Rapid ART
For ED, urgent care and street/shelter settings
Updated 1.19.2021
HIV diagnosis: confirmed positive, rapid test positive with high probability or HIV ag/ab positive with signal-to-cutoff >14.7.
- Disclose: “Your test shows that you have HIV.” (pause) “We’d like to offer you safe and effective treatment today. How do you feel about taking medications?” (pause and listen)
- Labs- add on, draw or order these labs if not already done:
- HIV-1 RNA Quantitative with Reflex to Genotype with RT/PI
- CD4 absolute count
- CMP
- CBC
- upreg if pregnancy potential.
- Ask 3 screening questions if patient wants a same-day prescription:
- “Have you ever taken HIV medications other than Truvada before?”
- If yes, be sure to get a genotype and consult or do a warm hand-off to an HIV provider who will determine the treatment regimen.
- “Are you having any headaches that are out of the ordinary?”
- If yes, refer for or get a CT to rule out lesion, blood for cryptococcal antigen, LP and admit if abnormal. Start OI treatment before ART.
- “Have you had a cough for more than 2 weeks, fevers, night sweats or weight loss in past month or so?”
- If yes, refer for or get a chest x-ray and sputa to rule out TB. Start TB treatment before ART.
- “Have you ever taken HIV medications other than Truvada before?”
- Prescribe rapid ART and link to care if patient does not report the contraindications above.
- Prescribe Biktarvy 1 tab PO daily, 30-day supply, no refills.
- If pregnant or high potential: prescribe Tivicay 50 mg 1 tab PO + Truvada 1 tab PO daily.
- If has Medi-Cal, write on script: “HIV med, bill to Medi-Cal carve-out” for coverage.
- If no prescriber is onsite, contact your team’s provider via telemedicine if available.
- Provide a warm hand-off: personal call or message to HIV team/provider with patient.
- Aim for intake visit and med check with HIV team within 1-2 days.
References
- Guidelines followed: DHHS adult HIV ART guidelines 9/2019, IAS HIV ART guidelines 10/2020.
- The full set of recommended baseline labs include: HIV VL, CD4, CMP, lipids, pregnancy test, hep A/B/C, TB screen, STIs, HIV RT/PR genotype, Cryptococcal antigen if CD4<100.