O'Shea Jesse, Yuan Xin, Lu Jen-Feng, Buchacz Kate, Iqbal Kashif, Johnston Marie, Beer Linda, Weiser John
Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
DLH Corporation, Atlanta, GA, USA.
J Acquir Immune Defic Syndr. 2025 May 8. doi: 10.1097/QAI.0000000000003690.
Rapid linkage to HIV care and antiretroviral therapy (ART) initiation is now the standard of care for treating people with HIV (PWH). Understanding and intervening on barriers to rapid enrollment and ART initiation are needed to meet the goals of the Ending the HIV Epidemic in the U.S. initiative.
We analyzed 2021 data from the Medical Monitoring Project on characteristics of 455 facilities providing care to a national probability sample of U.S. PWH.
Overall, only 19.9% (95% CI 16.0%-23.9%) of HIV facilities could routinely offer a first appointment in <1 business day (rapid enrollment). The most commonly reported barriers to rapid enrollment were insufficient provider capacity (56%), patient preference (50%), and patients lacking required documents (19%). The most commonly reported documents required for enrollment were positive HIV antibody or detectable viral load (52%), government-issued identification (36%), proof of residence (24%), and proof of income (22%). RWHAP-funded facilities more frequently required these documents than non-RWHAP-funded facilities. Most facilities (73%) were routinely able to obtain a 30-day supply of ART during the first HIV care provider visit (rapid ART initiation). The most commonly reported barriers to rapid ART included unavailable test results (56%), delays in getting medication paid for (49%), unavailable starter packs (36%), inability to afford copayment (31%), and patient preference (29%).
Structural, provider-related, or patient-level barriers may delay rapid clinic enrollment or ART initiation. HIV care programs can benefit from removing barriers to care, easing requirements for clinical enrollment and ART prescriptions, and improving patient readiness.
快速连接到艾滋病护理并开始抗逆转录病毒治疗（ART）现在是治疗艾滋病病毒感染者（PWH）的护理标准。为实现美国“终结艾滋病流行”倡议的目标，需要了解并干预快速登记和开始ART的障碍。
我们分析了医疗监测项目2021年的数据，这些数据来自为美国PWH全国概率样本提供护理的455家机构的特征。
总体而言，只有19.9%（95%CI 16.0%-23.9%）的艾滋病机构能够在不到1个工作日内常规提供首次预约（快速登记）。快速登记最常报告的障碍是提供者能力不足（56%）、患者偏好（50%）以及患者缺少所需文件（19%）。登记最常报告所需的文件是HIV抗体阳性或可检测到病毒载量（52%）、政府颁发的身份证件（36%）、居住证明（24%）和收入证明（22%）。由瑞安·怀特艾滋病紧急救援计划（RWHAP）资助的机构比非RWHAP资助的机构更频繁地要求提供这些文件。大多数机构（73%）能够在首次艾滋病护理提供者就诊期间常规获得30天的ART供应（快速开始ART）。快速开始ART最常报告的障碍包括检测结果不可用（56%）、支付药物费用的延迟（49%）、起始药包不可用（36%）、无力支付自付费用（31%）以及患者偏好（29%）。
结构、提供者相关或患者层面的障碍可能会延迟快速诊所登记或开始ART。艾滋病护理项目可从消除护理障碍、放宽临床登记和ART处方要求以及提高患者准备程度中受益。
