Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA.
AIDS Care. 2023 Apr;35(4):545-554. doi: 10.1080/09540121.2022.2104799. Epub 2022 Jul 27.
Immediate antiretroviral therapy (iART) has been shown to decrease time to viral suppression. Our center underwent significant practice transformation to support iART, including a same-day Open Access (OA) model and enhanced care coordination. We examined whether same-day ART at linkage was associated with favorable proximate and long-term HIV care outcomes. From 2018 to 2019, patients newly diagnosed with HIV, linked to care at our institution, and iART eligible were included. We evaluated the association between iART and time to viral suppression, and between iART and initial/sustained viral suppression and retention in care. We also evaluated the association between use of OA and frequency of care coordination with the same outcomes. Of the 107 patients included, 72 initiated same-day ART at linkage and 35 did not. There was no statistically significant differences in whether patients were ever suppressed, had sustained viral suppression, or were retained in care between those who received same-day ART and those who did not. More care coordination was associated with retention in care (RR 1.21 [1.01-1.5]; = 0.05). Organizing vital services and ensuring implementation strategies that facilitate iART, while tailoring the approach to the patient's comfort level, is likely optimal for longitudinal HIV care engagement.
立即抗逆转录病毒治疗 (iART) 已被证明可缩短病毒抑制时间。我们中心进行了重大的实践转变，以支持 iART，包括当天开放获取 (OA) 模式和增强的护理协调。我们研究了在联系时进行当天的 ART 是否与有利的近期和长期 HIV 护理结果相关。从 2018 年到 2019 年，纳入了在我们机构新诊断出 HIV、与护理联系并符合 iART 条件的患者。我们评估了 iART 与病毒抑制时间之间的关联，以及 iART 与初始/持续病毒抑制和保持护理之间的关联。我们还评估了 OA 的使用与相同结果的护理协调频率之间的关联。在 107 名纳入的患者中，72 名在联系时开始了当天的 ART，35 名没有。在接受当天 ART 和未接受当天 ART 的患者中，是否曾经被抑制、是否持续病毒抑制或是否保持护理方面，没有统计学上的显著差异。更多的护理协调与保留护理相关（RR 1.21 [1.01-1.5]； = 0.05）。组织重要服务并确保实施策略促进 iART，同时根据患者的舒适程度调整方法，可能是长期 HIV 护理参与的最佳选择。
