Assessing BE FASTER, a Community of Practice Among Ryan White Part A Clinics in Houston, to Increase Rapid Initiation of Antiretroviral Therapy: A Qualitative, Longitudinal Study.

Background: Rapid initiation of antiretroviral therapy (Rapid ART) is a key strategy for the Ending the HIV Epidemic inititative. In Harris County, Texas, a priority Ending the HIV Epidemic jurisdiction, 57% of persons with HIV receive care at 1 of 5 public agencies that receive funding from the Ryan White HIV/AIDS Program. The Ryan White HIV/AIDS Program is administered by the US Department of Health and Human Services, Health Resources and Services Administration, and HIV/AIDS Bureau. This program administers grants to clinics and local/state programs to deliver medical and support services (Part A) for low-income persons with HIV. In 2019, 39% of recently diagnosed persons with HIV in Houston took > 1 month to start ART. Herein, the authors evaluate the acceptability of the Baylor College of Medicine ECHO Facilitating Antiretroviral StART Earlier (BE FASTER) program, a community of practice collaborative among 5 Ryan White Part A Clinics, to increase Rapid ART in Harris County, Texas.

Methods: Semistructured interviews across 4 time points were conducted among health care workers participating in the BE FASTER program. Interviews took place from November 2021 through February 2023 and were analyzed using rapid qualitative analysis.

Results: A total of 29 participants were interviewed. Analyses revealed 6 themes: 1) Rapid ART protocols varied between clinics; 2) participants were interested in getting to know Rapid ART staff at other Ryan White clinics; 3) participants enjoyed the active components of BE FASTER and asked for more opportunities to engage; 4) at the end of BE FASTER, participants reported that they had streamlined their processes for Rapid ART, but barriers to long-term retention remained an ongoing challenge; 5) participants reported an increased sense of community from participating in the BE FASTER program; and 6) overall, participants had a positive experience with BE FASTER.

Conclusions: Participants found BE FASTER valuable and reported a positive impact on their cross-agency interactions. The BE FASTER program using the ECHO model can augment the creation of cross-organizational networks for Rapid ART.