Implementation of a Rapid Entry Program Decreases Time to Viral Suppression Among Vulnerable Persons Living With HIV in the Southern United States. (28th June 2018)

• Record Type: Journal Article
• Authors: Colasanti, Jonathan; Sumitani, Jeri; Mehta, C Christina; Zhang, Yiran; Nguyen, Minh Ly; del Rio, Carlos; Armstrong, Wendy S
• Is Part Of: Open forum infectious diseases. Volume 5:Number 6(2018)
• Publication Date: 2018-06-28
• Subjects: antiretroviral therapy -- HIV -- rapid entry -- viral suppression; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy104
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Rapid entry programs (REPs) improve time to antiretroviral therapy (ART) initiation (TAI) and time to viral suppression (TVS). We assessed the feasibility and effectiveness of a REP in a large HIV clinic in Atlanta, Georgia, serving a predominately un- or underinsured population. Methods: The Rapid Entry and ART in Clinic for HIV (REACH) program was implemented on May 16, 2016. We performed a retrospective cohort study with the main independent variable being period of enrollment: January 1, 2016, through May 15, 2016 (pre-REACH); May 16, 2016, through July 31, 2016 (post-REACH). Included individuals were HIV-infected and new to the clinic with detectable HIV-1 RNA. Six-month follow-up data were collected for each participant. Survival analyses were conducted for TVS. Logistic and linear regression analyses were used to evaluate secondary outcomes: attendance at first clinic visit, viral suppression, TAI, and time to first attended provider visit. Results: There were 117 pre-REACH and 90 post-REACH individuals. Median age (interquartile range [IQR]) was 35 (25–45) years, 80% were male, 91% black, 60% men who have sex with men, 57% uninsured, and 44% active substance users. TVS decreased from 77 (62–96) to 57 (41–70) days ( P < .0022). Time to first attended provider visit decreased from 17 to 5 days, and TAI from 21 to 7 days ( P < .0001), each remaining significant in adjusted models. Conclusions: This is the largest rapid entry cohort described in the United States and suggests that rapid entry is feasible and could have a positive impact on HIV transmission at the population level.