Analysis of Clinical Outcomes Following Implementation of a Rapid Antiretroviral Therapy Initiation Protocol at a Local HIV Clinic

Abstract

Rapid antiretroviral therapy (ART) refers to initiating HIV treatment within seven days of diagnosis. Multidisciplinary teams that implement rapid ART protocols can be effective in addressing the holistic needs of HIV patients. The purpose of this study was to evaluate a multidisciplinary team’s implementation of a rapid ART protocol through a retrospective pre and post study design among 627 patients referred to a local HIV clinic between January 2017 and December 2022. We observed a 46% difference in the median number of days from diagnosis to first visit (p < 0.001) between pre implementation (“pre”) [median days = 13] and post implementation groups (“post”) [median days = 7] and a 17% difference in median days from first visit to viral suppression (p < 0.05) between pre (median days = 63) and post groups (median days = 52). An adjusted Cox proportional hazards model showed a higher probability of having a first visit with a medical provider following diagnosis sooner in the post group compared to the pre group (hazard ratio [HR]: 1.53, p < 0.001). The post group also had a higher probability of achieving viral suppression sooner compared to the pre group (HR: 1.55, p < 0.01) where 98% achieved viral suppression in the post group within 12-months compared to 90% in the pre group. These results show that after the introduction of a rapid ART protocol implemented by a multidisciplinary team, there were significantly shorter days to first visit and greater viral suppression outcomes among the post group compared to the pre group.