Test & Treat Rapid Access Program

After a successful pilot in 2016, the Florida Department of Health (FDOH) in Miami-Dade County made their Test & Treat Rapid Access Program (TTRA) a standard of care for all Miami-Dade County Ryan White HIV/AIDS Program (RWHAP) Part A subrecipients. TTRA aims to connect people to antiretroviral therapy (ART) within three days of a positive HIV test result. Through TTRA, clients with a new HIV diagnosis in Miami-Dade County can access ART, receive other services and counseling, start enrollment in RWHAP, and connect to HIV primary care during the initial visit. At Borinquen Health Care Center, one of the clinical sites participating in TTRA, 76% of clients were virally suppressed within three months of receiving a rapid ART start, and 95% were retained in care for 12 months.

Miami-Dade County, FL

Implementation Guide
Evidence-Informed Intervention
Evidence-Informed Intervention
Icon for Intervention Type
Clinical service delivery model
Icon for HIV Care Continuum
HIV diagnosis; Linkage to HIV medical care; Prescription of antiretroviral therapy; Viral suppression
Icon for Focus Population
People with a new diagnosis of HIV; People with HIV who are not in care
Icon for Priority Funding
RWHAP Part A; State funding
Icon for Setting
Community health center, including Federally Qualified Health Centers (FQHCs); RWHAP-funded clinic or organization
Need Addressed

Rapid ART initiation is often defined as the provision of HIV care and ART on the same day as or within seven days (or another short time period) from a person’s diagnosis of HIV.1 A shortened timeline between a person’s HIV diagnosis and treatment has been linked to improvements in viral suppression and retention to care.2,3 Prior to TTRA, Miami-Dade County found that it took about three months to link a new client to care and to initiate ART. By including TTRA as a main strategy in its 2016 Ending the Epidemic (EHE) plan, FDOH aimed to reduce HIV incidence while improving linkage to care in Florida.

“It is about getting to zero, it's about eradicating this disease. And I think that Test and Treat Rapid Access is the way to go. Anyone that wants to receive treatment and medication same day, I believe that it should be to be available.”

Core Elements
HIV testing and linkage to care

When a person tests positive for HIV in Miami-Dade County, the individual is given a list of TTRA providers and select where they would like to receive treatment. FDOH can then send an email to the selected provider that includes some information about the person. A patient navigator plays a central role throughout the TTRA process, including the initiation of the intake process at the provider site. For example, Borinquen has a single TTRA email address, through which FDOH testing staff can reach the patient navigator, clinicians, the pharmacy, and case managers. The Borinquen patient navigator then educates the client about HIV progression and HIV care, conducts an initial client intake assessment, and sets up various aspects of the initial visit, escorting the client to meet other staff in the TTRA process during the initial clinical appointment.

Initial clinical appointment and ART prescription

On the same day or within three days, a TTRA client receives a clinical appointment at their provider of choice. During this appointment, the provider’s staff conduct a medical and psychosocial evaluation, take baseline labs, provide counseling on ART, and link the client to HIV primary care. The patient navigator connects the client with a staff person to assess the client’s eligibility and begin enrollment in the RWHAP. During this initial clinical appointment, the clinician provides a short-term and long-term prescription for ART. The short-term ART prescription means the client has medication in-hand that first day. FDOH uses state funds to cover 30-day starter packs for all TTRA clients (regardless of health care coverage status); providers may also have seven-day starter packs from pharmaceutical manufacturers. Many providers have onsite pharmacies to provide ART that day and the provider can invoice FDOH or the appropriate payor source afterwards. To ensure availability for these initial clinical TTRA appointments, providers may block calendar appointments for TTRA.

Support services

Each TTRA client receives a mental health referral and is allowed to receive a mental health appointment within the first 30 days of TTRA enrollment, covered under the Miami-Dade County RWHAP Part A program. The provider’s patient navigator also makes referrals for the client to receive other services, such as nutrition assistance and dental care.

Follow-up care

Within two weeks of the initial visit, the client receives another TTRA clinical appointment. By this time, any baseline lab results are available and can be discussed. Depending on the client’s needs, the clinician meets with the client again after one month, and then every three months thereafter. At Borinquen, the TTRA patient navigator stays in contact with a new TTRA client for one year after the initial visit.

Treatment for clients out of care

Miami-Dade County’s TTRA program reaches not only people with a new diagnosis of HIV but also people with HIV who are not engaged in care. About one-third of all the TTRA clients from July 2018 to June 2022 were previously in care in Miami-Dade County but were not currently engaged in care. The TTRA process for these individuals is the same, except the patient navigator talks with the client about why they may have been lost to care and addresses those barriers.

