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Multicenter Study
. 2025 Apr 15;98(5S):e192-e204.
doi: 10.1097/QAI.0000000000003619.

Policymaker Perspectives on Implementation Determinants of Rapid ART and Same-Day PrEP in Seven Priority Jurisdictions for Ending the HIV Epidemic: A Multisite Qualitative Study

Anna-Sophia Katomski  1 , Ana Michaela Pachicano  2 , Alithia Zamantakis  2   3 , Nanette D Benbow  2   3   4 , Cathleen Willging  5 , Joseph G Rosen  6 , Elena P Rosenberg-Carlson  7 , Wilson Gomez  1 , Alison B Hamilton  8 , Jessica E Kassanits  2 , Robin Gaines Lanzi  9 , Joyce L Jones  10 , Tequetta Valeriano  11 , Russell A Brewer  12 , Aadia I Rana  13 , Uyen Kao  7 , Maile Karris  14 , Jill Blumenthal  14 , Sheree R Schwartz  1 , Laura K Beres  6
Affiliations
Multicenter Study

Policymaker Perspectives on Implementation Determinants of Rapid ART and Same-Day PrEP in Seven Priority Jurisdictions for Ending the HIV Epidemic: A Multisite Qualitative Study

Anna-Sophia Katomski et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Although rapid antiretroviral therapy (ART) and same-day pre-exposure prophylaxis models (henceforth "rapid START") are feasible, acceptable, and cost-effective in various contexts, significant barriers have hindered their broader implementation and scalability in the United States. Ryan White-funded clinics are cornerstones for HIV services, yet strategies are urgently needed to facilitate equitable rapid START adoption across contexts. This study aimed to identify common factors influencing rapid START to inform strategies applicable throughout jurisdictional settings.

Methods: The Network for Implementation Science in HIV examined the current implementation of rapid START among diverse Ryan White Part A-D-funded organizations across seven Ending the HIV Epidemic jurisdictions across the United States. Semistructured interviews (n = 13) were administered from March 2023 to August 2024, with HIV leadership across jurisdictions to identify rapid START implementation determinants and strategies to catalyze rapid START delivery. Data were deductively analyzed using the Consolidated Framework for Implementation Research.

Results: Prominent barriers to rapid ART implementation across settings included provider/patient hesitancy and awareness gaps, siloed care systems, and funding complexities. Prominent implementation facilitators included learning collaboratives, technology integration, and clear contracting language. Key constraints to same-day pre-exposure prophylaxis implementation included funding inequities and suboptimal client/patient awareness, whereas enablers included integrated care models, availability of starter packs, and medication-assistance programs.

Conclusions: Several consistent key barriers and facilitators spanned multiple Ending the HIV Epidemic jurisdictions despite contextual differences (eg, Medicaid expansion). Collaborative efforts between system leaders and service providers were universally characterized as essential for equitable adoption and penetration of rapid START models.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Frequency of CFIR codes for rapid ART implementation across 6 EHE jurisdictions.
FIGURE 2.
FIGURE 2.
Frequency of CFIR codes for same-day PrEP implementation across 6 EHE jurisdictions.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention. Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data—United States and 6 Territories and Freely Associated States, 2022. Vol. 29. 2024. HIV Surveillance Supplemental Report. Available at: https://www.cdc.gov/hiv-data/nhss/national-hiv-prevention-and-care-outco.... Accessed June 15, 2024.
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