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AIDS. 2018 Dec 21. doi: 10.1097/QAD.0000000000002124. [Epub ahead of print]

RAPID ART: High virologic suppression rates with immediate ART initiation in a vulnerable urban clinic population.

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Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA.
Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA.
San Francisco Department of Public Health, San Francisco, CA.



Little is known about long-term viral suppression (VS) rates for patients who start ART soon after diagnosis. We describe virologic outcomes from the San Francisco-based Ward 86 RAPID-ART program.


Retrospective review of clinic-based cohort METHODS:: IN 2013, Ward 86 adopted immediate ART at the first visit after HIV diagnosis. Patients were referred from testing sites, offered same-or next-day intakes, and received multidisciplinary evaluation, support, and insurance enrollment/optimization. Patients were provided ART starter packs and close follow-up. Demographics and labs were extracted from medical records. Subsequent viral loads (VLs) were obtained from public health surveillance data. Kaplan-Meier curves summarized distribution of times to 1st VS; VS rates at last VL recorded were calculated.


Of 225 patients referred to RAPID-ART from 2013-17, 216 (96%) were started on immediate-ART: median age 30; 7.9% women; 11.6% African-American, 26.9% Hispanic, 36.6% white; 51.4% with substance use; 48.1% with mental health diagnoses; 30.6% unstably housed; baseline median CD4 441; median VL 37,011. By 1 year after intake, 95.8% achieved VS to <200 at least once. Over a median follow-up time of 1.09 years (0-3.92), 14.7% of patients had viral rebound, but most (78%) resuppressed. VS rates were 92.1% at last recorded VL.


In an urban clinic with high rates of mental illness, substance use and housing instability, immediate ART provided through a RAPID program resulted in VS at last VL measurement for >90% of patients over a median of 1.09 years. Rapid ART for vulnerable populations is acceptable, feasible, and successful with multidisciplinary care and municipal support.

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