Restricted accessResearch articleFirst published online 2025-11
The AHORA Study: A Real-World Mixed-Methods Study Investigating the Effectiveness of,and Experiences with,Rapid Antiretroviral Therapy Initiation in People with Advanced HIV in the Rio Grande Valley,Texas
The Rio Grande Valley (RGV) comprises counties with some of the highest prevalence of HIV in Texas. The predominantly Latino population also faces socioeconomic challenges, including high poverty rates, low health literacy, and transiency, contributing to increased risk of advanced HIV disease. AHORA was a real-world mixed-methods study evaluating viral control and immune reconstitution in a Latino population with advanced HIV disease, who were enrolled in a rapid start treatment program with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) at two clinics in the RGV. To explore reasons for late diagnosis and experiences of rapid antiretroviral therapy (ART) initiation, document analysis and 27 in-depth semi-structured interviews were conducted with 18 individuals receiving treatment and 9 clinic staff. Median time to an HIV-1 RNA level <200 copies/mL was 5.3 weeks, with 90.5% (19/21) achieving this by Week 24. There were statistically significant differences in mean HIV-1 RNA levels, CD4% and CD4 counts between baseline and Week 24. Strategies to maximize ART engagement were grounded in person-centered care and included regular appointment reminders and transportation assistance. Common barriers to accessing care included limited HIV knowledge and financial constraints. These were addressed through education and financial support, including the provision of treatment samples at no cost, independent of insurance status. The AHORA study effectively showcases the benefits of rapid B/F/TAF initiation for individuals with advanced HIV in the RGV, facilitating early viral suppression and improved health outcomes. It also emphasizes the critical role of person-centered care and tailored support services in overcoming health care access barriers.
Centers for Disease Control and Prevention. Diagnoses, deaths, and prevalence of HIV in the United States and 6 territories and freely associated states, 2022. Centers for Disease Control and Prevention: 2024.
2.
Guilamo-RamosV, Thimm-KaiserM, BenzekriA, et al.The invisible US Hispanic/Latino HIV crisis: Addressing gaps in the national response. Am J Public Health, 2020; 110(1):27–31.
3.
Guilamo-RamosV, Thimm-KaiserM, BenzekriA. The U.S. Latino HIV crisis—Ending an era of invisibility. N Engl J Med, 2024; 391(18):1665–1668.
4.
Centers for Disease Control and Prevention. HIV diagnoses | 2023 | Ages 13 years and older | All races/ethnicities | Both sexes | All transmission categories | US Map-State Level. Available from: https://gis.cdc.gov/grasp/nchhstpatlas/main.html [Last accessed: January8, 2025].
5.
Centers for Disease Control and Prevention. HIV diagnoses | 2022 | Ages 13 years and older | All races/ethnicities | Both sexes | All transmission categories | Texas-County Level. Available from: https://gis.cdc.gov/grasp/nchhstpatlas/maps.html [Last accessed: January17, 2025].
De La GarzaR, RodrigoH, FernandezF, et al.The Increase of HIV-1 infection, neurocognitive impairment, and type 2 diabetes in the Rio Grande Valley. Curr HIV Res, 2019; 17(6):377–387; doi: 10.2174/1570162x17666191029162235
8.
Services TDoSH. Texas HIV Surveillance Report. 2022.
9.
HuhnGD, CrofootG, RamgopalM, et al.Darunavir/cobicistat/emtricitabine/tenofovir alafenamide in a rapid-initiation model of care for human immunodeficiency virus type 1 infection: Primary analysis of the DIAMOND study. Clin Infect Dis, 2020; 71(12):3110–3117; doi: 10.1093/cid/ciz1213
RolleCP, BerheM, SinghT, et al.Dolutegravir/lamivudine as a first-line regimen in a test-and-treat setting for newly diagnosed people living with HIV. AIDS, 2021; 35(12):1957–1965; doi: 10.1097/qad.0000000000002979
12.
World Health Organization. WHO guidelines approved by the guidelines review committee. World Health Organization: Geneva; 2017.
13.
SaagMS, BensonCA, GandhiRT, et al.Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2018 recommendations of the international antiviral society-USA panel. JAMA, 2018; 320(4):379–396; doi: 10.1001/jama.2018.8431
14.
KoenigSP, DorvilN, DévieuxJG, et al.Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: A randomized unblinded trial. PLoS Med, 2017; 14(7):e1002357; doi: 10.1371/journal.pmed.1002357
15.
RosenS, MaskewM, FoxMP, et al.Initiating antiretroviral therapy for HIV at a patient’s first clinic visit: The RapIT randomized controlled tria. PLoS Med, 2016; 13(5):e1002015; doi: 10.1371/journal.pmed.1002015
16.
CoffeyS, BacchettiP, SachdevD, et al.RAPID antiretroviral therapy: High virologic suppression rates with immediate antiretroviral therapy initiation in a vulnerable urban clinic population. AIDS, 2019; 33(5):825–832; doi: 10.1097/qad.0000000000002124
17.
ColasantiJ, SumitaniJ, MehtaCC, et al.Implementation of a rapid entry program decreases time to viral suppression among vulnerable persons living with HIV in the southern United States. Open Forum Infect Dis, 2018; 5(6):ofy104; doi: 10.1093/ofid/ofy104
18.
