Starting patients on ART on the day of their HIV diagnosis increases rates of retention in care and sustained viral suppression, according to study findings from a rapid-start program in New Orleans.
Jason Halperin, MD, MPH, an infectious disease physician at CrescentCare Health, and colleagues previously showed that the rapid-start program reduced the median time to linkage to care from 30 days to 1.3 days and more than halved the median time to viral suppression from 68 days to 30.
“The benefits of immediate access to ART are many,” Halperin told Infectious Disease News. “I am hoping these data will lead to the [HHS] guidelines supporting this model nationally.”
Halperin explained that achieving viral suppression increases patient health outcomes and removes the risk for transmission, which can lift a burden from patients.
“Our clinic has demonstrated that a community-based clinic in the Southern U.S.” — which is disproportionately affected by HIV — “can initiate a rapid-start program,” he said. “Key components include support of clinic leadership, provider buy-in, a dedicated linkage coordinator, streamlined processes for clinic enrollment, insurance eligibility assessment and medication access. The last component can be accessed through Ryan White funding, patient assistance or a combination of the two.”
In the most recent study, the results of which were published in Open Forum Infectious Diseases, Halperin and colleagues evaluated two groups of patients enrolled in the program between Dec. 6, 2016, through Feb. 28, 2018:
- Patients who were newly diagnosed, linked to care within 72 hours of diagnosis and offered same-day ART, referred to as CrescentCare Start Initiative (CCSI) patients; and
- ART-naive patients who were diagnosed after 72 hours, linked to care on day of contact and offered same-day ART, referred to as Early Intervention Services (EIS) patients.
According to the study, 130 patients were referred to the CCSI program, and 97% were linked to care within 72 hours, with four lost to follow-up. Of the remaining 126 patients, all immediately started ART. Halperin and colleagues reported that 99.2% achieved viral suppression, with the median time to from diagnosis to viral suppression being 29 days. Moreover, 92% of patients in the CCSI group met retention in care criteria and 90% experienced continued viral suppression.
Of the 70 patients in the EIS program, 69 were linked to care, with a median time from diagnosis to linkage of 27.5 days, and 98.6% were prescribed ART on the day of linkage. The researchers reported that 94.2% of patients in the EIS program achieved viral suppression, occurring a median of 28 days after linkage, 80% met retention in care criteria, and 77% continued to be virally suppressed.
“A rapid-start intervention, ART on day of diagnosis, is well-tolerated, safe, leads to sooner viral suppression and is now shown, in this cohort, to increase rates of retention in care and sustained viral suppression,” Halperin said. “There are national educational programs to assist clinics in developing a rapid-start model. I am co-chairing one of these educational series.”
By Marley Ghizzone