Rapid antiretroviral therapy (ART) initiation improves clinical outcomes and reduces HIV transmission, but disparities in timely treatment remain. This study assessed the status and determinants of rapid ART initiation among newly diagnosed HIV/AIDS patients in Chongqing, China, from 2021 to 2025. This retrospective cohort study included 34,271 newly diagnosed HIV/AIDS patients aged ≥ 18 years from the National Integrated AIDS Prevention and Control Information System. Rapid ART initiation was defined as treatment within 7 days of diagnosis. Descriptive analyses, chi-square tests, Cochran-Armitage trend tests, and multivariate logistic regression were performed to identify factors associated with rapid initiation. Overall, 40.3% of patients initiated ART within 7 days. Median time from diagnosis to treatment decreased from 13 days (IQR: 6–30) in 2021 to 7 days (IQR: 2–14) in 2025, while rapid initiation rates increased significantly over time ( P < 0.001). Patients diagnosed in 2024–2025, females, married or divorced/widowed individuals, those with higher education, homosexual transmission, and BIC/FTC/TAF regimens were more likely to initiate ART rapidly. Lower likelihoods were observed among non-local residents, individuals infected through injection drug use or other routes, patients identified through medical institutions, and those without baseline CD4 testing. Rapid ART initiation in Chongqing improved substantially between 2021 and 2025, although disparities persisted across subgroups. Strengthening integrated testing-diagnosis-treatment services, cross-regional care coordination, health education, and simplified ART regimens may further improve timely treatment uptake and HIV care outcomes. Not applicable.
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