Outcomes of Rapid Restart among People with Previously Diagnosed HIV at a Safety-Net HIV Clinic in San Francisco.

Abstract

Background: Little is known about outcomes of rapid restart of antiretroviral therapy (ART) among people with HIV re-linking to care.

Setting: Safety-net HIV clinic in San Francisco.

Methods: Using electronic medical record data, we conducted a retrospective study of adults with HIV (≥18 years old, out of care, self-reported off ART) seen for rapid (same-day) restart of ART. Descriptive statistics summarized baseline sociodemographic and clinical variables. Chi-square and Fisher's exact tests assessed associations between sociodemographic or clinical variables and two primary outcomes: 1) viral suppression (VS) (HIV viral load <200 copies/mL) within 180 days, and 2) sustained re-engagement in care (≥1 primary care provider visit both within 90 and 91-180 days after rapid restart). Complete case VS analysis included those with baseline viremia and follow-up HIV viral loads (VLs). In sensitivity analysis, those with missing follow-up VLs were considered non-suppressed.

Results: Between August 2020-October 2023, 141 adults (median age 42 years; 85% cis-male; 26% Latino/a) presented for rapid restart. Housing instability/homelessness (46%), substance use (61%), and mental illness (49%) were common. Among those with baseline viremia who returned for follow-up VLs, VS was attained in 79% and associated significantly with non-Latino/a ethnicity (87% non-Latino/a vs. 57% Latino/a, p=0.004). However, VS was 58% when considering missing follow-up VLs as non-suppressed. Sustained re-engagement in care was observed in only 33%.

Conclusion: Following rapid restart, sustained re-engagement in care and VS were low. Evaluation of key processes of rapid restart, retention efforts, and studies on effective re-engagement support strategies are needed.