experienced immediate ART encounters as supportive; 2) individuals viewed immediate ART as sensible, and; 3) immediate ART offered emotional relief by offsetting fears of death and providing agency over one’s health. Reasons for declining immediate ART ranged from simply needing a few more days to complex interactions of logistical and psychosocial barriers. Conclusion Immediate ART was highly acceptable to urban persons with newly diagnosed HIV infection. Immediate ART was viewed as natural next step after HIV diagnosis and provided a sense of control over one’s health, mitigating anxiety over a decline in physical health. As such, immediate ART somewhat eased but in no way obviated the psychosocial challenges of HIV diagnosis.

Outcomes and Predictors of Rapid Antiretroviral Therapy Initiation for People With Newly Diagnosed HIV in an Integrated Health Care System

“…Another reason for this observation is that the rapid ART strategy may not provide enough time to address HIV stigma, social determinants of health, and medical mistrust, leading to loss to follow-up and lower medication adherence. This was observed in a qualitative study on the rapid ART strategy in San Francisco, which showed high acceptability but found that some patients hesitated to undergo rapid ART due to complex psychosocial and structural challenges [ 26 ]. Studies in South Africa, Ethiopia, and a large program in Sub-Saharan Africa have also shown that same-day ART initiation resulted in more loss to follow-up [ 13–15 , 27 ].…”

The Rapid interaction: a qualitative study of provider approaches to implementing Rapid ART

“…Further, patient data from this study were analyzed separately [ 39 ], and without inferring direct links between meaningful care elements that patients reported and those intended by providers, we can broadly identify concordance across findings. Patient findings published in 2021 show that, in addition to the offer of the ART itself, patients valued the emotional support of the “ART encounter,” and that Rapid ART as a process helped offset patient fears [ 39 ].…”

Experiences of initiating rapid antiretroviral therapy among people newly diagnosed with HIV in East London: a qualitative study

“…Literature looking at rapid ART has found high uptake rates, in a variety of settings 8–10 12 13. Qualitative studies in the USA, Eastern Africa and South Africa show various barriers to and facilitators of uptake among people living with HIV and their healthcare professionals 14–23. Barriers include time to adjust to the new HIV diagnosis, shock, denial, fear of domestic violence, anticipated side-effects and logistical issues.…”

“…Barriers include time to adjust to the new HIV diagnosis, shock, denial, fear of domestic violence, anticipated side-effects and logistical issues. Facilitators such as wanting to improve health, a sense of agency, the benefits of viral suppression and provider knowledge and attitudes have been reported 14–23…”