Test and Be Treated: Faster and Easier Entry to HIV Care
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: It can take months after a client requests an HIV test for them to be confirmed as having HIV infection, counseled, linked to care, scheduled; initially evaluated, and finally begun on antiretroviral therapy. Our team�comprised of leading investigators from UCSF/Zuckerberg SF General Hospital, the SF Department of Public Health, the SF AIDS Foundation, East Bay AIDS Center, and Kaiser Permanente�have led programs pioneering approaches to early HIV diagnosis, and have recently shown that same-day ART initiation dramatically improves ART uptake and the rate of viral suppression. Now, new testing technologies have emerged that for the first time will give HIV RNA viral load, HIV confirmation, and disease staging results at the point of care. In order to control HIV in the Bay Area, we designed a novel ART initiation strategy for acute infections. This approach is known as the RAPID program (Rapid Antiretroviral Program for Individuals with new Diagnosis), which includes rapid testing and same-day initiation of ART. Preliminary results of this strategy showed a significantly faster time to undetectable viral load compared with patients receiving the standard of care. This led to RAPID�s endorsement by SF�s multi-sector �Getting to Zero� (G2Z) consortium as one of three key tools � along with PrEP expansion and enhanced efforts to retain patients in care � to achieving G2Z�s goals of zero new HIV infections, zero HIV deaths, and zero HIV stigma. Given the success of RAPID thus far, we plan to now adapt, expand and evaluate its use in other settings, developing materials for its dissemination to other jurisdictions. Our current proposal is a 4-year demonstration project involving phased implementation of the RAPID model. The new testing algorithm will be piloted in a year 1 Pilot Phase. In the Implementation Phase (years 2-3), new technologies will be used to provide same-day confirmed results in the Bay Area�s two largest HIV testing sites (Magnet and SF City Clinic, the municipal STD clinic), which will give clients RAPID ART using a starter pack, to bridge care while patients are helped to find their new HIV provider elsewhere. In the Expansion Phase (years 3-4), the RAPID ART protocol will be started for newly-diagnosed patients at Oakland�s East Bay AIDS Center (EBAC), and patient outcomes will be tracked at collaborating HIV clinical care sites (ZSFG, Kaiser-Permanente Northern California, and EBAC). Immediate lessons learned will be applied to an updated RAPID model, which will be prepared for dissemination and replication at priority HIV prevention sites serving highly vulnerable clients (EBAC-affiliated testing sites, serving Oakland and surrounding communities, the SF AIDS Foundation 6th Street Harm Reduction Center, and other SFAF-affiliated testing sites including through Glide, St James Infirmary, and the youth center LYRIC). There are three specific aims to our proposal. Aim 1: To implement and evaluate Magnet and SFCC same-day point of care HIV confirmatory algorithms. Aim 2: To implement, refine, and evaluate a RAPID ART initiation strategy for all high-risk individuals who test positive for HIV at participating prevention sites. Aim 3: To estimate the impact of RAPID ART and same-day diagnosis on patient-level outcomes (satisfaction with care, linkage, retention, viral suppression) and on population level outcomes (viral suppression, HIV transmission, health care costs), assuming alternate models of scale-up.