East Bay Getting to Zero

HIV Testing and Rapid ART

(Same-day HIV antiretroviral therapy)

Streamlined work flow for non-HIV providers

Updated 9.13.2023

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 you suspect acute HIV infection (exposure in the past 4 weeks or less), also send a lab-based HIV RNA viral load test (Quest 40085 or LabCorp 550430).
  • 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 taken Cabenuva (injectable cabotegravir/rilpivirine) or Apretude (injectable cabotegravir for PrEP), use Symtuza for rapid ART and include integrase (INSTI) testing in the genotype. If they want to restart their previous regimen, and there is documentation of it in the EHR, consider offering them the same regimen.
  • Prescribe rapid ART and link to care if patient does not report the contraindications above. 
    • For most people: 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 they used Cabenuva or Apretude: prescribe Symtuza, 1 tab once daily with food.
    • 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.”)
    • Follow-up with a med check with the HIV team within 1-2 days and HIV clinic visit within 1 week.