Educational Intervention to Promote Offering of Rapid Antiretroviral Therapy Among Primary Care Providers in a Correctional Facility in California,2017-2023

Abstract

Rapid initiation of antiretroviral therapy (rapid ART) is a clinical strategy where HIV treatment is initiated on day of HIV diagnosis, resulting in improved retention in care and virologic suppression. HIV specialists historically have prescribed ART, but recent efforts have increased prescribing among primary care providers. Justice-involved individuals have lower rates of engagement in care along the HIV care continuum compared with the general population; evaluating the effect of rapid ART prescribing by provider type can aid in improving outcomes among this population. The purpose of this case study was to compare rates of offering rapid ART to those newly diagnosed with HIV in a California county jail following an educational intervention that aimed to increase prescribing by primary care providers in the jail. The educational intervention included an educational session, creation of an electronic health record (EHR) note template containing prompts for the offering of rapid ART, and the creation of an EHR order set for relevant laboratory tests. Forty-two individuals were newly diagnosed with HIV in the jail from May 2017 through December 2023. Medical record review indicated that rapid ART offering increased by 36% (56% [9 of 16] vs 92% [24 of 26]) after the intervention versus preintervention, with 50% (13 of 26) offered by primary care physicians following the intervention, compared with 7% (1 of 16) offered by primary care providers preintervention. This intervention serves as a test case that highlights the ability to expand rapid ART offering by primary care providers in resource-limited settings such as jails.