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Rapid Start Protocol

  • 1.  Rapid Start Protocol

    Posted 07-28-2021 09:20
      |   view attached
    Hello,

    I'm working on an immediate antiretroviral treatment (iART) simplified protocol and was hoping to get some feedback on the attached document. Hoping this two page flowsheet can serve as a clinical tool. Any feedback would be appreciated.

    Thank you,

    George Froehle PA-C, AAHIVS
    geofroehle@gmail.com

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    George Froehle
    Peter Shalit MD & Associates
    Minneapolis MN
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  • 2.  RE: Rapid Start Protocol

    Posted 07-28-2021 15:49
    Hello George,

    That was comprehensive. I believe you covered everything. I also developed a Rapid Stat at my place of work. It really helps with treatment and workflow. One more thing, educating staffs and members of your clinic is the key to a successful implementation of rapid or immediate ART. 

    Best of luck!



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    Lucy Efobi
    Linden NJ
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  • 3.  RE: Rapid Start Protocol

    Posted 08-06-2021 09:45
    Excellent protocol; our confirmatory is done as soon as possible before starting iART. I did start someone who came with a confirmatory positive from a Health department in a neighboring state, so I started him on ART. I went ahead and did another confirmatory with a Genosure etc. He was negative on our confirmatory. We are an Urban Medical Center and we see many HIV patient's in our department. So then it came down to who will pay for this first month of ART (before samples)? He did not have insurance. I treated it as PEP due to unprotected sex and his fear of acquiring HIV. But it is challenging.

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    Temme Martin
    Truman Medical Center, Sr. Nurse Practitioner-Infectious Disease, AAHIVS
    Temme.martin99@gmail or Temme.martin@tmcmed.org
    816-298-3306-c
    Kansas City, Missouri
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  • 4.  RE: Rapid Start Protocol

    Posted 07-29-2021 10:42
    Hi George,
    Great tool, may I use it in our practice.  Two questions:  how can I add Dovato to the medication choice​; do you always do 2 Hiv rapid tests before rapid starting.

    thanks so much,
    Gwen

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    Gwen Verlinghieri
    AIDS Care Group
    Swarthmore PA
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  • 5.  RE: Rapid Start Protocol

    Posted 07-29-2021 11:10
    Hi Gwen,

    It is currently recommended to not use Dovato. This is because it should only be used in those with a viral load less than 500,000 and we don't typically have this back when we start iART. However, if you do have that back and it's below 500,000, then you could provide it. 

    We typically do require 2 positive rapids - this was the protocol for the Discover Trial (looking at Truvada vs Descovy for PrEP0 when someone tested positive on a rapid. 

    You can certainly use it.

    Thank you,

    George

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    George Froehle
    CentraCare
    Minneapolis MN
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  • 6.  RE: Rapid Start Protocol

    Posted 07-29-2021 10:42
    interesting protocol - you might want to look at the protocol used in San Fran though I am assuming it is similar to yours.  Have you implemented it yet?  We have tried rapid ART but have not been that successful due to some of the following: emotional reaction of pt and needing to absorb info; lack of enough case management staff; some loss to f/up after the first visits.  I am interesting in your choice of ARVs - no thoughts re: dovato - I dont use it much as well.  Finally what is your timeline to be considered immediate art?

    Best - Sara

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    Sara Back
    North Central Bronx Hospital
    New York NY
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  • 7.  RE: Rapid Start Protocol

    Posted 08-01-2021 13:16
    According to the STAT data and the Dovato package labeling, I think its an excellent choice for Rapid Start.   You can always make and adjustment with no harm to the patient if need to which will be unlikely.

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    Ronald Johnson
    GMHC/Duane Reade
    Brooklyn NY
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  • 8.  RE: Rapid Start Protocol

    Posted 08-02-2021 11:18
    Just a statement that Dovato is not to be used as initial treatment if viral load is >500,000. Given we won't have that back, I feel a bit more comfortable with Biktarvy, but definitely provider preference.

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    George Froehle
    CentraCare
    Minneapolis MN
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  • 9.  RE: Rapid Start Protocol

    Posted 08-02-2021 10:53
    Hi George, thanks for sharing this!  This is a helpful guide.  I have a question related to starting before the results of a confirmation test such as a reflex HIV 1/2 differentiation test return - is the rec here to do the quick start b/c it's rare that the differentiation test comes back neg and you find a false positive?

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    Aliza Norwood
    Austin TX
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