Implementing Rapid Initiation of Antiretroviral Therapy for Acute HIV Infection Within a Routine Testing and Linkage to Care Program in Chicago

Abstract

Growing evidence suggests that rapid initiation of antiretroviral therapy for HIV improves care continuum outcomes. We evaluated process and clinical outcomes for rapid initiation in acute HIV infection within a multisite health care–based HIV testing and linkage to care program in Chicago. Through retrospective analysis of HIV testing data (2016-2017), we assessed linkage to care, initiation of antiretroviral therapy, and viral suppression. Of 334 new HIV diagnoses, 33 (9.9%) individuals had acute HIV infection. Median time to linkage was 11 (interquartile range [IQR]: 5-19.5) days, with 15 days (IQR 5-27) to initiation of antiretroviral therapy. Clients achieved viral suppression at a median of 131 (IQR: 54-188) days. Of all, 69.7% were retained in care, all of whom were virally suppressed. Sites required few additional resources to incorporate rapid initiation into existing processes. Integration of rapid initiation of antiretroviral therapy into existing HIV screening programs is a promising strategy for scaling up this important intervention.

Brief Report: Blood and Genital Fluid Viral Load Trajectories Among Treated and Untreated Persons With Acute HIV Infection in Malawi

“…16 In the United States, the median time to viral suppression (<200 copies/mL) was 131 days after AHI diagnosis, largely reflecting delays in linkage to care. 17 In our study, nearly 95% of participants initiated ART within 4 weeks of study enrollment, 93% achieved blood VL suppression (<400 copies/mL) within 12 weeks (84 days) and 75% achieved <1,000 copies/mL (the accepted threshold by the World Health Organization) within 4 weeks. VLs at diagnosis were lower among those who started ART than those who did not, although not to a degree that would be expected to change time to viral suppression, particularly given the potency of the selected ART regimen.…”

Essential elements of and challenges to rapid ART implementation: a qualitative study of three programs in the United States

“…Some settings receive newly diagnosed patients as referrals from outside their system while others do not—a factor that can affect the volume of RAPID patients. Evidence suggests that, in the United States, settings with existing HIV testing programs or strong referral partnerships between testing and clinic entities may be in a position to implement a RAPID program without adding significant resources [ 11 , 17 ]. In locations with weak HIV testing and ART delivery infrastructure and limited human resources, implementation of RAPID programming may be less feasible.…”

“…Implementation of RAPID programming, while growing, is not yet widespread. While RAPID programming can be resource-intensive, studies show that it is effective in achieving rapid initiation of ART and reduced time to virologic suppression [ 12 , 17 – 19 ]. Just how resource-intensive is an open question, and key questions about optimal implementation of RAPID remain.…”

Benefits and Risks of Rapid Initiation of Antiretroviral Therapy: A Systematic Review and Meta-Analysis

“…However, the thresholds used to define virus inhibition in different settings and periods are inconsistent. The CASCADE HIV trial defined viral inhibition as viral load <100 copies/mL (Labhardt et al, 2018;Amstutz et al, 2020), while in several HIV trials in the United States, viral inhibition was defined as viral load <200 copies/mL (Pilcher et al, 2017;Bacon et al, 2020;McNulty et al, 2020).…”