BourdeauB, ShadeSB, KoesterKA, et al.Rapid start antiretroviral therapies for improved engagement in HIV care: Implementation science evaluation protocol. BMC Health Serv Res, 2023; 23(1):503; doi: 10.1186/s12913-023-09500-w
19.
ServinAE, MuñozFA, ZúñigaML. Healthcare provider perspectives on barriers to HIV-care access and utilisation among Latinos living with HIV in the US-Mexico border. Cult Health Sex, 2014; 16(5):587–599; doi: 10.1080/13691058.2014.886131
20.
CreswellJW, Plano ClarkVL. Designing and Conducting Mixed-Methods Research. SAGE Publications Inc.: 2018.
21.
TongA, SainsburyP, CraigJ. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care, 2007; 19(6):349–357; doi: 10.1093/intqhc/mzm042
22.
ManzanoA. The craft of interviewing in realist evaluation. Evaluation, 2016; 22(3):342–360; doi: 10.1177/1356389016638615
23.
BraunV, ClarkeV. Using thematic analysis in psychology. Qual Res Psychol, 2006; 3(2):77–101; doi: 10.1191/1478088706qp063oa
24.
O’ConnorC, JoffeH. Intercoder reliability in qualitative research: Debates and practical guidelines. Int J Qual Methods, 2020; 19:1609406919899220; doi: 10.1177/1609406919899220
25.
MilesM, HubermanA. Qualitative data analysis: An expanded sourcebook. SAGE: London; 1994.
26.
BagchiAD, DavisT. Clinician barriers and facilitators to routine HIV testing: A systematic review of the literature. J Int Assoc Provid AIDS Care, 2020; 19:2325958220936014; doi: 10.1177/2325958220936014
27.
ReiningerBM, BarrosoCS, Mitchell-BennettL, et al.Socio-ecological influences on health-care access and navigation among persons of Mexican descent living on the U.S./Mexico border. J Immigr Minor Health, 2014; 16(2):218–228; doi: 10.1007/s10903-012-9714-3
28.
BlackburnCC, SierraLA. Anti-immigrant rhetoric, deteriorating health access, and COVID-19 in the Rio Grande Valley, Texas. Health Secur, 2021; 19(S1):S50–S56; doi: 10.1089/hs.2021.0005
29.
PantelicM, SteinertJI, ParkJ, et al.‘Management of a spoiled identity’: systematic review of interventions to address self-stigma among people living with and affected by HIV. BMJ Glob Health, 2019; 4(2):e001285; doi: 10.1136/bmjgh-2018-001285
30.
GhosnJ, ChowJ, GandhiM, et al.Rapid start with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) as initial treatment in people with human immunodeficiency virus-1 (HIV-1): A systematic literature review of clinical and patient-reported outcomes. HIV Med, 2025; 26(9):1375–1394; doi: 10.1111/hiv.70065
31.
ZhangX, GuanH, DiX, et al.Clinical benefits of rapid initiation of antiretroviral therapy within 14 days for newly diagnosed late-presentation people living with human immunodeficiency virus (PLWH). Drug Discov Ther, 2025; 19(2):112–123; doi: 10.5582/ddt.2025.01011
32.
ChristopoulosKA, ErgueraXA, VanderZandenL, et al.A qualitative study of the experience of immediate antiretroviral therapy among urban persons with newly diagnosed human immunodeficiency virus. Open Forum Infect Dis, 2021; 8(12):ofab469; doi: 10.1093/ofid/ofab469
ManusovEG, DiegoVP, SmithJ, et al.UniMóvil: A mobile health clinic providing primary care to the colonias of the Rio Grande Valley, South Texas. Front Public Health, 2019; 7:215; doi: 10.3389/fpubh.2019.00215
36.
FuentesA, CoulehanK, ByrdD, et al.Neurocognitive, sociocultural, and psychological factors impacting medication beliefs among HIV-seropositive latinx adults. AIDS Patient Care STDS, 2023; 37(12):616–625; doi: 10.1089/apc.2023.0173
37.
PanagiotoglouD, OldingM, EnnsB, et al.; Localized HIV Modeling Study Group. Building the case for localized approaches to HIV: Structural conditions and health system capacity to address the HIV/AIDS epidemic in six U.S. Cities. AIDS Behav, 2018; 22(9):3071–3082; doi: 10.1007/s10461-018-2166-6
38.
ElenduC, AmaechiDC, ElenduTC, et al.Shaping sustainable paths for HIV/AIDS funding: A review and reminder. Ann Med Surg (Lond), 2025; 87(3):1415–1445; doi: 10.1097/ms9.0000000000002976
JiangH, YinJ, FanY, et al.Gender difference in advanced HIV disease and late presentation according to European consensus definitions. Sci Rep, 2015; 5:14543; doi: 10.1038/srep14543
41.
DevottaK, Woodhall-MelnikJ, PedersenC, et al.Enriching qualitative research by engaging peer interviewers: a case study. Qualitative Research, 2016; 16(6):661–680; doi: 10.1177/1468794115626244
