Lessons learned from U.S. rapid antiretroviral therapy initiation programs

TY - JOUR

T1 - Lessons learned from U.S. rapid antiretroviral therapy initiation programs

AU - Doshi, Rupali K.

AU - Hull, Shawnika

AU - Broun, Aaron

AU - Boyani, Saanjh

AU - Moch, Darryl!

AU - Visconti, Adam J.

AU - Castel, Amanda D.

AU - Baral, Stefan

AU - Colasanti, Jonathan

AU - Rodriguez, Allan E.

AU - Jones, Joyce

AU - Coffey, Susa

AU - Monroe, Anne K.

N1 - Publisher Copyright: © The Author(s) 2023.

PY - 2023/11

Y1 - 2023/11

N2 - Background: Rapid antiretroviral therapy initiation (R-ART) for treatment of HIV has been recommended since 2017, however it has not been adopted widely across the US. Purpose: The study purpose was to understand facilitators and barriers to R-ART implementation in the U.S. Research Design: This was a qualitative design involving semi-structured interviews. Study Sample: The study sample was comprised of the medical leadership of nine US HIV clinics that were early implementers of R-ART. Data Collection and Analysis: In-depth, semi-structured interviews were performed. The Consolidated Framework for Implementation Research (CFIR) was used to guide thematic analysis. Results: We identified three main content areas: strong scientific rationale for R-ART, buy-in from multiple key stakeholders, and the condensed timeline of R-ART. The CFIR construct of Evidence Strength and Quality was cited as an important factor in R-ART implementation. Buy-in from key stakeholders and immediate access to medications ensured the success of R-ART implementation. Patient acceptance of the condensed timeline for ART initiation was facilitated when presented in a patient-centered manner, including empathetic communication and addressing other patient needs concurrently. The condensed timeline of R-ART presented logistical challenges and opportunities for the development of intense patient-provider relationships. Conclusions: Results from the analysis showed that R-ART implementation should address the following: 1) logistical planning to implement HIV treatment with a condensed timeline 2) patients’ mixed reactions to a new HIV diagnosis and 3) the high cost of HIV medications.

AB - Background: Rapid antiretroviral therapy initiation (R-ART) for treatment of HIV has been recommended since 2017, however it has not been adopted widely across the US. Purpose: The study purpose was to understand facilitators and barriers to R-ART implementation in the U.S. Research Design: This was a qualitative design involving semi-structured interviews. Study Sample: The study sample was comprised of the medical leadership of nine US HIV clinics that were early implementers of R-ART. Data Collection and Analysis: In-depth, semi-structured interviews were performed. The Consolidated Framework for Implementation Research (CFIR) was used to guide thematic analysis. Results: We identified three main content areas: strong scientific rationale for R-ART, buy-in from multiple key stakeholders, and the condensed timeline of R-ART. The CFIR construct of Evidence Strength and Quality was cited as an important factor in R-ART implementation. Buy-in from key stakeholders and immediate access to medications ensured the success of R-ART implementation. Patient acceptance of the condensed timeline for ART initiation was facilitated when presented in a patient-centered manner, including empathetic communication and addressing other patient needs concurrently. The condensed timeline of R-ART presented logistical challenges and opportunities for the development of intense patient-provider relationships. Conclusions: Results from the analysis showed that R-ART implementation should address the following: 1) logistical planning to implement HIV treatment with a condensed timeline 2) patients’ mixed reactions to a new HIV diagnosis and 3) the high cost of HIV medications.

KW - CFIR

KW - HIV/AIDS

KW - implementation

KW - qualitative

KW - treatment initiation

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U2 - 10.1177/09564624231185622

DO - 10.1177/09564624231185622

M3 - Article

C2 - 37461333

SN - 0956-4624

VL - 34

SP - 945

EP - 955

JO - International Journal of STD and AIDS

JF - International Journal of STD and AIDS

IS - 13

ER -