Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN.
Division of Social and Behavioral Sciences, University of Memphis School of Public Health, Memphis, TN.
J Acquir Immune Defic Syndr. 2022 Jul 1;90(S1):S56-S64. doi: 10.1097/QAI.0000000000002986.
Rapid antiretroviral therapy (ART) initiation, in which people living with HIV start ART within days of diagnosis, is a key component of the US Ending the HIV Epidemic initiative.
The Memphis Metropolitan Statistical Area ranked fourth in the United States for the highest HIV incidence per 100,000 population in 2018. Rapid ART programs are limited in the Memphis Metropolitan Statistical Area, and our objective was to identify local implementation barriers.
We conducted participatory process mapping and in-depth interviews to detail steps between HIV testing at the municipal health department's Sexually Transmitted Infections Clinic and ART prescription from a nearby high-volume Ryan White-funded HIV Clinic.
Process mapping identified 4 modifiable, rate-limiting rapid ART barriers: (1) requiring laboratory-based confirmatory HIV results, (2) eligibility documentation requirements for Ryan White-funded services, (3) insufficient HIV Clinic medical provider availability, and (4) variability in ART initiation timing among HIV Clinic providers. Staff at both sites highlighted suboptimal communication and sense of shared management between facilities, limited resources to address important social determinants of health, and lack of Medicaid expansion in Tennessee as key barriers. In-depth interview themes negatively affecting rapid ART initiation included clinic burden; provider knowledge, attitudes, and beliefs; and client psychosocial needs.
Our preimplementation work identified modifiable and systemic barriers to systems flow and patient-level outcomes. This work will inform the design and implementation of a locally relevant rapid ART program in Memphis, a community disproportionately affected by the HIV epidemic.
快速抗逆转录病毒治疗（ART）的启动，即艾滋病毒感染者在诊断后数天内开始接受 ART，是美国终结艾滋病毒流行倡议的一个关键组成部分。
孟菲斯都会统计区在 2018 年按每 10 万人 HIV 发病率排名全美第四。在孟菲斯都会统计区，快速 ART 项目有限，我们的目标是确定当地的实施障碍。
我们进行了参与式流程映射和深入访谈，详细描述了市卫生部门性传播感染诊所的 HIV 检测与附近高容量 Ryan White 资助的 HIV 诊所的 ART 处方之间的步骤。
流程映射确定了 4 个可修改的、限制快速 ART 的障碍：（1）需要基于实验室的确认性 HIV 结果，（2）Ryan White 资助服务的资格文件要求，（3）HIV 诊所医疗服务提供者的供应不足，以及（4）HIV 诊所提供者之间的 ART 启动时间的差异。两个地点的工作人员都强调了设施之间沟通不畅和共同管理意识不足、解决重要健康决定因素的资源有限，以及田纳西州没有扩大医疗补助计划等问题。对快速 ART 启动产生负面影响的深入访谈主题包括诊所负担、提供者的知识、态度和信念以及客户的心理社会需求。
我们的实施前工作确定了系统流程和患者结果方面的可修改和系统性障碍。这项工作将为在孟菲斯实施一项与当地相关的快速 ART 项目提供信息，孟菲斯是一个受 HIV 流行影响不成比例的社区。
