Discussion
PWH, POC HIV VL, HIV infection, acute HIV infection, EHE, HIV infections
HIV INFECTIONS, HIV INFECTION, ACUTE HIV INFECTION
This clinical trial may demonstrate that HIV testing algorithms using a POC HIV VL screening test has the potential to facilitate same-day initiation of ART or PrEP and improve the diagnosis of acute HIV infection, which may be missed using existing HIV testing algorithms. Detection of acute HIV infection is especially important, since persons with acute HIV infection often have high viral loads which are associated with high transmission risk. Accurately diagnosing HIV infections with POC HIV VL screening tests could facilitate counseling and LTC while the patient is still in the clinical encounter. Having accurate real-time information on the HIV VL in PWH may also impact key treatment decisions, particularly in acute and episodic care settings. Further, having real-time results has the potential to reduce delays in ART initiation and reduce loss to follow up. Finally, assessment of HIV status among those at risk for HIV infection using a POC HIV VL test could also expedite referral for care and initiation of PrEP.Same-day ART recommendation has the potential to improve patient health outcomes. In a prior Haitian study, 347 participants were enrolled in the same-day ART group and 356 participants were enrolled in standard ART group. The results of the study showed that the probability of remaining in care 12 months post enrollment for participants in the same-day ART group was higher (risk ratio 1.21) than for those in the standard ART group (p = 0.015) [In high-income settings like the US, more evidence supporting same day ART initiation is needed. The Panel on Antiretroviral Guidelines for Adults and Adolescents [Same-day PrEP initiation may encourage engagement in care, reduce loss to follow-up, and reduce linkage barriers by eliminating the need for multiple visits to a healthcare facility. A barrier to same-day PrEP initiation is the possibility of prescribing PrEP for individuals with undiagnosed, acute HIV infection based on the results of rapid tests with imperfect sensitivity. This may lead to antiretroviral resistance. To minimize this risk, and to provide reassurance to patients and providers, sensitive HIV VL tests can be used to provide a definitive HIV test result before prescribing PrEP [EHPOC study sites, located in a high HIV burden area and an EHE jurisdiction, serve historically socio-economically disadvantaged populations and are ideal locations to serve the Baltimore City community members, including individuals who have no insurance or are underinsured, and marginalized populations that often do not have equity of access to research.