East Bay Getting to Zero

Rapid ART

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Rapid ART

(HIV antiretroviral therapy)

For ED, urgent care and street/shelter settings

Updated 3.19.2021

HIV diagnosis:

  • confirmed positive,
  • or rapid test positive with high probability of confirmed positive based on clinical impression and/or S/CO ratios. 

Disclose and evaluate for 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:
    • CMP
    • CBC
    • upreg if pregnancy potential.
  • Ask 3 screening questions to rule-out previous ART, crypto, TB and PCP if patient wants ART:
    • “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 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.
  • 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.
    • 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.”)
    • 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 RNA PCR viral load, CD4, CMP, lipids, pregnancy test, hep A/B/C, TB screen, STIs, HIV RT/PR genotype, cryptococcal antigen if CD4<100.