{"id":35909,"date":"2019-03-28T09:45:30","date_gmt":"2019-03-28T09:45:30","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=35909"},"modified":"2019-03-29T13:36:54","modified_gmt":"2019-03-29T13:36:54","slug":"same-day-art-is-effective-in-san-francisco-rapid-art-clinic","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/35909","title":{"rendered":"Same-day ART is effective in San Francisco Rapid-ART clinic"},"content":{"rendered":"

\"\"Simon Collins, HIV i-Base<\/span><\/strong><\/p>\n

Offering same-day ART on diagnosis as part of comprehensive care at a specialist HIV clinic in San Francisco reported such significant benefits that it is the standard of care in the city. <\/span><\/b><\/p>\n

Sara Coffey and colleagues presented a retrospective analysis of 225 newly diagnosed individuals referred to Ward 86 Rapid-ART programme from 2013 to 2017. Of these, 98% (216\/225) accepted same day ART (4 declined, 3 were not offered and 2 were lost to follow-up). [1]<\/span><\/p>\n

Baseline characteristics included median age 30 years (range 16-61) with median CD4 count and viral load of 441 (range: 3 to 1905) cells\/mm3<\/sup>and 37,000 (range: 0 to >10 million) copies\/mL respectively.<\/span><\/p>\n

This was a largely male cohort (7.9% women). Ethnicity was 12% African American, 27% Hispanic and 37% white. <\/span><\/p>\n

This is also a cohort with complex social factors: 51% reported substance use, 48% had a major mental health diagnosis and 30% were either homeless or had unstable housing.<\/span><\/p>\n

Median time from the Rapid-ART clinic visit to starting ART start was 0 days (range 0 to 56) achieving undetectable viral load in median of 41 days.<\/span><\/p>\n

Over a median follow-up of 1.1 years (range 0 to 3.9) 96% participants had at least one viral load <200 copies\/mL with 92% undetectable at one year. Viral rebound >200 copies\/mL was reported for 14% of participants with 78% of these resuppressing to <200 copies\/mL.<\/span><\/p>\n

These results support the effectiveness from offering same-day ART in the context of a multidisciplinary care package (including case worker support for insurance, housing etc), even in a complex population with high rates of substance use, mental health issues and homelessness.<\/span><\/p>\n

Early results from the pilot study of this programme in 39 men were first presented at the IAS conference in 2015. [2]<\/span><\/p>\n

comment<\/h3>\n

A similar model has been developed at some UK clinics including 56 Dean Street which has reported similar rates of high patient acceptability. [3]<\/strong><\/p>\n

All projects work to integrate other social support within this model, but prioritise starting ART which other services become involved.<\/strong><\/p>\n

ART in the San Francisco project is almost exclusions based on integrase-inhibitors which both overcomes concerns which results from drug resistance tests are still ongoing, but also minimises risk of serious side effects.\u00a0<\/strong><\/p>\n

References<\/p>\n

    \n
  1. Coffey S et al. High rates of virologic suppression after rapid ART start in a safety-net clinic. Conference on Retroviruses and Opportunistic Infections (CROI), 4-7 March 2019, Seattle. Poster abstract 515.
    \n<\/span>http:\/\/www.croiconference.org\/sessions\/high-rates-virologic-suppression-after-rapid-art-start-safety-net-clinic<\/a> (abstract and poster)<\/li>\n
  2. Pilcher C et al. Providing same day, observed ART to newly diagnosed HIV+ outpatients is associated with improved virologic suppression. 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2015), 19 \u2013 22 July 2015. Oral abstract WEAB0104.
    \n    http:\/\/www.abstract-archive.org\/Abstract\/Share\/70312<\/a>\u00a0(abstract)
    \n    http:\/\/pag.ias2015.org\/PAGMaterial\/Webcast\/2230_13083\/webcast.mp4<\/a>\u00a0(webcast)<\/li>\n
  3. Whitlock G et al. Rapid initiation of antiretroviral treatment in newly diagnosed HIV: experience of a central London clinic. 23rd BHIVA 4-7 April 2017, Liverpool. Oral abstract O14.
    \n    http:\/\/www.bhiva.org\/documents\/Conferences\/2017Liverpool\/Presentations\/170406\/GaryWhitlock.pdf<\/a>\u00a0(PDF)
    \n    http:\/\/www.bhiva.org\/170406GaryWhitlock.aspx<\/a>\u00a0(webcast)<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base Offering same-day ART on diagnosis as part of comprehensive care at a specialist HIV clinic in San Francisco reported such significant benefits that it is the standard of care in the city. Sara Coffey and colleagues …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,3,41],"tags":[264],"class_list":["post-35909","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-antiretrovirals","category-treatment-strategies","tag-croi-2019"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/35909","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=35909"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/35909\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=35909"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=35909"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=35909"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}