“We did expand beyond just the newly diagnosed because we thought it was important to focus on the folks that were lost to care and give them the same opportunity to get back into care same day and with a prescription same day.”


Between July 2018 and June 2022, 2,821 people with HIV were linked to care and prescribed ART through TTRA in Miami-Dade County. At Borinquen Health Care Center, one of the participating sites, outcomes were tracked for 108 TTRA clients served between January 2021 and December 2021.

Evaluation dataElectronic health record data on client demographics, service utilization, and health outcomes. 
  • Percent of clients who received ART within 24 hours of their first visit in the clinic.
  • Percent of clients virally suppressed within three months.
  • Percent of clients retained in care for 12 months.
  • 100% of Borinquen TTRA clients received ART within 24 hours of their first visit to the clinic.
  • 76% of clients were virally suppressed within 3 months.
  • 95% of clients were retained in care for 12 months.

Source: Borinquen Health Care Center Rapid Start Site Profile.

Planning & Implementation

Driven at the state level. In 2016, Florida developed a statewide EHE plan that included “Test and Treat” as a key strategy. FDOH created an initial protocol for TTRA based on San Francisco’s RAPID process, and then approached Miami-Dade County to pilot this process.

Piloted at a county level. In 2016, Miami-Dade County piloted TTRA by working with University of Miami’s (UM) Jackson Memorial Hospital. The pilot demonstrated that linkage to ART on the same day as a person’s diagnosis was feasible and that people who started ART earlier had higher rates of retention in care and viral suppression.4,5 After the successful pilot, Miami-Dade County required all its RWHAP Part A subrecipients to implement TTRA.

Ongoing partnership with providers. Miami-Dade County worked closely with providers to offer TTRA guidance and resources but also allowed space for individual providers to consider their own processes and context while implementing TTRA.6 Miami-Dade County disseminated a TTRA protocol that emphasized the goal of connecting clients to care within three days but allowed providers to make adjustments based on local service delivery. When all RWHAP Part A subrecipients implemented TTRA after the pilot, UM Jackson Memorial Hospital worked with the new TTRA providers to help them adapt their workflows and to conduct trainings.


Since the 2016 pilot in Miami-Dade County, FDOH has worked to implement TTRA with all Miami-Dade County RWHAP Part A subrecipients and in all Florida counties, connecting more people to HIV treatment quickly. For uninsured clients, RWHAP Part B covers the cost of medication as part of Emergency Financial Assistance (EFA) funds in the short-term (30 days), while RWHAP Part A covers the cost of medical and mental health care coverage. During this 30-day timeframe, subrecipients work with clients to enroll them in RWHAP or other health care coverage they are eligible for. For insured clients, RWHAP Parts A and B have worked together to develop a payment policy to make TTRA available until the client secures prior authorization for ART. 

Lessons Learned

  • Providers offering TTRA in Miami-Dade County meet monthly for case conferences to discuss any new issues for clients diagnosed that month. All Florida TTRA providers meet periodically for larger “Share and Learn” meetings, in which they discuss policy and data management updates, share new data on TTRA outcomes, and give feedback on TTRA implementation in general. These meetings, which were held virtually and less frequently during the COVID-19 pandemic, are crucial for providers to learn from each other to resolve issues, and for FDOH and Miami-Dade County to learn about implementation challenges that would help fine-tune TTRA protocols.
  • The patient navigator role is crucial to guide new clients through the TTRA process via warm handoffs. Staff from Miami-Dade County emphasize that someone should be with the client “every step of the way,” making a new process involving different staff a seamless and less stressful experience. For example, at Borinquen, the patient navigator is the first contact for a client and physically escorts or connects the client with both the clinician for medical care and other staff to start RWHAP enrollment. 
  • Both Miami-Dade County and FDOH encourage providers to designate a local “champion” to educate fellow clinicians or other staff on the TTRA process, especially if they are hesitant to provide treatment prior to a confirmatory test. For example, Borinquen’s TTRA clinical champion mentors clinicians to help them feel more comfortable providing TTRA.

“…really giving them the support from the beginning. I think is really important because if they've been out of care for a while they really need that support, I'm sure they've got a lot of things going on in their life and just having someone there… [patient navigators are] really there to provide that support.”

Florida Department of Health in Miami-Dade County
Kira Villamizar, MPH
HIV/AIDS Program Coordinator

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