Positive Care Center, a clinic within Hennepin Healthcare, implemented the Rapid Access program in 2018, providing clients with antiretroviral therapy (ART) on the same day as HIV diagnosis. The clinic receives referrals from the neighboring Red Door Clinic, a public health sexually transmitted disease (STD) clinic, and other community partners. Pharmacists, embedded within Positive Care Center’s care team, help clients with their treatment plans and adherence strategies. Over 90% of clients served through Rapid Access in 2021 received ART on the same day as diagnosis, and 82% of clients were retained in care at six months.
Rapid ART is the provision of ART within a short period (usually defined as same day or within seven days) from when a person receives a diagnosis of HIV or is reengaged in HIV care.1 By shortening the timeline between diagnosis and treatment, rapid ART can help reduce client time to reach viral suppression, and improve other outcomes such as retention in care.2,3 Staff consider Rapid Access a natural extension of existing Positive Care Center activities, prioritizing timely care.
Community partner testing sites, including the neighboring Red Door Clinic, Hennepin County Health Care for the Homeless (HCH), and The Aliveness Project, refer clients with a new diagnosis of HIV to the Positive Care Center by calling a designated nurse line. The nurse then schedules an initial visit for the client, ideally within 72 hours of diagnosis. A Rapid Access social worker helps the client arrange transportation, or staff from the testing site accompany the client to the initial visit.
During the initial visit, the client meets with a clinician, a pharmacist, the Rapid Access social worker, and a benefits counselor, and receives a prescription for ART. The clinician requests baseline labs and spends approximately an hour with the client, providing HIV education and medication adherence counseling. The clinician focuses on making the client feel comfortable and tailors discussion topics to the client’s needs and level of understanding. A benefits counselor and social worker also meet with the client to support enrollment into MinnesotaCare (Medicaid) and the AIDS Drug Assistance Program (ADAP) if needed; they also connect the client to other support services. Health care coverage information is immediately shared with the onsite pharmacist and clinician, so that the appropriate medication can be selected. The pharmacist discusses the recommended regimen with the client, including potential side effects, medication safety, storage, and adherence and tools to support it. The visit ends with the client picking up the prescription at the onsite pharmacy.
“When they come in to see me, then I have an hour, and a lot of that hour is just sitting down and getting to know the person and making sure that they feel very warm and welcome in this clinic, because…my goal is just that they keep coming back to clinic.”
Positive Care Center staff communicate frequently with the client over the first several months of starting ART to ensure continuity of care, and that the client is not experiencing any side effects. The pharmacist contacts the client within the first two weeks and maintains ongoing communication, while the clinician sees the client for at least two visits in the first six months. The Rapid Access social worker is available to the client during these visits. After the third visit, the client becomes part of long-term case management at the Positive Care Center.
The Positive Care Center studied 172 clients who either had a new diagnosis of HIV or were reengaged in care from January through December 2021, finding improvements in clients receiving ART on the same day as diagnosis and retention in care.
|Electronic health record (EHR) data was used to track testing information, health care utilization and outcomes for Rapid Access clients. The EHR is shared with the Red Door Clinic, which facilitates access to testing information.
Source: Positive Care Center Rapid Start Site Profile developed under the Rapid ART Dissemination Assistance Provider project.
Partnerships with testing sites. Clinicians at the Positive Care Center also work at neighboring public health STD clinics, facilitating referrals of clients who may have been tested for HIV outside of the Positive Care Center.
Clinical appointment availability. Positive Care Center ensures clients have same-day access to a clinician and medication through designated slots reserved for walk-ins, and generous physician and nurse practitioner staffing. Due to high no-show rates staff can double-book in certain circumstances.
Rapid eligibility for the Ryan White HIV/AIDS Program (RWHAP) and ADAP. The RWHAP Part B established a process for providers, including the Positive Care Center, to help clients apply quickly for RWHAP and ADAP through Provide Enterprise, its data management system.
Protocol development and staff buy-in. The Positive Care Center medical director and Rapid Access program manager developed Rapid Access protocols with input from other clinic staff. They gave feedback and shared their concerns over planning for and implementing Rapid Access, helping inform protocol development and modifications.
- Through the 2013 expansion of the Minnesota Medicaid program and state-funded programs, residents of Minnesota have ample health care coverage options, which cover most medical care costs.
- Clients who are uninsured at the time of HIV diagnosis receive a two-week supply of medications from the Positive Care Center; the pharmacy then bills for these once the client’s health care coverage is in place.
- RWHAP Parts A and B fund Rapid Access services not already covered through health care coverage, such as patient navigation and case management. In addition, the RWHAP Part B helped fund Rapid Access start-up costs associated with planning, including designated time for the program manager.
- Clients who are reengaging in care are also candidates for Rapid Access. Staff attribute a recent increase in reengaged clients to the COVID-19 pandemic, which they assumed prompted clients to seek treatment as a protective measure.
- Having four pharmacists embedded within Positive Care Center’s multidisciplinary care team improves client access and collaboration across staff.
- The initial visit lasts approximately two hours, which can be overwhelming for some clients. Positive Care Center hopes to shorten the visit by completing some clinical and supportive tasks (e.g., baseline labs and HIV education) beforehand.
- Positive Care Center’s EHR supports Rapid Access by allowing clients to see lab results, receive appointment reminders, message clinical staff with concerns, and upload documentation for program eligibility determination.
“… the first visit is a lot for patients. And it can be really overwhelming. So, I gauge the level of engagement and involvement that I have at that first visit based on how the visit is going, [and] what the doctor or nurse say [about] how they’re doing.”
- NIH. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV: Initiation of Antiretroviral Therapy. 2019.
- Ford N, Migone C, Farzan A, et al. Benefits and risks of rapid initiation of antiretroviral therapy. AIDS. 2018;32(1):17-32. doi:10.1097/QAD.0000000000001671
- Bacon OML, Coffey SC, Hsu LC, et al. Development of a citywide rapid antiretroviral therapy initiative in San Francisco. Am J Prev Med. 2021;61(5 Suppl 1):S47–S54. doi:10.1016/j.amepre.2021.06.001