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

Abstract

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.

Keywords: CFIR; HIV/AIDS; implementation; qualitative; treatment initiation.