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Same-day ART start improves HIV outcomes

Rapid ART initiation raised 90-day treatment start and 10-month viral suppression versus standard multi-visit initiation.

Source

Initiating Antiretroviral Therapy for HIV at a Patient's First Clinic Visit: The RapIT Randomized Controlled Trial

Rosen S, Maskew M, Fox MP, et al. · PLoS medicine · 2016

doi.org/10.1371/journal.pmed.1002015Read the full paper ↗261 citationscc by

What they did

RapIT randomised adults at two public clinics to accelerated first-visit ART initiation versus usual stepwise initiation, then compared ART start by 90 days and viral suppression by 10 months.

What they found

Of 463 enrolled, rapid-arm patients initiated ART by 90 days far more often (97% vs 72%) and had higher 10-month suppression (64% vs 51%).

The limits

What it doesn't show

Unblinded service trial in two clinics may not generalise to all settings; suppression was not universal even in the rapid arm.

Key terms

RapIT
Rapid Initiation of Treatment randomised service trial.
ART
Antiretroviral therapy for HIV.
Viral suppression
Plasma HIV RNA reduced below the study threshold.
Same-day initiation
Starting ART at or near the first clinic visit.
Risk difference
Absolute percentage-point difference between arms.
Standard care
Usual multi-visit ART preparation pathway.

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RapIT compared:

Common questions

90-day initiation rapid vs standard?

97% vs 72%.

10-month suppression?

64% vs 51%.

How many enrolled?

463.

Was it randomised?

Yes—unblinded individually randomised.

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