Huntridge Rapid Start Initiative

The Huntridge Family Clinic is one of Nevada’s largest providers of LGBTQ+ whole-person care. In 2018, the clinic launched the Rapid Start Initiative to provide same-day antiretroviral therapy (ART) treatment to clients with a new diagnosis of HIV. The Huntridge Rapid Start Initiative also provides comprehensive services through case management, immediately enrolling clients with a new diagnosis into the Ryan White HIV/AIDS Program (RWHAP), performing needs assessment for wraparound services, and connecting clients to those services. Rapid ART and comprehensive case management led to positive health outcomes at Huntridge. Over 90% of clients received ART on the same day as diagnosis, and 78% of clients were retained in care within the first year of starting treatment.

Las Vegas, NV

Implementation Guide
False
Evidence-Informed Intervention
Icon for Intervention Type
Clinical service delivery model
Icon for HIV Care Continuum
Linkage to HIV medical care; Retention in HIV medical care; Prescription of antiretroviral therapy
Icon for Ending the HIV Epidemic in the U.S. Strategy
Treat
Icon for Focus Population
People with a new diagnosis of HIV
Icon for Priority Funding
RWHAP Part A; RWHAP Part B; Non-RWHAP
Icon for Setting
RWHAP-funded clinic or organization
Need Addressed

People who go untreated for HIV are at risk of developing severe health conditions.1 Rapid ART serves as a lifesaving strategy that provides individuals with immediate access to treatment (usually same day or within seven days of diagnosis). Numerous studies have shown that rapid ART is associated with accelerated entry into care, shorter times to viral suppression, fewer health complications, and reductions in HIV transmission.2

Core Elements
Point-of-care testing and same-day ART prescription

Huntridge Family Clinic tests all interested walk-in clients and clients with a scheduled appointment, with a rapid HIV test. Results are available within 20 minutes. If a client receives a positive test result, a confirmatory test is initiated, and a case manager begins the RWHAP enrollment process. A clinician then meets with the client to dispense an ART “starter pack,” which can include seven to 30 days of medication. Huntridge also tests clients for other sexually transmitted infections (STIs), including hepatitis C.

External referrals

The LGBTQIA+ Center of Southern Nevada also refers clients with a new diagnosis of HIV to Huntridge for linkage to care and treatment. Other external referrals may come from the local health department, hospital emergency rooms, community health centers , and out-of-state clinics. Huntridge links clients to care immediately by scheduling appointments with a clinician and a case manager and providing same-day ART starter packs.

Client navigation

During a client’s initial appointment, a case manager uses a checklist to address all medical and non-medical needs, and develops an action plan and timeline for items that need follow-up. Case managers help clients enroll in RWHAP, health care coverage including Medicaid, and Nevada’s AIDS Drug Assistance Program (ADAP), which provides insurance premium and co-pay support. They also connect clients to other key resources such as food, housing, and transportation assistance. Clients eligible for the RWHAP are provided commercial health care coverage via the Nevada Medication Assistance Program (i.e., ADAP). Additionally, clients who test negative for HIV are introduced to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) services to prevent HIV.

Follow-up care

Seven to 10 days after the initial appointment, a client meets with a case manager to address social needs and finalize RWHAP enrollment (e.g., submit supporting documents). After 30 days, the client meets with a clinician for follow-up services, including lab tests and medication review. All clients return every three months for follow-up care for the first year. After that, clients can return every six months for routine care or maintain the three-month follow-up schedule if preferred.

Medication accessibility

Huntridge has built strong connections with specialty pharmacies that provide ongoing and accessible HIV treatment to their clients. Pharmacies maintain their medication inventory and keep Huntridge fully stocked with ART. Pharmacies also provide in-house pick-up for clients, as well as delivery for those who request it. Huntridge plans to incorporate their own pharmacy into the clinic.

Outcomes

Huntridge evaluated the outcomes of 400 individuals with a new diagnosis of HIV, who were new to care, or out of care in 2021, finding improvements in clients receiving ART on the same day as diagnosis, and retention in care within the first year of starting treatment. 

