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

A C Pettit; A A Ahonkhai; L Pierce; P F Rebeiro; C M Valdebenito; J Woods; L Gregory; C Walton; R Nash; N A Summers; A Van Wylen; D Thompson; M Hayes-Winton; A Eke; L C Pichon; C M Audet

doi:10.1093/ofid/ofae660

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

Open Forum Infect Dis. 2024 Nov 20;11(12):ofae660. doi: 10.1093/ofid/ofae660. eCollection 2024 Dec.

Authors

A C Pettit¹, A A Ahonkhai², L Pierce², P F Rebeiro¹, C M Valdebenito³, J Woods⁴, L Gregory⁵, C Walton⁵, R Nash⁵, N A Summers⁶, A Van Wylen⁷, D Thompson⁷, M Hayes-Winton⁸, A Eke⁹, L C Pichon³, C M Audet^{1

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Affiliations

¹ Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
³ University of Memphis School of Public Health, Division of Social and Behavioral Sciences, Memphis, Tennessee, USA.
⁴ Angelic Branding Consulting, Nashville, Tennessee, USA.
⁵ Tennessee Department of Health, Nashville, Tennessee, USA.
⁶ Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁷ Christ Community Health Services, Memphis, Tennessee, USA.
⁸ Shelby County Health Department, Memphis, Tennessee, USA.
⁹ Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
¹⁰ Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

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.