East Bay Getting to Zero

Rapid ART

Quick Rapid ART guide
Complete Rapid ART guide
How to get treatment for community members
Contact UCSF HIV warmline for help

Rapid ART

(Same-day HIV antiretroviral therapy)

Streamlined work flow for non-HIV providers

Updated 5.3.2022

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

Diagnosing HIV:

  • confirmed positive HIV antigen/antibody test,
  • 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. 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.”)
    • Aim for intake visit and med check with HIV team within 1-2 days.

References