Journal Article

Provider Perspectives on Rapid Treatment Initiation Among People Newly Diagnosed With HIV: A New Message of “Urgency”?

Samoff, Erika, Uhrig Castonguay, Breana J., Gay, Cynthia L., Hatcher, Sarah, Mobley, Victoria, McNeil, Candice J., Mancuso, Noah, Golin, Carol E., Okumu, Eunice, Abbott, Rica, Swygard, Heidi, Watson, Sable

2024

Overview

Background Early initiation of antiretroviral therapy improves human immunodeficiency virus (HIV) outcomes. However, achieving earlier treatment initiation is challenging for many reasons including provider awareness and clinic barriers; this study sought to understand perceptions of an early initiation program. Methods We interviewed 10 providers from 3 HIV clinics in North Carolina (October-November 2020). We asked providers about overall perceptions of early initiation and the pilot program. We developed narrative summaries to understand individual contexts and conducted thematic analysis using NVivo. Results Providers believed earlier initiation would signal an “extra sense of urgency” about the importance of antiretroviral therapy—a message not currently reflected in standard of care. Safety was a consistent concern. Cited implementation barriers included transportation assistance, medication sustainability, and guidance to address increased staff time and appointment availability. Conclusion Our qualitative findings highlight the need for training on the safety of early initiation and addressing staffing needs to accommodate quicker appointments. Plain Language Summary Doctor and clinic staff perspectives on a program to immediately start HIV treatment among patients newly diagnosed with HIV Treating human immunodeficiency virus (HIV) is easier than ever. Starting newly diagnosed persons on HIV medication as soon as possible is a now recommended goal. However, starting patients right away can be challenging. This study interviewed doctors and clinic staff to better understand their perspectives prior to implementing a program that would provide newly diagnosed patients with HIV treatment immediately. Results showed that some doctors are worried patients will not return after receiving their medications. Providers want support for linking patients to the clinic and ensuring they will be able to receive their next dose of medication when they come in. Other providers saw the benefits of reducing HIV stigma if the program can more quickly start patients on treatment. Some providers explained that when you go to the doctor and are sick you receive medications immediately, yet for newly diagnosed patients living with HIV, patients can be told to come back a month later to start treatment. Some providers believe shifting this messaging may also help patients take their medications better. Most providers saw the need for clinics to have more same-day appointment availability to meet the needs of the new program. Overall, providers were excited about the opportunity to improve the HIV care by offering HIV medications to newly diagnosed patients immediately.

• Publisher: SAGE Publications,SAGE PUBLICATIONS, INC,SAGE Publishing
• Subject: Adult / Anti-HIV Agents - therapeutic use / Antiretroviral drugs / Antiretroviral therapy / Attitude of Health Personnel / Clinics / Drug therapy / Drugs / Female / Health Personnel - psychology / HIV / HIV Infections - drug therapy / Human immunodeficiency virus / Humans / Male / Medical treatment / Middle Aged / Newly diagnosed / North Carolina / Perceptions / Prescription drugs / Qualitative Research / Safety / Staffing / Therapy / Time-to-Treatment - statistics & numerical data / Urgency