Development of a City-wide Rapid Antiretroviral Therapy Initiation Toolkit for People Newly Diagnosed With HIV in the Southern United States

Abstract

Background: Rapid antiretroviral therapy (ART) initiation, in which individuals with HIV start treatment within days of diagnosis, is a key component of the United States (US) Ending the HIV Epidemic initiative. The Memphis Metropolitan Statistical Area ranks second in the US for HIV incidence, yet only ∼60% of individuals link to treatment within 1 month of diagnosis. This study aimed to identify barriers and strategies for implementing rapid ART initiation in Memphis.

Methods: From August to December 2022, we conducted process mapping guided by the Consolidated Framework for Implementation Research to outline the steps from 3 HIV testing sites to ART prescription at 3 Ryan White-funded clinics in Memphis, Tennessee. We used modified conjoint analyses to prioritize barriers and identify strategies for improving rapid ART implementation, focusing on the importance and feasibility of changes.

Findings: Prioritized barriers included intersectional stigma and a lack of access to centralized information about the rapid ART program, branding and logo development, inter- and intra-organizational networking and communication, testing and treatment resources (HIV testing kits and ART starter packs), rapid ART knowledge, and organizational champions. Strategies to address these barriers were compiled into a local rapid ART toolkit.

Conclusions: We identified modifiable systemic barriers to rapid ART initiation in Memphis, a community disproportionately affected by HIV. The strategies developed to address these barriers informed the creation of a locally relevant rapid ART toolkit for future evaluation. These methods could be applied in other high-burden areas seeking to develop local rapid ART models.

Figure 1.

Modified conjoint analysis result example, Memphis/Shelby County, Tennessee 2023. Yellow square: Competing priorities (primary care for HIV-negative people); orange square: need for flexible scheduling; green square: HIV/LGBTQ stigma; pink square: lack of rapid HIV confirmatory test kits; black star: need for centrally located and easily accessible rapid ART model information; purple star: social determinants of health, trauma, and stigma needs often take priority over rapid ART initiation; red star: lack of networking and communication across and within HIV care and service organizations; green star: lack of identification of program goals and feedback toward goals; orange star: need to identify each participating organization's internal champion/opinion leader and implementation leader; yellow star: lack of ART pharmaceutical sample starter packs.