Immediate Antiretroviral Therapy: The Need for a Health Equity Approach

Ofole Mgbako, Magdalena E. Sobieszczyk, Susan Olender, Peter Gordon, Jason Zucker, Susan Tross, Delivette Castor and Robert H. Remien
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Ofole Mgbako: Division of Infectious Disease, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
Magdalena E. Sobieszczyk: Division of Infectious Disease, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
Susan Olender: Division of Infectious Disease, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
Peter Gordon: Division of Infectious Disease, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
Jason Zucker: Division of Infectious Disease, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
Susan Tross: HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY 10032, USA
Delivette Castor: Division of Infectious Disease, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
Robert H. Remien: HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY 10032, USA

IJERPH, 2020, vol. 17, issue 19, 1-10

Abstract: Immediate antiretroviral therapy (iART), defined as same-day initiation of ART or as soon as possible after diagnosis, has recently been recommended by global and national clinical care guidelines for patients newly diagnosed with human immunodeficiency virus (HIV). Based on San Francisco’s Rapid ART Program Initiative for HIV Diagnoses (RAPID) model, most iART programs in the US condense ART initiation, insurance acquisition, housing assessment, and mental health and substance use evaluation into an initial visit. However, the RAPID model does not explicitly address structural racism and homophobia, HIV-related stigma, medical mistrust, and other important factors at the time of diagnosis experienced more poignantly by African American, Latinx, men who have sex with men (MSM), and transgender patient populations. These factors negatively impact initial and subsequent HIV care engagement and exacerbate significant health disparities along the HIV care continuum. While iART has improved time to viral suppression and linkage to care rates, its association with retention in care and viral suppression, particularly in vulnerable populations, remains controversial. Considering that in the US the HIV epidemic is sharply defined by healthcare disparities, we argue that incorporating an explicit health equity approach into the RAPID model is vital to ensure those who disproportionately bear the burden of HIV are not left behind.

Keywords: HIV; antiretroviral therapy; rapid; health equity (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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