The RapIT study was a randomized strategy evaluation of the feasibility, effectiveness, and cost-effectiveness of rapid ART initiation using accelerated clinic procedures and point-of-care laboratory tests. Outpatient, non-pregnant, HIV-positive adults who came to two South African clinics for an HIV test or CD4 count, consented to study participation, and were eligible for ART under 2010 guidelines were randomized 1:1 to rapid ART initiation or to standard care. Those who were assigned to rapid ART initiation had the possibility of receiving their first dose of ARVs on the same day, while those assigned to standard care follow the clinic’s usual procedures for starting ART. A second sample of ART-eligible pregnant women were offered rapid ART initiation in a programmatic evaluation conducted alongside the randomized evaluation, with a retrospective comparison group. The cost effectiveness of the rapid initiation strategy was assessed as the cost per patient achieving the primary outcome of viral suppression within 10 months of study enrollment.
The study found that non-pregnant patients offered same-day ART initiation were 36% more likely to start ART within 90 days and 26% more likely to be virally suppressed 10 months later than those who were offered standard initiation. Same-day initiation is thus a promising strategy for increasing earlier uptake of ART, reducing pre-initiation loss to follow-up, and improving the health of the HIV-positive population.
The following publications emanate from this project:
HE2RO staff involvedProfessor Ian Sanne Sydney Rosen Matthew Fox Dr Mhairi Maskew Constance Mongwenyana Given Malete Hazel Tau Michael Mothapo
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