Essential elements of and challenges to rapid ART implementation: a qualitative study of three programs in the United States.

Autor: Koester KA; Department of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA. Kimberly.koester@ucsf.edu., Moran L; Department of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA., LeTourneau N; Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA., VanderZanden L; Howard Brown Health Center, 4025 N. Sheridan Rd, Chicago, IL, USA., Coffey S; Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA., Crouch PC; San Francisco AIDS Foundation, 470 Castro Street, San Francisco, CA, USA., Broussard J; San Francisco AIDS Foundation, 470 Castro Street, San Francisco, CA, USA., Schneider J; Howard Brown Health Center, 4025 N. Sheridan Rd, Chicago, IL, USA., Christopoulos KA; Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2022 Mar 31; Vol. 22 (1), pp. 316. Date of Electronic Publication: 2022 Mar 31.
DOI: 10.1186/s12879-022-07297-3
Abstrakt: Background: Antiretroviral therapy (ART) initiation on the day of an HIV diagnosis or as soon as possible after diagnosis, known as rapid ART (henceforth "RAPID"), is considered to be a safe and effective intervention to quickly reduce viral load and potentially improve engagement in care over time. However, implementation of RAPID programming is not yet widespread. To facilitate broader dissemination of RAPID, we sought to understand health care worker experiences with RAPID implementation and to identify essential programmatic elements.
Methods: We conducted 27 key informant interviews with medical providers and staff involved in RAPID service delivery in three distinct clinical settings: an HIV clinic, a Federally Qualified Health Center and a sexual health and wellness clinic. Interviews were structured around domains associated with the Consolidated Framework for Implementation Research and were audio-recorded, transcribed, and thematically analyzed.
Findings: We identified seven (7) essential elements across settings associated with successful RAPID program implementation. These high-impact elements represent essential components without which a RAPID program could not function. There was no one requisite formation. Instead, we observed a constellation of essential elements that could be operationalized in various formations and by various people in various roles. The essential elements included: (1) presence of an implementation champion; (2) comfort and competence prescribing RAPID ART; (3) expedited access to ART medications; (4) expertise in benefits, linkage, and care navigation; (5) RAPID team member flexibility and organizations' adaptive capacity; (6) patient-centered approach; and (7) strong communication methods and culture.
Conclusions: The RAPID model can be applied to a diverse range of clinical contexts. The operational structure of RAPID programs is shaped by the clinical setting in which they function, and therefore the essential elements identified may not apply equally to all programs. Based on the seven essential elements described above we recommend future implementers identify where these elements currently exist within a practice; leverage them when possible; strengthen them when necessary or develop them if they do not yet exist; and look to these elements when challenges arise for potential solutions.
(© 2022. The Author(s).)
Databáze: MEDLINE
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