Patient Perspectives on Rapid Antiretroviral Treatment Initiation for HIV: Implications for Best Practices.

Abstract

Rapid start of antiretroviral therapy (ART) has been recommended by the World Health Organization since 2017 and is an important approach toward optimizing HIV care. Our objective was to understand the experiences of people with HIV (PWH) undergoing rapid start and to synthesize lessons learned to improve our program. This mixed-methods study recruited newly diagnosed patients establishing care at an urban safety-net clinic in Dallas, TX, between 2021 and 2022. Eligible PWH were ART-naïve and diagnosed with HIV within 12 months prior to the rapid start visit. Participants completed baseline and follow-up surveys 3-12 months after enrollment. A subset of participants completed semi-structured interviews to capture their experiences with HIV and elucidate barriers and facilitators to rapid start. Interviews were evaluated using thematic analysis. Qualitative and quantitative findings were integrated to develop best practices. In total, 199 participants (35.5 ± 11.6 years; 73.9% men; 39.7% Black; 48.7% Hispanic; 38.2% heterosexual risk transmission of HIV) participated in the study. Completed surveys and interviews (n = 20) centered around five themes: (1) social and emotional needs, (2) patient-centered approach, (3) cultural competence, (4) structural navigation, and (5) longitudinal support. Key elements of a rapid start program include evaluating and fostering support networks; emphasizing patient-centered care like tailored education on HIV; acknowledging distinctive cultural values and behaviors of the patients; improving structural factors, including support for insurance issues; and strengthening longitudinal support past the rapid start visit. Such lessons can serve as a blueprint for other practices, particularly in the US South, looking to establish or strengthen rapid start programs.