I wanted it as soon as possible: a qualitative exploration of reactions to access to same-day ART start among participants in San Diego’s ART-NET project

ABSTRACT

Rapid start of antiretroviral therapy (ART) is quickly becoming best practice around the world. In the US, programs exist to facilitate rapid ART start, but little is known about the experiences of newly diagnosed individuals receiving these recommendations and services. Twenty participants (19 men who have sex with men and 1 transgender woman) from an early ART start program were interviewed to better understand these experiences. Interviews were analyzed for main themes in three general areas: reasons to start, reasons to delay, and factors influencing early ART adherence. Participants reported starting anywhere from right away (same visit as diagnosis) to within a few weeks (median 10.5 days). Reasons to start right away included fear of what could happen if not treated, personal health, influence of people/resources at the clinic, and study participation. Most had small delays in ART start because of structural (insurance, costs) and intentional delays (getting additional medical consultations). Adherence facilitators included desires to improve CD4/viral load and positive beliefs in benefits of suppression. Participants were largely supportive of rapid ART start and appeared to rely on CD4/viral load as “proof” of need for ART, which may be particularly helpful for asymptomatic, newly diagnosed individuals starting ART.

KEYWORDS:

• ART start
• rapid
• immediate
• newly diagnosed
• MSM
• qualitative interviews

Disclosure statement

KRA had a Gilead Sciences educational grant from 2016–2017 through the University of Michigan. MH and SJL report grant funding from Gilead Sciences.

Additional information

Funding

This study was funded through a supplement on NIH AI036214, and supported by the following NIH grants MH100974, AI106039, and MH113477, with Gilead Sciences support for drug provision (CO-US-236-1557) in the San Diego Primary Infection Resource Consortium (SD PIRC, NIH AI106039).