565. Implementing HIV Rapid Entry in a Community Infectious Disease Practice
Session: Poster Abstract Session: HIV: Linkage to Care and Viral Suppression in the Care Cascade
Thursday, October 4, 2018
Room: S Poster Hall
Background: Successful achievement of “90-90-90” HIV care continuum goals depends on increasing diagnosis, linkage to care, and treatment initiation. Recent improvement efforts include immediate linkage and antiretroviral (ARV) therapy access. Outcome data has been reported from projects implemented in academic settings where multiple Ryan White Care Act (RWCA) services are available. The purpose of this project was to assess feasibility of Rapid Entry in a 4-physician community ID practice.

Methods: Goals of the Rapid Entry project are: 1st visit within 3 business days of diagnosis and ARV start at entry. Outcomes assessed include time to 1st visit, ARV start, and virologic suppression. Retention in care is assessed at 6 and 12 months. Comparison is made to “standard of care” (SOC; n = 35) patients seen during 24 months prior to project implementation. Patients with new HIV diagnosis made while hospitalized were excluded.

Results: 34 patients with new HIV diagnosis started care during project period. Demographics and baseline labs were similar between groups. 4 Rapid patients were injection drug users (IDU) vs none in SOC. Time to 1st visit averaged 13 days (range 1-48) with 12 patients (37%) seen within 3 business days (SOC 7-189 days, mean 36). 19 patients (56%) started ARVs at the 1st visit (SOC 1/3%); 23 (68%) by day 7 (SOC 5/15%). Time to virologic suppression was significantly less in the Rapid group.

SOC

Rapid

t

p

Mean

Mean

(df)

(SD)

(SD)

n

n

Days from Diagnosis to 1st Appt

36.11

12.32

3.56*

0.001**

-37.61

-11.97

-41

35

34

Days from 1st Appt to ARV

20.82

7.75

3.28

0.002**

-17.39

-14.84

-64

34

32

Days from ARV to <20

107.48

64.41

2.43*

0.019**

-81.73

-41.29

-45.84

31

17

Days from 1st Appt to <20

128.35

70.59

3.03*

0.004**

-87.81

-44.03

-45.77

31

17

*Adjusted df used because assumption of homogeneity of variance was violated.

**p < α = .05

Conclusion: Preliminary results are comparable to reports from larger studies, suggesting that reduced time to 1st visit and ARV initiation shortens interval to virologic suppression. Implementing Rapid Entry in a community setting is challenging but feasible, requiring high levels of staff commitment, flexibility, and communication. Efforts in process to further improve Rapid Entry include strategies to engage/retain those infected via injection drug use and shortening time to referral from outside test sites.

John Cafardi, M.D.1, Thomas Lamarre, M.D.1, Douglas Haas, M.D.1, Patricia Young, M.D.1, Janice Stockton, MSN, AACRN1 and Robert Kallmeyer, PhD2, (1)Infectious Diseases, The Christ Hospital, Cincinnati, OH, (2)Arts and Sciences, The Christ College of Nursing and Health Sciences, Cincinnati, OH

Disclosures:

J. Cafardi, Gilead: Grant Investigator , Salary .

T. Lamarre, None

D. Haas, None

P. Young, None

J. Stockton, None

R. Kallmeyer, None

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