Rapid Start accelerates the initiation of antiretroviral therapy (ART) and entry into HIV medical care for people with HIV who are newly diagnosed, new to care, or out of care. The initiative funds 15 implementation sites that have the capacity and infrastructure to support rapid start, have initiated pilot programs, or are ready to expand rapid start services, with the goal of replicating and expanding successful rapid start models. Implementation sites include Ryan White HIV/AIDS Program (RWHAP)- funded clinics, FQHCs, academic medical centers, and community-based organizations.
This HRSA HIV/AIDS Bureau SPNS initiative funds organizations across the United States in the implementation and evaluation of “Rapid Start” interventions. The project is supported through funding from the Department of Health and Human Services (HHS) Minority HIV/AIDS Fund (MHAF).
|University of Illinois||Chicago, IL|
|Abounding Prosperity||Dallas, TX|
|Valley AIDS Council||Harlingen, TX|
|AIDS Foundation||Houston, TX|
|AltaMed||Los Angeles, CA|
|St. John's Well Child and Family Center||Los Angeles, CA|
|Compass Cares||Macon, GA|
|Golden Valley Health Centers||Merced, CA|
|Empower U||Miami, FL|
|La Casa de Salud||New York City, NY|
|University of Miami||Miami, FL|
|SUNY Downstate||New York City, NY|
|Desert AIDS Project||Palm Springs, CA|
|Multnomah County Health Dept||Portland, OR|
|Washington University||St. Louis, MO|
Accelerated access to medical visit with an HIV provider
On-site testing or strong partnerships between testing programs and Rapid Start implementation sites
Warm hand-offs and accessible linkage coordinators
Accelerated insurance/payor approval & clinic enrollment
Accessible education on beginning ART
Early & sustained access to ART - Pre-approved ART regimens & starter pack of medications
Observed administration of the first dose
Follow-up with continued education, patient navigation efforts, and contact with retention teams
The University of California San Francisco (UCSF) has been funded by HRSA to act as the Evaluation and Technical Assistance Provider (ETAP). UCSF offers technical assistance to the implementation sites, evaluates the implementation of Rapid Start interventions and their outcomes on the HIV care continuum, and produces resources for future replication and scale-up in other RWHAP provider organizations.
All sites participate in the initiative-wide Learning Collaborative1 which provides the structure for the provision of technical assistance to implementation sites and provides a common set of implementation strategies for adoption, uptake, and integration of their rapid start interventions. Sites participate in regular initiative-wide learning sessions and receive individualized coaching to support local quality improvement projects to benefit implementation outcomes. The Learning Collaborative:
- Facilitates capacity building by providing trainings, offering TA, and facilitating peer-to-peer learning to share best practices and lessons learned
- Provides opportunities for engagement with subject matter experts to guide the development and implementation of Rapid Start
- Increases system-level capacity for adoption of Rapid Start to improve HIV care continuum outcomes
Multi-site Evaluation Focusing on Implementation, Effectiveness and Cost
Based in the Proctor Implementation Science Framework2 and Dynamic Capabilities Model,3 UCSF is using an Effectiveness-Implementation Hybrid Type 24 Design to assess the key implementation strategies for uptake of a rapid start intervention and assess HIV Care Continuum outcomes for the patients served by these 15 implementation sites. Using a mix of qualitative and quantitative data approaches (Embedded Experimental Model Design5), the ETAP multisite evaluation work includes:
- Conduct a process evaluation to characterize adaptation, implementation and barriers and facilitators to factors associated with Rapid Start intervention implementation
- Evaluate multi-site patient outcome data, including early entry into care, initiation of ART, rates of engagement, and retention in care after rapid ART initiation
- Assess the impact of adaptation and implementation of Rapid Start interventions on increased viral suppression (VS), shorter time to VS and/or durable and sustained VS
- Collect cost data to determine the labor, programmatic and structural costs associated with adapting and implementing the Rapid Start models and interventions at the implementation sites
Dissemination and Replication
Implementation tools will be developed through the course of the initiative, building to the capstone Replication and Implementation Manual (The Rapid Playbook). Other products could include:
- Toolkits that focus on overcoming specific challenges (e.g., preventing provider and staff burnout)
- Training curricula that can be used by the AETCs and other trainers
- Webinars and conference presentations about Rapid Start implementation
- Briefs for policy stakeholders that fund and support Rapid Start programs
- Journal articles describing findings
- Wells, S., Tamir, O., Gray, J., et al. (2018). Are quality improvement collaboratives effective? A systematic review. BMJ Quality & Safety, 27, 226-240.
- Proctor, E.K., Powell, B.J. & McMillen, J.C. (2013). Implementation strategies: recommendations for specifying and reporting. Implementation Science, 8, 139.
- Helfat C.E. et al.(2007). Dynamic Capabilities: Understanding Strategic Change in Organizations. Malden, MA: Blackwell.
- Curran, G. M., Bauer, M., Mittman, B., Pyne, J. M., & Stetler, C. (2012). Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical Care, 50, 217–226.
- Creswell, J.W. and Plano Clark, V.L. (2011). Designing and Conducting Mixed Methods Research. 2nd Edition, Sage Publications, Los Angeles.