Background: Very high rates of patient attrition from HIV care between HIV testing and antiretroviral therapy (ART) initiation have been documented in sub-Saharan Africa. Accelerating the steps required for ART initiation has been proposed to reduce attrition and achieve earlier treatment initiation. Methods: The RapIT study evaluated the effect of immediate ART initiation on ART uptake and retention in a COJ clinic and hospital. Non-pregnant adults receiving a positive HIV test or first CD4 count were randomized to standard initiation (3-4 clinic visits prior to ARV dispensing) or rapid initiation with point-of-care CD4 count, blood tests, and TB test if symptomatic; physical examination; accelerated education/counseling; and same-day ART dispensing. Treatment was initiated by a PHN and counselor; similar to those employed by COJ. Results: 174 patients were randomized to rapid and 182 to standard initiation. In both groups, 83% of patients newly diagnosed HIV+ were already eligible for ART. In the rapid group, 97% initiated treatment <1 month, compared to 54% in the standard group. All rapid group patients who did not initiate <1 month (n=5) were required to delay ART for TB treatment. At the three-month point, 98% of those who initiated in both groups were retained on ART. Treatment initiation took an average of 2.8 hours for rapid group patients not requiring Xpert. Conclusions: Immediate ART initiation using rapid tests and accelerated procedures is feasible and acceptable in public sector clinics and reduces pre-ART loss to follow up significantly. It should be considered for adoption in high-volume clinics.
Conference: COJ conference 2014, Johannesburg, South Africa