Time between presentation to HIV care and viral suppression has been too long. Rapid entry programs (REP) have demonstrated efficacy for select populations in San Francisco, South Africa and Haiti but no REPs have been reported from the Southern U.S. We assessed the feasibility and effectiveness of a REP in a large Ryan White (RW) funded clinic in Atlanta, Georgia. The clinic serves a predominantly minority and economically disadvantaged population. The REP goal was to enroll patients into clinic, complete a social needs assessment, provider visit, labs and give the option to start ART within 72 hrs.
A cohort of consecutive patients was enrolled in the REP protocol from May 16, 2016 to July 31, 2016. To assess the effectiveness of the REP, the intervention group was compared to new enrollees to clinic from the months preceding the REP (January 1, 2016 – May 15, 2016). Inclusion criteria were HIV+, new to the clinic (not necessarily new diagnosis) and viremic at intake. Six-month follow-up data were analyzed for each group. Time to viral suppression (VS) was the primary outcome. Time to provider visits and time to ART start, were secondary outcomes. A survival analysis compared time to viral suppression for the groups. Linear regression models were run for the secondary outcomes.
The sample size was 118 pre-REP and 91 post-REP. Pre-REP demographics include age 33 (IQR 24, 44), 81% male, 86% Black, 60% MSM, 58% uninsured, $8,808 (IQR 0, $18,668) annual income, 67% unstably housed, 9% incarcerated in last 6 months, 42% active substance use, CD4 141 cells/uL (IQR 33, 301) and 59% ART naïve. The post-REP group differed only in age being slightly older at 38 yo (IQR 27, 48) (p=0.039). The median time to VS decreased from 63 days (IQR 36, 112) to 45 days (30, 72) post-REP (p=0.0038). Regression analyses evaluating time to 1st scheduled visits, time to attended visit and time to ART start are shown in the table. Time to VS, first provider visits and ART start remained significant when adjusted for age, sex, race, ART nativity, INSTI use and baseline log10 VL.
This is the largest rapid entry cohort described in the U.S. Time to viral suppression, in an economically and socially disenfranchised population in the South, was significantly improved through implementation of a REP. This was likely due to shortening the time to initial provider visit and ART prescription. REP programs are feasible in the area of the US with greatest numbers of new infections.