Accelerated initiation of antiretroviral therapy by virtual health in service members newly diagnosed with HIV infection

Objectives: Delays in HIV antiretroviral therapy (ART) have been associated with HIV disease progression and forward transmission. We evaluated the effectiveness of an accelerated ART virtual protocol (VP) for active duty (AD) members with incident HIV diagnosis.

Methods: Under the traditional protocol (TP), service members stationed worldwide were evaluated in-person at Brooke Army Medical Center (BAMC) and received comprehensive HIV care. In February 2020, a VP was adopted to initiate HIV care at the local base. Chart reviews were conducted to obtain patient demographics and clinical data. Continuous variables were compared using 2-tailed t tests, categorical variables were evaluated with Fisher's exact or Chi squared tests.

Results: Time from HIV notification to ART initiation was significantly shorter with the VP compared to the TP (15 days vs 25 days; p = <0.05). The VP had a shorter time to viral suppression compared to the TP (96 days [SD ± 86] compared to 269 days [SD ± 300], p = <0.05).

Conclusions: The VP was associated with a shorter time to HIV specialty evaluation, ART initiation, and viral suppression. The use of virtual health protocols for other time sensitive medical interventions and/or for access to limited specialties should be considered as these may improve quality of care.