A large healthcare network has seen similar rates of rapid ART initiation before, during COVID-19

December 23, 2022

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The authors report no relevant financial disclosures.

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Patients newly diagnosed with HIV at Kaiser Permanente Northern California had similar rates of rapid ART initiation and viral suppression before and during COVID-19, despite widely reported disruptions caused by the pandemic.

“Immediate initiation of ART for HIV is a relatively recent change in the standard of care.” Christian Lee-Rodriguez, Ph.D, internal medicine specialist at Kaiser Permanente Northern California (KPNC), told Healio, noting that both WHO in 2017 and HHS in 2019 recommend prompt initiation of ART for newly diagnosed HIV infection. “Rapid ART became the standard of care, which was subsequently disrupted by the COVID-19 pandemic. Our study aimed to describe the impact on standard practice of rapid initiation of ART and subsequent time to viral suppression.


Lee-Rodriguez and colleagues conducted an observational cohort study involving members of KPNC, an integrated health care system that provides medical services, including evidence-based, multidisciplinary HIV care services, to more than 4 million patients. According to the study, patients included in the study were adults over the age of 18 who were newly diagnosed with HIV between March 1, 2019, and February 28, 2021.

Demographic and clinical data were obtained from the KPNC electronic medical record database as well as linked laboratory and pharmacy databases. The primary outcome was rapid initiation of ART, defined of the study as an ART prescription from a KPNC pharmacy within 7 days since HIV diagnosis. Secondary outcomes of the study were up to days viral suppression and the proportion of patients who achieved HIV viral suppression within one year of diagnosis.

Overall, the researchers identified 539 newly diagnosed HIV patients, including 281 diagnosed in the period before COVID-19 and 258 in during the period of COVID-19. Demographic characteristics were similar between them the periods before COVID-19 and during COVID-19. However, the study showed that patients in the pre-COVID-19 period were more likely to have commercial health insurance than those diagnosed during COVID-19 (95.4% vs. 90.3%; P = 0.01).

According to the study, 51.2% of patients started ART within 7 days of diagnosis, with 48.4% in the pre-COVID-19 period and 54.3% in the period during COVID-19 (P = 0.17). Furthermore, within 1 year of HIV diagnosis, 87.2% of patients before COVID-19 and 89.5% of patients during COVID-19 had HIV viral suppression (P = 0.40). According to the study, the average duration of time to viral suppression was 97.3 days during the period before COVID-19 and 80.6% days during COVID-19 (P = .05).

“Prompt initiation of ART remains the standard of care,” Lee-Rodriguez said. “While the COVID-19 pandemic has affected care delivery in ways that are still being explored, our study suggests that telemedicine may be a reliable and readily available encounter type to maintain retention in HIV care and achieve viral suppression.”

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