Rapid ART initiative reduces time from diagnosis to viral suppression by half
The rollout of an ART optimization initiative in San Francisco decreased median time from diagnosis to virologic suppression by nearly half, according to findings in Clinical Infectious Diseases.
“Although ART has been proven to improve the health of persons with HIV infection and to decrease sexual transmission of HIV, there is often a delay of weeks to months between HIV diagnosis and ART initiation, representing lost opportunities for treatment and prevention,” Oliver Bacon, MD, of the San Francisco City Clinic, Disease Prevention and Control Branch, in the San Francisco Department of Public Health, and the division of HIV, infectious diseases and global medicine at the University of California, San Francisco, told Healio. “Randomized trials in the international setting showed improved outcomes in persons who were started on ART on the day of diagnosis vs. those who were started according to standard of care.”
The multisector San Francisco Getting to Zero collaboration endorsed and prioritized immediate ART — within 6 days of diagnosis — for all San Franciscans starting in 2015, according to Bacon. The present study aimed to examine trends in ART initiation and virologic suppression during the early implementation of the Getting to Zero Rapid ART initiative.
Bacon and colleagues collected data on dates of HIV diagnosis, first care visit, ART initiation and virologic suppression for 1,354 patients with new HIV diagnoses from 2013 to 2017 from the San Francisco Department of Public Health HIV surveillance registry. The majority (89%) of patients were men and less than half were white.
According to Bacon, the study showed that from 2013, before the citywide Getting to Zero Rapid ART initiative, to the end of 2017, which was the second full year of the initiative, median time from diagnosis to the first medical visit decreased by 44%, from 9 to 5 days (P < .001), and median time from first medical visit to ART initiation decreased by 96%, from 28 days to 1 (P < .0001). Time to ART initiation improved across all sociodemographic groups studied, Bacon noted.
In addition, the median time from HIV diagnosis to first virologic suppression decreased by almost half, from 145 to 76 days (48%; P < .0001). By 2017, 28% of patients with new HIV diagnoses were rapidly started on ART, a finding that was independently associated with Latinx ethnicity (adjusted OR, 1.73; 95% CI, 1.15-2.60) and a more recent year of diagnosis (2017 aOR, 16.84; 95% CI, 8.03-35.33).
“In a collaborative setting, immediate ART initiation at HIV diagnosis is feasible at a citywide level across sociodemographic groups and is associated with improved virologic suppression at 1 year,” Bacon said. – by Caitlyn Stulpin
Disclosures: Bacon reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.