Colasanti Jonathan, Sumitani Jeri, Mehta C Christina, Zhang Yiran, Nguyen Minh Ly, Del Rio Carlos, Armstrong Wendy S
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Emory Center for AIDS Research, Atlanta, Georgia.
Open Forum Infect Dis. 2018 Jun 28;5(6):ofy104. doi: 10.1093/ofid/ofy104. eCollection 2018 Jun.
Rapid entry programs (REPs) improve time to antiretroviral therapy (ART) initiation (TAI) and time to viral suppression (TVS). We assessed the feasibility and effectiveness of a REP in a large HIV clinic in Atlanta, Georgia, serving a predominately un- or underinsured population.
The Rapid Entry and ART in Clinic for HIV (REACH) program was implemented on May 16, 2016. We performed a retrospective cohort study with the main independent variable being period of enrollment: January 1, 2016, through May 15, 2016 (pre-REACH); May 16, 2016, through July 31, 2016 (post-REACH). Included individuals were HIV-infected and new to the clinic with detectable HIV-1 RNA. Six-month follow-up data were collected for each participant. Survival analyses were conducted for TVS. Logistic and linear regression analyses were used to evaluate secondary outcomes: attendance at first clinic visit, viral suppression, TAI, and time to first attended provider visit.
There were 117 pre-REACH and 90 post-REACH individuals. Median age (interquartile range [IQR]) was 35 (25-45) years, 80% were male, 91% black, 60% men who have sex with men, 57% uninsured, and 44% active substance users. TVS decreased from 77 (62-96) to 57 (41-70) days ( < .0022). Time to first attended provider visit decreased from 17 to 5 days, and TAI from 21 to 7 days ( < .0001), each remaining significant in adjusted models.
This is the largest rapid entry cohort described in the United States and suggests that rapid entry is feasible and could have a positive impact on HIV transmission at the population level.
快速进入项目（REPs）可缩短开始抗逆转录病毒治疗（ART）的时间（TAI）以及实现病毒抑制的时间（TVS）。我们评估了在佐治亚州亚特兰大市一家大型艾滋病诊所实施的快速进入项目的可行性和有效性，该诊所服务的主要是未参保或参保不足的人群。
2016年5月16日实施了“诊所内艾滋病快速进入与ART”（REACH）项目。我们进行了一项回顾性队列研究，主要自变量为入组时间：2016年1月1日至2016年5月15日（REACH项目实施前）；2016年5月16日至2016年7月31日（REACH项目实施后）。纳入的个体为艾滋病毒感染者且是该诊所的新患者，其HIV-1 RNA可检测到。为每位参与者收集了6个月的随访数据。对实现病毒抑制进行了生存分析。采用逻辑回归和线性回归分析来评估次要结局：首次就诊的出勤率、病毒抑制情况、开始抗逆转录病毒治疗的时间以及首次就诊于医疗服务提供者的时间。
REACH项目实施前有117人，实施后有90人。年龄中位数（四分位间距[IQR]）为35（25 - 45）岁，80%为男性，91%为黑人，60%为男男性行为者，57%未参保，44%为活跃药物使用者。实现病毒抑制的时间从77（62 - 96）天降至57（41 - 70）天（P <.0022）。首次就诊于医疗服务提供者的时间从17天降至5天，开始抗逆转录病毒治疗的时间从21天降至7天（P <.0001），在调整模型中这些结果均保持显著。
这是美国描述的最大规模的快速进入队列研究，表明快速进入项目是可行的，并且可能在人群层面上对艾滋病毒传播产生积极影响。
