Lessons learned from U.S. rapid antiretroviral therapy initiation programs

Rupali K. Doshi, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Shawnika Hull, Rutgers University School of Communication and Information, New Brunswick, NJ, USA.
Aaron Broun, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Saanjh Boyani, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Darryl Moch, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Adam J. Visconti, The HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA), District of Columbia Department of Health, Washington, DC, USA.
Amanda D. Castel, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Stefan Baral, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Jonathan Colasanti, Emory University School of Medicine, Atlanta, GA, USA.
Allan E. Rodriguez, University of Miami Miller School of Medicine, Miami, FL, USA.
Joyce Jones, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Susa Coffey, University of California San Francisco School of Medicine, San Francisco, CA, USA.
Anne K. Monroe, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.

Document Type

Journal Article

Publication Date

7-17-2023

Journal

International journal of STD & AIDS

DOI

10.1177/09564624231185622

Keywords

CFIR; HIV/AIDS; implementation; qualitative; treatment initiation

Abstract

BACKGROUND: Rapid antiretroviral therapy initiation (R-ART) for treatment of HIV has been recommended since 2017, however it has not been adopted widely across the US. PURPOSE: The study purpose was to understand facilitators and barriers to R-ART implementation in the U.S. RESEARCH DESIGN: This was a qualitative design involving semi-structured interviews. STUDY SAMPLE: The study sample was comprised of the medical leadership of nine US HIV clinics that were early implementers of R-ART. DATA COLLECTION AND ANALYSIS: In-depth, semi-structured interviews were performed. The Consolidated Framework for Implementation Research (CFIR) was used to guide thematic analysis. RESULTS: We identified three main content areas: strong scientific rationale for R-ART, buy-in from multiple key stakeholders, and the condensed timeline of R-ART. The CFIR construct of Evidence Strength and Quality was cited as an important factor in R-ART implementation. Buy-in from key stakeholders and immediate access to medications ensured the success of R-ART implementation. Patient acceptance of the condensed timeline for ART initiation was facilitated when presented in a patient-centered manner, including empathetic communication and addressing other patient needs concurrently. The condensed timeline of R-ART presented logistical challenges and opportunities for the development of intense patient-provider relationships. CONCLUSIONS: Results from the analysis showed that R-ART implementation should address the following: 1) logistical planning to implement HIV treatment with a condensed timeline 2) patients' mixed reactions to a new HIV diagnosis and 3) the high cost of HIV medications.

Department

Epidemiology

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