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Gaps Remain in Immediate ART Initiation in NYC Clinics

Despite the high level of knowledge surrounding immediate initiation of ART, the practice is not yet the standard of care across clinics in NYC.

Initiating an antiretroviral therapy (ART) regimen immediately following a positive HIV test can decrease the amount of time to viral suppression and therefore reduce further transmission of HIV.

New York health officials have been working to expand access to immediate ART (iART) for people living with HIV through targeted programs at New York City clinics.

A team of investigators, led by individuals from the New York City Department of Health and Mental Hygiene, set out to assess iART knowledge, attitudes and practices among clinic staff, and identify barriers and facilitators to implementation.

Their findings were presented today in a poster session at the Conference on Retroviruses and Opportunistic Infections (CROI 2020).

The study team recruited at least 1 clinical and 1 non-clinical staff member from a sample of 30 NYC clinics providing care to 1 or more individuals living with HIV. The staff members were asked to complete a survey featuring questions about iART. The clinics were selected to secure a diverse representation of health outcomes, clinic resources, and locations.

The investigators performed descriptive and bivariate analyses on all collected data.

Responses were received from 46 individuals, representing 25 NYC clinics. In total, 98% of respondents reported prior knowledge of iART.

The investigators reported than more than 80% of respondents identified that iART can decrease time to viral suppression and increases patient retention. Additionally, 80% and 67% of survey respondents believed ART should be initiated on the same day or within 3 to 4 days of a positive HIV test, respectively.

On the other hand, 51% of survey respondents indicated they believe ART should not be initiated prior to confirmatory testing results, with non-clinical staff member respondents being “more likely to hold his belief” (OR 4.64, 95% CI: 1.24 —17.37).

According to the abstract, among all respondents, 66% reported 0 to 4 days as the typical length of time from a positive HIV test to ART initiation.

The investigators also found that NYC clinics that were serving a majority people of color were less likely to meet the same-day initiation benchmark (OR: 0.15, 95% CI: 0.0—0.95).

When looking at facility-level and patient-level barriers to ART, the study team found the most common were insurance barriers (76%), medication prior authorizations (50%), financial barriers (46%), and concern about false positives (37%).

“ART medication starter packs (63%) and patient education materials (52%) were the most commonly reported facilitators to iART,” the authors wrote.

Based on these findings, the investigators conclude that despite the high level of knowledge surrounding iART, the practice is not yet the standard of care across clinics in NYC.

“The proven benefits of iART warrant further efforts to overcome barriers to implementation with a focus on achieving health equity,” the investigators wrote in their abstract.

The study, Assessment of immediate initiation of antiretroviral therapy in New York City, was presented on Monday, March 9, 2020 in a virtual session of CROI 2020.