Same-day HIV treatment improves health outcomes

Starting antiretroviral therapy for HIV patients on the day they are diagnosed with the deadly virus may lead to better health outcomes and ensure a higher proportion of people undergo treatment, a new study has found.
The study found that 97 per cent of patients in the rapid-initiation group (dubbed the RapIT intervention) had started antiretroviral therapy (ART) within 90 days, compared to 72 per cent receiving standard care.
By 10 months of enrolment, 64 per cent of patients in the rapid group had good outcomes, in terms of viral suppression, compared to 51 per cent in the standard arm.

Most people with HIV in South Africa, which has world's largest HIV treatment programme, start ART later than they should, said Sydney Rosen, a professor at Boston University School of Public Health (BUSPH).
Once they get to a clinic, the treatment initiation process is long and complicated, Rosen said, with a first visit for an HIV test, a second visit to determine treatment eligibility, and several more visits for a physical exam, adherence education and counselling.
The researchers hypothesised that offering patients a chance to start treatment on the same day as their first clinic visit would improve the proportion of patients who made it through all the steps and underwent ART.

The study assigned 377 adult patients at two public clinics in South Africa to two groups.

One was offered the chance to start treatment on the same day, using rapid lab tests, accelerated counselling and a physical exam, and the other was assigned to standard treatment procedures, usually requiring three to five more clinic visits over a two- to four-week period.
"The RapIT intervention showed clinically meaningful improvements in ART uptake and viral suppression, providing proof of principle that a single-visit treatment approach can have benefits," Rosen said.
"The patients who likely benefited the most from it are those who would not otherwise have initiated treatment at all, or who would have waited until they were sick enough to compromise their prognosis," she said.

The study found that among patients who did start treatment within three months of study enrolment, loss to follow-up was higher in the rapid-intervention group than the standard group.
However, so many more patients in the standard group failed to start treatment at all - 28 per cent, compared to the rapid group's three percent - that patients in the rapid group still had overall better outcomes than did those in the standard group.
While the rapid intervention was successful in increasing the overall proportion of patients with successful health outcomes, "the rate of post-initiation attrition is a reminder that early retention in care and adherence support, once patients start treatment, remain high priorities for further research and interventions."

The study was published in the journal PLOS Medicine.