East Bay Getting to Zero

HIV Testing and Rapid ART

(Same-day HIV antiretroviral therapy)

Streamlined work flow for non-HIV providers

Updated 10.24.2023

Purpose: To provide HIV treatment as soon as possible after diagnosis and re-engagement in care; ideally on the same day as disclosure/referral and at least within the same week. Studies have shown that rapid antiretroviral treatment (ART) increases treatment rates and reduces viral load, transmission and morbidity/mortality.

Testing for and diagnosing HIV:

  • Send a lab-based HIV antigen/antibody serum test with reflex confirmation (Quest 91431 or LabCorp 083935). If confirmed positive, it is diagnostic for HIV.
  • And/or conduct a rapid HIV test. If positive, draw and send the confirmatory test (antigen/antibody and/or viral load) and consider offering rapid ART if the result is positive with high probability of HIV based on clinical impression and/or S/CO ratios. 
  • If the patient has any viral or STI symptoms or has had an exposure in the past 4 weeks, suspect acute HIV and send a lab-based HIV RNA viral load test (Quest 40085 or LabCorp 550430).
  • For questions and help, contact our HIV treatment teams or the HIV warmline.
  • ICD-10 billing code for HIV testing: Z11.4

Disclosing and prescribing Rapid ART:

  • Disclose:
    • “Your test shows that you (have/probably 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:
    • urine pregnancy test if there is pregnancy potential
    • ICD-10 billing codes for HIV care: B20 (symptomatic) or Z21 (asymptomatic).
  • Ask 3 screening questions for crypto, TB/PCP and prior ART if patient wants ART:
    • “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 cryptococcal meningitis treatment 2-10 weeks 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 2-8 weeks before ART. For PCP, initiate ART once stable on PCP treatment.
    • “Have you ever taken HIV medications before?”
      • If yes, make sure to get a genotype.
      • If they have not been on injectables and want to restart their previous regimen, and there is documentation of it in the EHR, consider offering them the same regimen.
      • If they have taken Cabenuva (injectable cabotegravir/rilpivirine) or Apretude (injectable cabotegravir for PrEP), include integrase (INSTI) testing in the genotype. Limit Biktarvy to a 14-day supply with close follow-up or use Symtuza for rapid ART.
  • Prescribe rapid ART and link to care if patient does not report the contraindications above. 
    • For most people: prescribe Biktarvy 1 tab PO daily, 14 to 30-day supply, no refills.
    • If pregnant or high potential: prescribe Tivicay 50 mg 1 tab PO + Truvada 1 tab PO daily.
    • If they used Cabenuva or Apretude: limit Biktarvy to a 14-day supply with close follow-up or prescribe Symtuza, 1 tab PO daily with food, no refills. Ensure RT and INSTI genotypes are sent.
    • If has Medi-Cal, write on script: “HIV med, bill to Medi-Cal carve-out” for coverage.
    • ICD-10 billing codes for HIV care: B20 (symptomatic) or Z21 (asymptomatic).
    • 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. Find direct contacts for HIV linkage navigators using this directory.
    • Highland ED: call HIV team at 510-437-8368 (M-F, 7:30-5:00) or EPIC route to: HIV and HCV (Hep C) Linkage. (e.g. “Started ART, please follow.”)
    • For questions and help, contact our HIV treatment teams or the HIV warmline.
    • Follow-up with a med check with the HIV team within 1-2 days and HIV clinic visit within 1 week.