Category Information
Evaluation data Electronic health record data to track client access to care and health outcomes.
Measures

Of clients with a new diagnosis of HIV, who were new to care, or who were out of care:

  • Percentage who began rapid ART on the same day as diagnosis, or referral to Huntridge
  • Percentage retained in care, defined as having a medical visit in each six-month period at least 90 days apart during the year after starting treatment
Results
  • 92% of clients began same-day rapid ART treatment
  • 78% of clients were retained in care during the year after starting treatment

Source: Verbal communication as part of the Rapid ART Dissemination Assistance Provider project.   

Planning & Implementation

Staffing and training. Huntridge staff consist of two full-time and two part-time nurse practitioners, HIV and STI testers, case managers, PrEP navigator(s), a peer advocate, and onsite lab technician(s). All these individuals work together to ensure clients receive seamless and timely access to care. Huntridge staff are trained on HIV testing, routine HIV care, including treatment of STIs, and risk reduction. Additionally, team members participate in external trainings to become certified in RWHAP enrollment.

Securing starter packs. Huntridge receives ART starter pack donations from multiple drug manufacturers, allowing the clinic to provide same-day treatment regardless of a client’s health care coverage status. 

Key partnerships. Huntridge works collaboratively with the LGBTQIA+ Center of Southern Nevada to facilitate linkage to care for clients with a new diagnosis of HIV. Local specialty pharmacies are also key partners in supplying medications not available in commercial pharmacies.

Designing a rapid ART approach. Huntridge based its rapid ART approach on that of the Max Clinic in Seattle, Washington, and available literature on best practices. Huntridge also participated in an RWHAP Part F AIDS Education and Training Center (AETC) learning collaborative, meeting regularly with other clinics to discuss clinic performance and rapid ART best practices. The AETC provided an online forum for participating clinics to share resources and discuss lessons learned. Huntridge developed workflows for HIV testing, accelerated access to medical appointments and ART starter packs, and specialized HIV case management to help clients with RWHAP enrollment, payment assistance, and linkage to support services.

Sustainability

Much of the medical care provided by Huntridge is paid for by health care coverage. Nevada expanded Medicaid in 2014, giving many clients the opportunity to enroll in this program. ADAP also plays a crucial role in assisting with health care coverage costs for some individuals. Huntridge uses RWHAP Part A and Part B funding for medical care, laboratory services, and support services not already covered by health care coverage. Additionally, Huntridge receives donated starter packs from pharmaceutical companies and funding through 340B rebates that cover costs for staffing, emergency housing, same-day lab expenses, and testing.

Lessons Learned
  • Many clients lack their own vehicles, and temperatures in Las Vegas can exceed 100 degrees, complicating the use of public transportation. Therefore, Huntridge facilitates access to care through ridesharing services.
  • Flexibility is important when implementing a rapid ART process. Although Huntridge staff researched other rapid ART models and developed initial internal workflows, they found that they needed to modify approaches based on early implementation lessons learned. These staff recommend that other clinics get started without “over planning” and continuously assess and modify their rapid ART programs.
  • Rapid ART involves changing clinic processes related to appointment scheduling and medication prescriptions. Buy-in from clinic leadership and a local champion who manages day-to-day operations are essential for ensuring these changes are made successfully.
  • Huntridge’s model of same-day treatment often requires staff to shift activities to focus their attention and care on a client with a new diagnosis of HIV. Staff must be flexible and prepared to adjust activities. 
  • Similarly, Huntridge has found success in hiring new staff dedicated to working with priority client populations. Hires who are passionate about serving the community have been more successful and likely to stay in their positions than hires with relevant professional experience, but no connection to the community. 
  • Huntridge staff focus on building trust and rapport with clients to ensure that they feel welcomed and adhere to treatment.
Resources & Tools

Presentations

Other Resources

Contact
Huntridge Family Clinic
John (Rob) Phoenix, APRN, FNP
Chief Medical Officer

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