While racial and socioeconomic disparities in HIV treatment access still persist in San Francisco, California, the city’s Rapid ART Program Initiative for New Diagnoses (RAPID) has been able to shrink the gap while improving overall rates of connection to HIV care, research published in Clinical Infectious Diseases finds.
The primary goal of RAPID is to link HIV-positive people to care within five days of their diagnosis, and to initiative antiretroviral therapy during their first care visit. The current study examines data spanning from 2013, when RAPID was first piloted, through 2017.
The study showed that by 2017, 28% of people newly diagnosed with HIV in San Francisco had their first HIV care visits within five days of diagnosis and began antiretroviral therapy within a day of that visit. Before the intervention, 2% of newly diagnosed people had met these criteria.
The initiative prioritized implementation in clinics serving underserved populations, which may partly account for its initial success in some subpopulations. From 2013 to 2017, the median time from HIV diagnosis to achievement of viral suppression dropped dramatically across all demographic groups, including from 147 days to 103 days among Black people, 139 days to 79 days among Latinx people, 143 days to 69 days among white people, and 161 days to 66 days among people who are homeless.
In an accompanying commentary, Edward M. Gardner, M.D., and Kellie L. Hawkins, M.D., M.P.H., focused on the potential for RAPID to help overcome disparities. For example, while people experiencing homelessness took longer on average to achieve viral suppression than did the general population, they still did so more quickly than they had prior to RAPID. It’s too early to tell, but “maybe getting people into the continuum quickly, with rapid linkage and [antiretroviral therapy] initiation after initial HIV diagnosis, will improve outcomes in some of the hardest to engage populations over time,” they wrote.
As we noted last week in This Week in HIV Research, an analysis of a model of the U.S. epidemic over the next 10 years predicted that addressing disparities would be crucial to achieving the goals of the Ending the HIV Epidemic plan. In RAPID, the reduced-but-persistent disparities in virologic outcomes show the need for addressing social determinants in addition to medical issues, study authors concluded.