Test & Treat Rapid Access Program

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.

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.

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.

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.

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.”