INITIATING ANTIRETROVIRAL THERAPY AT A PATIENT’S FIRST CLINIC VISIT: THE RAPIT STUDY

By  Professor Sydney Rosen  Dr Mhairi Maskew  Dr. Matthew Fox  Nyoni C  Constance Mongwenyana  Given Malete  Professor Ian Sanne  Bokaba D  Sauls C  Rohr J  |  | 

One of the most persistent operational challenges facing South Africa’s antiretroviral therapy (ART) programme is late presentation of patients for care and high rates of attrition from care between HIV testing and ART initiation. Even among those who have been diagnosed and found to be treatment-eligible, loss to care before starting ART has consistently been estimated at a third to a quarter of patients1,2.  There are multiple causes of loss to care before treatment initiation, but one reason is that starting ART is a lengthy and burdensome process, imposing long waits and multiple clinic visits on the patient. The process typically includes an HIV test (visit 1); determination of treatment eligibility (visit 2); adherence education and counseling and baseline blood tests (visits 3, 4, and 5), and physical examination and dispensing of ARVs (visit 6). Many patients do not make it all the way through this process from beginning to end. If patients are deterred from starting treatment by the complexity of the process, then one strategy for reducing losses of patients prior to ART initiation and encouraging earlier treatment initiation may be to shorten the time period, reduce the number of visits, and simplify the steps required before medications are dispensed. There have not yet been any rigorous, controlled evaluations of an integrated, rapid HIV treatment initiation algorithm incorporating clinic procedural changes and point-of-care (POC) laboratory tests for adult, non-pregnant patients. We therefore conducted a randomized controlled trial of rapid ART initiation that allowed patients to have treatment eligibility determined, all treatment preparation steps performed, and ARV medications dispensed on the day of their first HIV-related clinic visit.

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