Large health care network saw similar rates of rapid ART start before, during COVID-19
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Patients newly diagnosed with HIV at Kaiser Permanente Northern California had similar rates of rapid ART initiation and viral suppression before and during COVID-19 despite widely reported disruptions caused by the pandemic.
“Immediate initiation of ART for HIV is a fairly recent change in the standard of care,” Christian Lee-Rodriguez, MD, specialist in internal medicine at Kaiser Permanente Northern California (KPNC), told Healio, noting that both WHO in 2017 and HHS in 2019 recommended rapid initiation of ART in newly diagnosed HIV infection. “Rapid ART had become a standard of care that was subsequently interrupted by the COVID-19 pandemic. Our study aimed to describe the impact to the standard practice of rapid ART initiation and subsequent time to viral suppression.”
Lee-Rodriguez and colleagues performed an observational cohort study, including members of KPNC — an integrated health care system that provides medical services, including evidence-based, multidisciplinary HIV care services, to more 4 million patients. The study included adults aged 18 years and older who were newly diagnosed with HIV between March 1, 2019, and Feb. 28, 2021.
Demographic and clinical data were obtained from KPNC’s electronic medical record database, as well as linked laboratory and pharmacy databases. The primary outcome was rapid ART initiation, defined by the study as an ART prescription fill from a KPNC pharmacy within 7 days of HIV diagnosis. Secondary study outcomes were days to viral suppression and the proportion of patients who reached HIV viral suppression within one year of diagnosis.
Overall, researchers identified 539 patients newly diagnosed with HIV, including 281 diagnosed in the pre-COVID-19 period and 258in the during-COVID-19 period. Demographic characteristics were similar between the pre-COVID-19 and during-COVID-19 periods. However, the study showed that patients in the pre-COVID-19 period were more likely to have commercial health insurance than those diagnosed during COVID-19 (95.4% vs 90.3%; P = .01).
According to the study, 51.2% of patients started ART within 7 days of diagnosis, with 48.4% in the pre-COVID-19 period and 54.3% in the during-COVID-19 period (P = .17). Additionally, within 1 year of HIV diagnosis, 87.2% of pre-COVID-19 and 89.5% of during-COVID-19 patients had HIV viral suppression (P = .40). The average length of time to viral suppression was 97.3 days before the pandemic and 80.6 days during the pandemic (P = .05).
“Rapid initiation of ART remains the standard of care,” Lee-Rodriguez said. “While the COVID-19 pandemic impacted care delivery in ways that are still being studied, our study suggests that telemedicine may be a reliable and readily available encounter type to maintain retention in HIV care and reach viral suppression.”
- Mohr KB, et al. Open Forum Infect Dis. 2022;doi:10.1093/ofid/ofac639.
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