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Ward 86's RAPID Project: Rapid ART Initiation upon Diagnosis

Hiroyu Hatano discusses an initiative, "RAPID," that provides immediate ART to all patients newly diagnosed with HIV. She justifies the initiative by describing the individual and public health benefits of early initiation of therapy. For instance, research shows that viral load suppression alone is not sufficient to restore immunologic health. Data from cure research justifies why physicians should initiate treatment as soon as possible, because immediate initiation of ART during hyper-acute infection may protect certain reservoir cells from ever becoming infected. Additionally, treatment of an infected partner reduces the risk of transmission to HIV-negative partners and presumably aids long-term linkage to care.

Dr. Hatano goes on to describe how the RAPID program operates. Ward 86 will be notified via rapid pager of a new HIV diagnosis. Patients will come directly from testing site to be seen by an on-call RAPID provider who will take a medical history, conduct baseline labs, provide counseling, and initiate ART immediately, unless there is a clear contraindication. Each patient will be given a kit to take home as arrangements are made with insurance providers to get additional medications and other services. The RAPID physician will become the long-term provider for these patients. Dr. Hatano describes an initial case that was handled in this way, involving a patient with a positive viral load test and negative antibody test at a city clinic who was treated immediately during acute infection. Physicians at Ward 86 want to make the RAPID model a clinic-wide standard by the end of 2014.