Early virologic suppression after HIV infection improves individual health outcomes and decreases onward transmission. In 2015 San Francisco Getting to Zero (SFG2Z) adapted the Citywide RAPID initiative, to link all new HIV cases to care within 5 days of diagnosis and start ART at the first care visit. This analysis compares time from diagnosis to care enrollment, ART initiation, and virologic suppression in the post-RAPID (2016) to the pre-RAPID care era (2013), by gender, race/ethnicity, age, and housing.
HIV providers were trained on the RAPID protocol through passive (medical grand rounds, public SFG2Z consortium meetings) and active (public health detailing) capacity building, with sites caring for vulnerable populations prioritized early. Health Department (SFDPH) and community linkage navigators were trained on RAPID and made aware of RAPID-trained HIV clinicians. Dates of HIV diagnosis, first care visit, ART initiation, and first virologic suppression (HIV RNA<200 c/mL) were abstracted from the SFDPH HIV case registry.
From 2013 to 2016, median time from diagnosis to first virologic suppression in San Francisco decreased 54%, from 134 to 61 days. Decreases were seen across the RAPID continuum, in time from diagnosis to care (38%, from 8 to 5 days), care to ART initiation (96%, from 27 to 1 day), and ART to first suppression (46% from 70 to 38 days). Among subpopulations (figure), by 2016, time from diagnosis to care ranged from 3 days (youth 13-29 years) to 6 days (African Americans); time from care to ART was lowest among youth, Latinos, and Asians/Pacific Islanders (0 days), and highest among African-Americans and the homeless (6 days), despite improvements in these latter two groups, with 82% and 76% decrease in 2013-2016, respectively.
During a multisector initiative to optimize ART initiation across San Francisco, time from diagnosis to first virologic suppression was cut by more than 50%. Immediate ART initiation at care was achieved across many populations, but challenges remain in subpopulations such as the homeless.