by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

April 12, 2022

Featured Literature:
Koester KA, Moran L, LeTourneau N, et. al.  Essential elements of and challenges to rapid ART implementation: a qualitative study of three programs in the United States.  BMC Infect Dis.  2022 Mar 31; 22(1): 316.  Doi: 10.1186/s12879-022-07297-3.  PMID: 35361148.    

This qualitative study describes findings from 27 key informant interviews across three clinical settings in San Francisco and Chicago which implemented rapid ART services between 2013-2018.  It aimed to outline the essential elements and challenges of rapid ART implementation across different practice contexts.  Practices included an academic HIV clinic in a safety-net hospital system, a federally qualified health center, and a sexual health clinic/STI testing site (the sample from the FQHC site was smaller relative to the other two).  Clinical providers and staff with varying years of HIV care experience participated: they were queried on pre-implementation and implementation experiences, attitudes about rapid ART, and patient experiences.  Analysis revealed seven essential, “high impact” elements across settings that were associated with successful rapid ART programming: (1) presence of an implementation champion; (2) comfort and competence prescribing rapid ART; (3) expedited access to ART medications; (4) expertise in benefits, linkage, and care navigation; (4) team member flexibility and organizational adaptive capacity; (6) commitment to patient-centered care; and (7) strong communication methods and culture.

Author’s Commentary:

This study may be valuable reading for people interested in how rapid ART can be optimally implemented in high-volume clinical practices with differing structures and services.  It provides an important qualitative perspective on pieces and processes underlying the successes described in many rapid ART studies to date.  As authors point out, no one requisite formation was universal across settings, rather they observed a “constellation of essential elements that could be operationalized in various formations and by various people in various roles”.  Authors recommend that, to practically apply the identified elements, interested practices should determine where these elements currently exist, leverage them when possible, strengthen them when necessary (or develop them if they do not yet exist), and look to the elements for potential solutions when challenges arise.

The author has no conflicts of interest to disclose.

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