Changing Clinics and Other Issues
Similar proportions of participants in RAPID (21%) and non-RAPID care (23%) subsequently chose to receive care at a different clinic.
Clinic staff lost contact with a broadly similar proportion of participants in RAPID (10%) and non-RAPID care (15%).
For the purposes of this analysis, the research team chose to use a viral load level of 200 copies/mL as a goal of therapy in the short term. They found that, on average, participants in RAPID achieved a target viral load of 200 copies/mL faster (58 days) after their first clinic visit than non-RAPID participants who took nearly 80 days after their first clinic visit to reach the same level.
A Combined Effort
The research team noted that "starting ART immediately [after diagnosis] required additional time from all members of our multidisciplinary team." This issue arose because the researchers found that "our new patients lacked health insurance and often had immediate housing, substance use or mental health treatment needs. The addition of same-day ART into the first clinic visit therefore increased the urgency of arranging health insurance and also compressed the time available for social workers to begin the process of psychological and social stabilization."
Summing It Up
Based on their results, the researchers made the following statement:
"We found that a health system intervention to initiate ART on the same day as an HIV diagnosis was highly feasible in a real-world public health clinic in San Francisco. Same-day, observed initiation of ART was well accepted, was well tolerated by patients and did not appear to interfere with subsequent engagement in care."
It is likely that in the future more cities, regions and countries will prioritize programs such as RAPID to help improve the health of HIV-positive people and stem the spread of new infections.
Not Just in San Francisco
Researchers in Vancouver have also published their preliminary results with HIV diagnosis followed by the offer of initiating ART on the same day. Also, researchers in London, England, have reported their experience with a relatively early initiation of ART in people with very early HIV infection.
Negligible Risk: Updated results from two studies continue to show that antiretroviral treatment and an undetectable viral load is a highly effective HIV prevention strategy -- CATIE News
Starting ART on the same day as an HIV diagnosis in British Columbia -- TreatmentUpdate 210
Study heralds an important shift in care and treatment -- TreatmentUpdate 210
Detailed results from the START study -- TreatmentUpdate 210
CATIE statement on the use of antiretroviral treatment (ART) and an undetectable viral load to prevent the sexual transmission of HIV
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