Rapid start antiretroviral therapy (ART) protocols have emerged as an innovative care model for persons newly diagnosed with HIV (PNDWH). Shifting to a model where clinical pharmacists are at the forefront of rapid ART initiation may provide a sustainable solution for the logistical challenges that limit widespread implementation.
We conducted a preliminary retrospective analysis at Rhode Island’s largest HIV clinic to compare clinical outcomes of PNDWH before (1/2017 – 12/2017) and after (1/2019 – 8/2019) implementation of a Pharmacist Driven Rapid ART (PHARM-D RAPID) protocol. Prior to implementation of the protocol at this Ryan White clinic, patients attended an intake visit with a nurse upon HIV diagnosis, which preceded their first provider appointment and ART initiation by approximately 2 weeks. Following implementation of the PHARM-D RAPID protocol, PNDWH are evaluated by a multidisciplinary team on intake and offered rapid ART initiation by clinical pharmacists prior to their first provider visit. During intake, clinical pharmacists provide education, assess readiness to initiate ART, evaluate drug-drug interactions, resolve medication access issues, and recommend patient-specific ART to the triage physician for initiation. Follow-up phone calls are conducted by pharmacists 2 weeks following ART initiation. Clinical and demographic data were extracted from the electronic medical record. The primary outcome was time from intake visit to viral suppression (HIV RNA <200 copies/mL).
A total of 88 patients were included in the preliminary analysis; 55 and 33 in the pre-group and PHARM-D RAPID group, respectively. Baseline characteristics were similar between groups. Mean age was 37 with 85% male, 58% white, 25% black, 30% Hispanic, and 53% with MSM as their sole reported risk factor. 26% were uninsured, 25% presented with AIDS, and half had history of substance use (54%) and/or mental illness (50%). Pharmacists’ recommendations for ART regimens were accepted in all PHARM-D RAPID patients. Medication access issues were preemptively resolved in 61% of PHARM-D RAPID patients. Time from intake to viral suppression (81 vs. 34 days, P=0.001) and time from intake to ART (16 vs. 0 days, P<0.001) significantly decreased in the PHARM-D RAPID group.
Our PHARM-D RAPID protocol demonstrates a novel pathway for decreasing time to viral suppression and HIV transmission, which are key for achieving 90-90-90 efforts in a complex patient population.