Initiating antiretroviral treatment for newly diagnosed HIV patients in sexual health clinics greatly improves timeliness of viral suppression

Abstract

Objective: The 'JumpstART' program in New York City (NYC) public Sexual Health Clinics (SHC) provides patients newly diagnosed with human immunodeficiency virus (HIV) with antiretroviral medication (ART) (1-month supply) on day of diagnosis and active linkage to HIV care (LTC). We examined viral suppression (VS) among patients who did and did not receive JumpstART services.Design: Retrospective cohort.Methods: Among newly diagnosed SHC patients (23 November 2016-30 September 2018) who were matched to the NYC HIV surveillance registry to obtain HIV laboratory test results through 30 June 2019, we compared 230 JumpstART and 73 non-JumpstART patients regarding timely LTC (30 days), probability of VS (viral load < 200 copies/ml) by 3 months post-diagnosis, and time to and factors associated with achieving VS within the follow-up period.Results: Of 303 patients, 76% (230/303) were JumpstART and the remaining were non-JumpstART patients; 36 (11%) had acute HIV infections. LTC 30 days was observed for 63% of JumpstART and 73% of non-JumpstART patients. By 3 months post-diagnosis, 83% of JumpstART versus 45% of non-JumpstART patients achieved VS (log-rank, P < .0001). Median times to VS among virally suppressed JumpstART and non-Jump-stART patients were 31 (interquartile range [IQR]: 24-51) and 95 days (IQR: 52-153), respectively. For groups with and without timely LTC, JumpstART was associated with viral suppression within 3 months post-diagnosis, after adjusting for age and baseline viral load.Conclusions: Prompt ART initiation among SHC patients, some with acute HIV infections, resulted in markedly shortened intervals to VS. Immediate ART provision and active LTC can be key contributors to improved HIV treatment outcomes and the treatment-as-prevention paradigm, with potential for downstream, population-level benefit.

Antiretroviral therapy initiation within 7 and 8–30 days post-HIV diagnosis demonstrates similar benefits in resource-limited settings

“…Previous studies only focused on the benefits of rapid ART initiation [11][12][13][14] or ART initiation within 30 days after HIV diagnosis [15,16]. Our study was the first to compare the benefits of ART initiation within 7 and 8-30 days after HIV diagnosis at the individual clinical and public health levels.…”

The Cost of Operating Sexual Health Clinics During the Ending the (HIV) Epidemic Initiative in New York City

“…Although costs of PEP, PrEP, and ART initiation were covered by the clinics during the study period, SHCs have since transitioned to a prescription model that uses patient insurance and/or medication assistance programs to cover medications, which has substantially reduced clinic costs. Offering immediate HIV treatment at the time of diagnosis in SHCs allowed patients with HIV to initiate treatment earlier and achieve viral suppression more rapidly than they would have in the absence of EtE enhancements to the SHCs, 13 leading to improved individual outcomes and potentially preventing additional transmission.…”

Life Expectancy Among People With HIV in New York City, 2009–2018

“…The increase in life expectancy among people with HIV was mainly the result of advances in ART, including better agents and regimens, earlier initiation of treatment, and higher coverage of ART among people with HIV in NYC. 1,[15][16][17][18][19] Other factors also contributed to the increase in life expectancy among people with HIV in NYC, including earlier diagnosis of HIV, improvements in linkage to HIV care, treatment and management of comorbidities, and support services. [20][21][22][23][24] We identified differences in life expectancy, disparities in improvements in life expectancy, and persistent gaps in life expectancy between people with HIV and the NYC general population.…”

“…[25][26][27] To reduce racial and ethnic disparities among people with HIV, we need to address structural and systemic racism and target racial/ethnic minorities for diagnosis, linkage to care, retention in care, and support services including transportation, food, housing, and workforce development. 11,16,[20][21][22] For the general population, a broader approach is needed and the Urban Institute proposes 5 solution sets to reduce inequalities in healthy life expectancy: (1) payers, plans, and providers develop and implement standardized approaches to systematically assess health-related social needs, (2) private philanthropy and state or local governments jointly develop, finance, and maintain community resource networks and platforms where managed care organizations, providers, and consumers can connect with the healthrelated social services they need, (3) state Medicaid programs incentivize investments in nonmedical services with positive health sector payoffs, (4) federal, state, and local health officials establish sustainable mechanisms for operating and financing programs addressing health-related social needs that yield cross-sector payoffs, and (5) private-sector health care payers and providers align their organizational policies and activities to maximize impact on health-related social needs. 28 This analysis has strengths.…”