Immediate ART and clinical outcomes in New York City among patients newly diagnosed with HIV

ABSTRACT

Immediate antiretroviral therapy (iART) has been shown to decrease time to viral suppression. Our center underwent significant practice transformation to support iART, including a same-day Open Access (OA) model and enhanced care coordination. We examined whether same-day ART at linkage was associated with favorable proximate and long-term HIV care outcomes. From 2018 to 2019, patients newly diagnosed with HIV, linked to care at our institution, and iART eligible were included. We evaluated the association between iART and time to viral suppression, and between iART and initial/sustained viral suppression and retention in care. We also evaluated the association between use of OA and frequency of care coordination with the same outcomes. Of the 107 patients included, 72 initiated same-day ART at linkage and 35 did not. There was no statistically significant differences in whether patients were ever suppressed, had sustained viral suppression, or were retained in care between those who received same-day ART and those who did not. More care coordination was associated with retention in care (RR 1.21 [1.01–1.5]; p = 0.05). Organizing vital services and ensuring implementation strategies that facilitate iART, while tailoring the approach to the patient’s comfort level, is likely optimal for longitudinal HIV care engagement.

KEYWORDS:

• Immediate antiretroviral therapy
• HIV
• viral suppression
• retention in care
• practice transformation

Acknowledgements

The authors thank the diligent team at the HIV Center for Clinical and Behavioral Studies, including Robert Remien PhD, Susie Hoffman PhD, Curtis Dolezal PhD and the HIV Center postdoctoral fellows, for their assistance with the framing of the manuscript. The authors also thank Audrey Perez and our team of clinical nurses, care coordinators and providers responsible for iART implementation.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number H97HA27430, a Special Projects of National Institute of Mental Health Significance (SPNS) entitled “System-level Workforce Capacity Building for Integrating HIV Primary Care in Community Health Care Settings – Demonstration Sites for 1,189,500 from 2014-2018.” This information and these conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. This project was also funded in part by the NYCDOHMH through a contract with Public Health Solutions [18-NCT-670 for Status Neutral Linkage and Navigation in Clinical Settings PIs: Caroline Carnevale]. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the funders. OM was supported by the HIV Center for Clinical and Behavioral Studies [P30-MH43520] T32 postdoctoral fellowship [2T32MH019139-31].