1. Lessons learned from U.S. rapid antiretroviral therapy initiation programs
- Author
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Doshi, Rupali K., Hull, Shawnika, Broun, Aaron, Boyani, Saanjh, Moch, Darryl!, Visconti, Adam J., Castel, Amanda D., Baral, Stefan, Colasanti, Jonathan, Rodriguez, Allan E., Jones, Joyce, Coffey, Susa, and Monroe, Anne K.
- Abstract
Background Rapid antiretroviral therapy initiation (R-ART) for treatment of HIV has been recommended since 2017, however it has not been adopted widely across the US.Purpose The study purpose was to understand facilitators and barriers to R-ART implementation in the U.S.Research Design This was a qualitative design involving semi-structured interviews.Study Sample The study sample was comprised of the medical leadership of nine US HIV clinics that were early implementers of R-ART.Data Collection and Analysis In-depth, semi-structured interviews were performed. The Consolidated Framework for Implementation Research (CFIR) was used to guide thematic analysis.Results We identified three main content areas: strong scientific rationale for R-ART, buy-in from multiple key stakeholders, and the condensed timeline of R-ART. The CFIR construct of Evidence Strength and Quality was cited as an important factor in R-ART implementation. Buy-in from key stakeholders and immediate access to medications ensured the success of R-ART implementation. Patient acceptance of the condensed timeline for ART initiation was facilitated when presented in a patient-centered manner, including empathetic communication and addressing other patient needs concurrently. The condensed timeline of R-ART presented logistical challenges and opportunities for the development of intense patient-provider relationships.Conclusions Results from the analysis showed that R-ART implementation should address the following: 1) logistical planning to implement HIV treatment with a condensed timeline 2) patients’ mixed reactions to a new HIV diagnosis and 3) the high cost of HIV medications.
- Published
- 2023
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