Implementation of rapid processes for initiation of antiretroviral therapies (ART) and same-day pre-exposure prophylaxis (PrEP): Identification of barriers, facilitators, and implementation strategies from seven Ending the HIV Epidemic priority jurisdictions

Two evidence-based strategies to address the U.S. HIV epidemic are rapid initiation of antiretroviral therapy (rapid ART) for HIV treatment (generally within 7 days of diagnosis) and same-day pre-exposure prophylaxis (PrEP) for HIV prevention (generally on the same day as a non-reactive HIV test). While researchers are increasingly identifying implementation determinants of rapid ART, in particular, further research is needed to understand the landscape of implementation, as well as to identify key barriers and facilitators to the implementation of rapid HIV service processes, regardless of intervention, to inform implementation strategy selection and development. Key informant interviews were conducted with 13 individuals with high-level knowledge of the jurisdictional context vis-a-vis the implementation of rapid HIV service processes in seven Ending the HIV Epidemic jurisdictions between April 2023 and September 2024. Key informants included leaders within jurisdictions’ HIV/AIDS program or their equivalent. Rapid qualitative analysis was used to provide timely results and inform future data collection. Interview notetakers produced analytic memos, which were then transported into a cross-case analytic matrix to identify deductive themes across interviews. Across jurisdictions, large, well-resourced clinics and systems were implementing rapid processes to varying extents. However, little was known regarding implementation outside these well-funded clinics and systems due to a lack of data collection and monitoring across jurisdictions. Key determinants of the implementation of rapid included financing, available resources, interconnections within and across clinics, the legislative environment, leadership engagement, and supportive infrastructure. Existing implementation strategies included medication starter packs, implementation champions, learning collaboratives, and patient navigators. This study identified key Outer Setting determinants of rapid processes and existing implementation strategies with the potential for scaling up and out. This multisite study enabled comparison across jurisdictions, illuminating the role of regional and policy context.