Outcomes of Rapid Restart Among People With Previously Diagnosed HIV at a Safety-Net HIV Clinic in San Francisco.

BACKGROUND

Little is known about outcomes of rapid restart of antiretroviral therapy (ART) among people with HIV relinking to care.

SETTING

Safety-net HIV clinic in San Francisco.

METHODS

Using electronic medical record data, we conducted a retrospective study of adults with HIV (≥18 years old, out of care, self-reported off ART) seen for rapid (same-day) restart of ART. Descriptive statistics summarized baseline sociodemographic and clinical variables. χ 2 and Fisher exact tests assessed associations between sociodemographic or clinical variables and 2 primary outcomes: (1) viral suppression (VS) [HIV viral load (VL) <200 copies/mL] within 180 days and (2) sustained re-engagement in care (≥1 primary care provider visit both within 90 and 91-180 days after rapid restart). Complete case VS analysis included those with baseline viremia and follow-up HIV VLs. In sensitivity analysis, those with missing follow-up VLs were considered nonsuppressed.

RESULTS

Between August 2020-October 2023, 141 adults (median age 42; 85% cis-male; 26% Latino/a) presented for rapid restart. Housing instability/homelessness (46%), substance use (61%), and mental illness (49%) were common. Among those with baseline viremia who returned for follow-up VLs, VS was attained in 79% and associated significantly with non-Latino/a ethnicity (87% non-Latino/a vs. 57% Latino/a, P = 0.004). However, VS was 58% when considering missing follow-up VLs as nonsuppressed. Sustained re-engagement in care was observed in only 33%.

CONCLUSION

After rapid restart, sustained re-engagement in care and VS were low. Evaluation of key processes of rapid restart, retention efforts, and studies on effective re-engagement support strategies are needed.