Initiation of Rapid Start Antiretroviral Therapy (ART) in Men Who Have Sex with Men (MSM)

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)

Grace Kathryn Wilkins (Creator)

Institution

The University of North Carolina at Greensboro (UNCG )

Web Site: http://library.uncg.edu/

Advisor

Lori Lupe

Abstract: Background: Human immunodeficiency virus (HIV) persists as a significant global health problem. Men-who-have-sex-with-men (MSM) remains the primary mode of HIV transmission in all regions of the United States, accounting for about 70% of new HIV infections each year. The U.S. South carries a heavier HIV burden when compared with other regions of the country.Current national and international guidelines recommend that all persons with a confirmed HIV positive (HIV+) test should begin antiretroviral therapy (ART) as soon as possible after diagnosis. Considerable variation in time to starting ART exists due to barriers to accessing medication which are multi-factorial and include linkage and access to HIV medical care, financial classification, insurance issues and method of receipt of medication. To reduce HIV-associated morbidity, mortality, new HIV infections, and related health care costs, rapid initiation of ART is necessary to decrease time to viral suppression. Early diagnosis and treatment of HIV affords MSM the opportunity for improved quality of life and a decrease in forward transmission of HIV infections. Consequences of delayed therapy, using traditional processes for engaging in care, result in increased number of AIDS diagnoses, non-AIDS associated co-morbidities and HIV transmission. Purpose: The purpose of this research project was to implement an accelerated ART program in an Infectious Disease Clinic in the southeastern U.S. among HIV+ MSM to reduce the time from date of initial HIV+ diagnosis to linkage to care (initial intake visit), thereby decreasing the number of days until the first dose of ART was administered, resulting in decreased time to viral load suppression, and improving linkage and retention in HIV care after initiating ART. Methods: Permission to conduct the study was granted from the Institutional Review Board of the University of North Carolina at Greensboro; a waiver of informed consent was granted due to the retrospective nature of this study. A university-based infectious disease (ID) clinic in the southern U.S. initiated an accelerated start ART program among HIV+ MSM. The rapid start ART program for newly diagnosed HIV+ MSM involved the initiation of ART across an MSM population between the ages of 18-34. A goal was set of =14 working days from diagnosis (HIV positive test result) to intake (linkage to care) visit and =7 days from intake visit to receipt of first dose of antiretroviral medication. Strategies focusing on rapid treatment initiation show promise in improving linkage and retention in care with the added benefit of decreasing time to viral suppression. Twenty newly diagnosed HIV+ MSM were included in the retrospective chart review. Ten charts were reviewed for MSM aged 18-34 who were newly diagnosed pre-intervention (between 2016 to 2018) and ten charts were reviewed for MSM who were included in the intervention group (diagnosed between March 2022 to October 2022). Results: Of the 20 charts reviewed, 10 participants were managed by rapid start ART, the pre-intervention group received the clinic’s standard of care. In the pre-intervention group 7 patients were scheduled for a linkage-to-care care visit within 14 days of their HIV diagnosis; 9 patients in the intervention group were scheduled for a linkage-to-care visit within 14 days of HIV diagnosis. Among the pre-intervention group it was an average of 30.9 days between the linkage-to-care visit and taking the first dose of ART, while the intervention group took their first dose of ART within 24 hours of their linkage to care visit. Nine patients in the intervention group were virally suppressed at the time of the first visit with their primary HIV provider, while 7 patients in the pre-intervention group were virally suppressed at the first medical provider visit. All intervention patients accepted rapid start. There were no adverse events or drug toxicities necessitating change of therapy. No participants were lost to follow-up in either group.Recommendations and Conclusions: Due to the small size of the sample population for this project, replication of the interventions in a larger group of newly diagnosed HIV+ MSM is recommended. Participants were able to begin ART through the disbursement of donated meds so that ART could be initiated as soon as possible after confirmed HIV diagnosis. There is need for a formalized process for accessing ART by medication samples or activation of medication assistance cards for patients to receive starter packs of ART to last 7-14 days (pending approval of HIV medication assistance program or prior authorization processes for privately insured patients).

Initiation of Rapid Start Antiretroviral Therapy (ART) in Men Who Have Sex with Men (MSM)
PDF (Portable Document Format)
14715 KB
Created on 1/11/2024
Views: 158

Additional Information

Publication

Other

Language: English

Date: 2023

Keywords

men-who-have-sex-with-men, gay and bisexual men, rapid start antiretroviral therapy, linkage to care, retention in care, barriers to rapid start ART, barriers to accessing ART, treatment as prevention (TasP), human immunodeficiency virus (HIV), ending the HIV epidemic, HIV medication assistance, HIV linkage to care, nurse led HIV care, advanced practice nurse led HIV care

Email this document to