Rapid Antiretroviral Therapy (ART) Protocol

The OC Health Care Agency (HCA) is seeking applications from licenses hospital emergency departments to develop practical and sustainable protocols to initiate Rapid Antiretroviral Therapy (ART) for people newly diagnosed with HIV or re-engaging in care.

Rapid Antiretroviral Therapy (Rapid ART) Protocol Development is intended to support the development of practical, evidence-based protocols that improve linkage to care for individuals newly diagnosed with HIV and people living with HIV (PLWH) who are re-engaging in care. This RFA solicits protocol development and implementation planning, not direct clinical service delivery.

The goal of this opportunity is to increase and streamline linkage to HIV care in emergency settings by developing a feasible workflow and protocols for providing ART within seven (7) days of diagnosis, disclosure, or re-engagement. Selected applicants will collaborate with the HCA to design patient-centered procedures that can be integrated into existing clinical operations, reduce delays to treatment, and improve patient outcomes.

As of 2024, there were 6,955 PLWH in Orange County who are aware of their HIV status and an estimated 1,706 individuals who remain unaware of their infection. In 2024, 230 individuals in Orange County were newly diagnosed with HIV, and 56 (24%) were concurrently diagnosed with AIDS, indicating prolonged undiagnosed infection prior to testing. Among all PLWH aware of their status, 72.1% achieved viral suppression which is crucial for maintaining health and preventing the transmission of HIV. Additionally, 78.2% received HIV care, and 57.0% were retained in care. For additional local surveillance data, please visit: OChealthinfo.com. OC Health Care Agency | Orange County California - Health Care Agency

Rapid ART is the immediate initiation of HIV therapy at the time of diagnosis or immediately upon reengaging in care for PLWH. Early treatment improves health outcomes and reduces HIV transmission. While best practice is to initiate ART within 72 hours, for the purposes of this RFA, “Rapid ART” is defined as initiating ART within seven (7) calendar days of an HIV diagnosis or disclosure of results.

Protocols developed for this RFA shall include:

• Required staff training topics to support Rapid ART implementation.
• Roles and responsibilities of all staff involved.
• Partnerships with HIV care providers to ensure seamless transition to long-term treatment.
• How access to affordable medications will be ensured, regardless of insurance status.
• A workflow/diagram showing steps from positive test to medication start.
• Anticipated barriers and strategies to address them, including referral pathway.
• How newly diagnosed patients will be identified, engaged, and linked to care immediately.
• How patients who have fallen out of care will be identified and reengaged.
• Key topics to cover with patients during Rapid ART initiation (e.g., adherence, side effects, benefits) .

Protocol development will include that patients should receive counseling on the importance of daily medication adherence, potential side effects, the benefits of ART and that follow-up appointments should be scheduled within 1-2 weeks to reassess psychosocial needs, address challenges, and provide support services.

Awardees are expected to create evidence-based, streamlined, and practical protocols that integrate Rapid ART into existing emergency department setting workflows, minimize handoffs, and treat initiation of ART as a standard component of care.