The Southern Nevada Rapid Start of Anti-Retroviral Therapy (Rapid stART) program improves access to immediate HIV treatment in the region. Led by the Office of HIV within Clark County Social Service, Rapid stART was initially developed and implemented at 28 sites to link clients to a prescribing HIV provider within seven days of their HIV diagnosis, and included a Rapid stART Response Team to support clients through the process. The Rapid stART program has increased linkage to HIV medical care, initiation of antiretroviral therapy (ART) within seven days, and viral suppression.
NV
Prior to Rapid stART in Southern Nevada, there was no uniform standard for linking clients with a new diagnosis of HIV to medical care. While some clients were linked to a provider and started ART quickly, others might not start care for weeks. People who go untreated for HIV are at risk of developing severe health conditions.1 The Rapid stART protocol was developed and implemented to link a client to a prescribing HIV provider within seven days of diagnosis (ideally on the same day) and have them begin ART immediately at, or shortly after, their first HIV medical appointment.
When a client with a new diagnosis of HIV is identified, the testing provider calls the Rapid stART Response Team; this team is responsible for facilitating coordinated action to ensure immediate access to HIV care for the client. A Rapid stART Response team member connects with the client and evaluates their payor sources for health care; clients without health care coverage are screened for eligibility for Medicaid, the Ryan White HIV/AIDS Program (RWHAP), and other assistance programs. The team member also assists the client with choosing a Rapid stART provider and making an appointment. If needed, transportation to and from the provider is coordinated. A Rapid stART rideshare program was established to address transportation barriers.
After the medical visit, the Rapid stART Response Team maintains contact with the client to ensure engagement in care and treatment adherence, and to coordinate supportive service needs. The team stays in contact with the referring provider and confirm the client’s linkage to care. The Rapid stART Response Team also provides education to and cultivates relationships with other agencies, including nontraditional testing sites to build the Rapid stART network of provider agencies.
Within seven days of a client’s HIV diagnosis, a visit with an HIV medical provider is scheduled to take place. A Rapid stART Response Team member attends the medical appointment with the client, if requested. Rapid stART employs a client-led approach to services, which are provided by a multidisciplinary care team, including the medical provider, case manager, pharmacist, and others. In addition to the medical visit where all initial HIV and other labs are completed, a case manager completes a psychosocial assessment, and with the client, establishes a plan for future medical appointments and other services. This care plan includes a consistent communication strategy.
ART is immediately prescribed and provided through the pharmacy. Alternatively, clients may receive short-term “starter packs” of HIV medications to provide immediate treatment until eligibility for assistance programs is determined.
Clients receive science-based education, along with resources, on the importance of viral suppression in maintaining overall health and wellness, and its value as high-impact HIV prevention. Ongoing treatment adherence counseling is provided.
Rapid stART expanded from three to 28 facilities across Southern Nevada. Linkage to HIV medical care within seven days of diagnosis, initiation of ART within seven days, and viral load suppression within 60 days of ART initiation all improved from baseline in 2019 to 2022. Data from March 2023–February 2024 continue to show Rapid stART is successful in getting people connected to HIV care and initiating ART on the same day that they receive their first medical appointment.
| Category | Information |
|---|---|
| Evaluation data | CAREWare integrated with the Rapid stART Module |
| Measures | Of clients with a new HIV diagnosis who were referred to care:
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| Results | From 2019 to 2022:
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Source: Communication with Southern Nevada Rapid stART team
Learning collaborative for participating sites. Multiple stakeholders were involved in a learning collaborative to implement Rapid stART. These included the University Medical Center, the largest public hospital in Southern Nevada, the Southern Nevada Health District Community Health Center, Huntridge Family Clinic, and eight agencies funded by the RWHAP. The learning collaborative was supported by a team from the University of California, San Francisco, the Clark County Social Service Office of HIV, and the Pacific AIDS Education & Training Center.
Through six virtual learning sessions the learning collaborative provided a forum for networking and peer exchange, offering presentations on the Rapid stART protocol and quality improvement methods, exploration of challenges and successes, and planning in preparation for quality improvement action periods. During these action periods, site teams tested changes and measured progress in Plan-Do-Study-Act cycles.
Technical assistance (TA). Funding from the RWHAP Part F Special Projects of National Significance (SPNS) initiative Capacity Building in the RWHAP to Support Innovative Program Model Replication supported coaches to assess progress, and provide feedback and TA to implementing sites.
Strengthening referral networks. The Rapid stART Response Team cultivates relationships with other agencies and has built up a comprehensive list of service providers to ensure clients have access to various support systems.
Staff roles. Client navigators communicate frequently with the client; work to address client barriers to care as well as their questions and concerns; and coordinate services between providers. Medical providers complete a comprehensive medical visit; ensure required labs are completed; prescribe ART and ensure clients receive ART on the same day as appointment; provide medication adherence support; and answer questions about care. Case managers complete a psychosocial assessment; create a care plan with clients; identify immediate barriers and provide referrals to address barriers; coordinate supportive services; and screen clients for RWHAP eligibility.
Development of a Rapid stART module. As part of the learning collaborative, TriYoung Inc. (an information technology consultant), led the development and implementation a data reporting tool called the Rapid stART module to track the following Rapid stART performance measures: linkage to HIV medical care within seven days of diagnosis date or referral source date; initiation of ART within seven days; median days to Initiation of ART; viral suppression within 60 days of ART; and retention in care, defined as two medical visits within the reporting period, 90 days apart. The Rapid stART module is connected directly to and posts within CAREWare and records the data that is required for Ryan White Services Report (RSR) reporting: client demographics; date of HIV diagnosis; referral date; medical visits; viral load lab results; and ART medication. Non-RWHAP funded providers can also access the Rapid stART module using a secure interface.
Clark County uses EHE funds for clinics in Southern Nevada to initiate Rapid stART for people with a new diagnosis of HIV. Case managers then coordinate eligibility and client flow through the system of care so that clients eligible for RWHAP services or Medicaid can move from EHE to other payors with more robust HIV care and support services once eligibility is determined.
Rapid stART is ongoing at all 28 agencies, and now Clark County is working to expand Rapid stART to 15 additional agencies in 2024 with the overall goal to have all HIV services providers in the jurisdiction in the program. This expansion will include engaging with non-RWHAP funded agencies.
