Pettit A C, Ahonkhai A A, Pierce L, Rebeiro P F, Valdebenito C M, Woods J, Gregory L, Walton C, Nash R, Summers N A, Van Wylen A, Thompson D, Hayes-Winton M, Eke A, Pichon L C, Audet C M
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Open Forum Infect Dis. 2024 Nov 20;11(12):ofae660. doi: 10.1093/ofid/ofae660. eCollection 2024 Dec.
Rapid antiretroviral therapy (ART) initiation, in which individuals with HIV start treatment within days of diagnosis, is a key component of the United States (US) Ending the HIV Epidemic initiative. The Memphis Metropolitan Statistical Area ranks second in the US for HIV incidence, yet only ∼60% of individuals link to treatment within 1 month of diagnosis. This study aimed to identify barriers and strategies for implementing rapid ART initiation in Memphis.
From August to December 2022, we conducted process mapping guided by the Consolidated Framework for Implementation Research to outline the steps from 3 HIV testing sites to ART prescription at 3 Ryan White-funded clinics in Memphis, Tennessee. We used modified conjoint analyses to prioritize barriers and identify strategies for improving rapid ART implementation, focusing on the importance and feasibility of changes.
Prioritized barriers included intersectional stigma and a lack of access to centralized information about the rapid ART program, branding and logo development, inter- and intra-organizational networking and communication, testing and treatment resources (HIV testing kits and ART starter packs), rapid ART knowledge, and organizational champions. Strategies to address these barriers were compiled into a local rapid ART toolkit.
We identified modifiable systemic barriers to rapid ART initiation in Memphis, a community disproportionately affected by HIV. The strategies developed to address these barriers informed the creation of a locally relevant rapid ART toolkit for future evaluation. These methods could be applied in other high-burden areas seeking to develop local rapid ART models.
快速抗逆转录病毒治疗（ART）启动，即艾滋病毒感染者在诊断后数天内开始治疗，是美国“终结艾滋病毒流行”倡议的关键组成部分。孟菲斯都会统计区的艾滋病毒发病率在美国排名第二，但只有约60%的感染者在诊断后1个月内开始接受治疗。本研究旨在确定在孟菲斯实施快速ART启动的障碍和策略。
2022年8月至12月，我们在实施研究综合框架的指导下进行了流程映射，以概述田纳西州孟菲斯市3个艾滋病毒检测点到3个由瑞安·怀特基金资助的诊所开具ART处方的步骤。我们使用改良的联合分析对障碍进行优先级排序，并确定改善快速ART实施的策略，重点关注变革的重要性和可行性。
优先级障碍包括交叉污名化，以及缺乏获取有关快速ART项目的集中信息、品牌和标志开发、组织间和组织内的网络与沟通、检测和治疗资源（艾滋病毒检测试剂盒和ART启动包）、快速ART知识以及组织倡导者。针对这些障碍的策略被汇编成一个当地的快速ART工具包。
我们确定了孟菲斯市快速ART启动中可改变的系统性障碍，孟菲斯是一个受艾滋病毒影响尤为严重的社区。为解决这些障碍而制定的策略为创建一个与当地相关的快速ART工具包以供未来评估提供了参考。这些方法可应用于其他寻求开发当地快速ART模式的高负担地区。
