Uptake of rapid antiretroviral therapy following HIV diagnosis: An eight-year retrospective analysis at a UK clinic

Abstract

Background

To evaluate the outcomes of rapid antiretroviral therapy (ART) initiation following HIV diagnosis at 56 Dean Street in London, UK, following the implementation of the Rapid Initiation Option (RIO) in 2016.

Methods

We conducted a retrospective case-note review of all individuals newly diagnosed with HIV between 1 January 2017 and 31 December 2024. We analysed demographics, timing of ART initiation, and reasons for delayed treatment (>90 days). Differences between early (<2 days) and later ART initiators were assessed.

Results

Of 1081 individuals diagnosed, 1008 (93.2%) initiated ART at 56 Dean Street. Median time to ART initiation was 7 days (IQR 4–14), with 15.3% starting within 2 days. Median time to ART initiation remained stable from 2017 to 2024, despite disruptions due to the COVID-19 and mpox pandemics. Faster initiators were more likely to have recently acquired HIV, higher baseline viral loads, prior 56 Dean Street attendance, and prior PrEP use (all P < 0.05). Delayed initiation occurred in 2.2%, mainly due to poor attendance, personal choice, or being outside the UK. Demographic characteristics did not differ significantly between rapid and later initiators.

Conclusions

Rapid ART initiation has been sustained over 8 years through the RIO pathway. The model remained robust during healthcare disruptions. Familiarity with services and recent testing were associated with more rapid initiation, supporting the importance of patient-centred, adaptable care pathways.