East Bay Getting to Zero

East Bay Rapid ART (HIV treatment) guidance

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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. 
  • 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.