Early HIV viral load suppression (VLS) is associated with decreased mortality and HIV transmission. The New York City Department of Health & Mental Hygiene Sexual Health Clinics (SHC) identify 10% of new HIV cases and 20% of acute HIV infections (AHI) citywide. The NYC SHC recently introduced Jumpstart (JS): on-site HIV antiretroviral (ARV) treatment with navigation. JS was designed to expedite HIV treatment initiation, support VLS, and improve adherence. We report on implementation and preliminary outcomes of the JS efforts available at 6 of 8 SHC.
NYC SHC patients are routinely tested for HIV via rapid antibody test; individuals at highest risk are screened for AHI via pooled Nucleic Acid Testing. Patients eligible for JS were > 18 years, lived in-state and reported no prior ARV treatment. Initiation visits included 30-day supply of ARVs, navigation, medical monitoring and linkage to HIV primary care. Using medical record data, we described JS initiates 11/23/16-7/31/17, their pretreatment drug resistance (PDR) patterns, CD4, viral load, care linkage, and VLS of those requiring additional ARV from SHC.
149 patients initiated ARVs. 108 patients were newly diagnosed at SHC offering JS; of these, 78 (72%) initiated ARVs (38/78 (49%) at diagnosis; 68/78 (87%) within 7 days). 71 additional patients initiated ARVs (20 newly diagnosed patients were transferred from SHC that did not yet have JS; 51 were previously diagnosed). Of the 149 ARV initiates, 126 (85%) were men reporting sex with men, 100 (67%) were Hispanic or black; 70 (47%) were foreign born. Median age was 29 years; 15 (10%) had AHI; 25 (17%) had CD4<200; 46 (31%) had baseline VL ≥100,000. 24 of 127 with baseline genotyping had evidence of PDR, most commonly to non-nucleoside ARVs. One patient required a change in therapy due to PDR. 30-day linkage to care was 84% (82/98) among new positives and 63% (32/51) among previous positives. Of 149 ARV initiates, 64 (43%) required a second month of ARV from SHC. The majority of these patients (41/64; 64%) had attended an appointment at a linkage facility. Among those with VL testing at SHC follow-up, 87% (45/52) had achieved VLS by day 45.
Incorporation of same-day HIV navigation and ARV initiation is feasible in the setting of a public health clinic system, with high patient acceptability. Scale up to all 8 SHC clinics is expected in 2018. Future evaluation will assess impact of these efforts on time to VLS.