RAPID antiretroviral therapy: high virologic suppression rates with immediate antiretroviral therapy initiation in a vulnerable urban clinic population

AIDS. 2019 Apr 1;33(5):825-832. doi: 10.1097/QAD.0000000000002124.


Objective: Little is known about long-term viral suppression rates for patients who start antiretroviral therapy (ART) soon after diagnosis. We describe virologic outcomes from the San Francisco-based Ward 86 Rapid ART Program for Individuals with an HIV Diagnosis (RAPID) ART program.

Design: Retrospective review of clinic-based cohort.

Methods: In 2013, Ward 86 adopted immediate ART at the first visit after HIV diagnosis. Patients were referred from testing sites, offered same or next-day intakes, and received multidisciplinary evaluation, support, and insurance enrollment/optimization. Patients were provided ART starter packs and close follow-up. Demographics and labs were extracted from medical records. Subsequent viral loads were obtained from public health surveillance data. Kaplan-Meier curves summarized distribution of times to first viral suppression; viral suppression rates at last viral load recorded were calculated.

Results: Of 225 patients referred to RAPID ART from 2013 to 2017, 216 (96%) were started on immediate-ART: median age 30; 7.9% women; 11.6% African-American, 26.9% Hispanic, 36.6% white; 51.4% with substance use; 48.1% with mental health diagnoses; 30.6% unstably housed; baseline median CD4 cell count 441 cells/μl median viral load 37 011. By 1 year after intake, 95.8% achieved viral suppression to less than 200 cells/μl at least once. Over a median follow-up time of 1.09 years (0-3.92), 14.7% of patients had viral rebound, but most (78%) resuppressed. Viral suppression rates were 92.1% at last recorded viral load.

Conclusion: In an urban clinic with high rates of mental illness, substance use and housing instability, immediate ART provided through a RAPID program resulted in viral suppression at last viral load measurement for more than 90% of patients over a median of 1.09 years. RAPID ART for vulnerable populations is acceptable, feasible, and successful with multidisciplinary care and municipal support.

MeSH terms

  • Adolescent
  • Adult
  • Anti-HIV Agents / therapeutic use*
  • CD4 Lymphocyte Count
  • Clinical Protocols
  • Female
  • Follow-Up Studies
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • HIV Infections / immunology
  • Humans
  • Male
  • Middle Aged
  • Population Surveillance
  • Retrospective Studies
  • San Francisco / epidemiology
  • Time-to-Treatment / statistics & numerical data*
  • Viral Load / drug effects*
  • Vulnerable Populations*
  • Young Adult


  • Anti-HIV Agents