How Same-Day Start Therapy is Changing Lives
A groundbreaking approach to HIV care is transforming diagnosis from a waiting game into a day of empowerment.
Imagine receiving a life-changing HIV diagnosis and leaving your healthcare provider's office the same day with a treatment plan already in action. This revolutionary approach to HIV care, known as Rapid Start Antiretroviral Therapy (RSA), is transforming outcomes for people newly diagnosed with HIV.
Unlike conventional models that often involved weeks or months of waiting before starting treatment, RSA initiates medication as soon as possible after diagnosis—sometimes the same day—before all baseline test results even return. Recent research reveals how this paradigm shift, particularly with modern medication regimens, is dramatically accelerating viral suppression while improving patient experiences.
For decades, the standard approach to initiating HIV treatment followed a cautious, protracted timeline. After an initial positive test, patients would typically endure a series of follow-up appointments, extensive baseline laboratory testing, resistance genotyping, and counseling sessions before receiving their first prescription. This process often stretched over several weeks or even months.
The consequences of this delay were significant. Research has shown that the longer the gap between diagnosis and treatment initiation, the higher the risk of patients being lost to follow-up. Additionally, during this untreated period, individuals unknowingly continued to potentially transmit the virus to others, and their own immune systems faced ongoing damage from the progressing infection.
The INSIGHT START study in 2015 fundamentally changed our understanding of HIV treatment timing by demonstrating clear benefits of initiating antiretroviral therapy early in the course of HIV infection, even in patients with relatively preserved immune function. This evidence paved the way for more aggressive treatment approaches that prioritize speed without compromising safety 1 .
The RoCHaCHa study (Real World Community-Based HIV Rapid Start Antiretroviral with B/F/TAF versus prior models of antiretroviral therapy start) represents a landmark investigation into the practical implementation of RSA. Conducted at Trillium Health, a community health center in Rochester, NY, this pilot study compared outcomes between patients receiving RSA and historical controls who underwent conventional treatment initiation 1 2 .
The researchers employed a straightforward yet powerful approach:
The RSA process at Trillium Health featured a multidisciplinary approach including providers, care managers, pharmacists, and testing specialists who collaborated to create a seamless experience for patients. The clinic's in-house pharmacy enabled same-day medication pickup, while care managers conducted comprehensive needs assessments to identify and address potential barriers to adherence 2 .
The findings from the RoCHaCHa study demonstrated dramatic advantages for the rapid start approach:
| Viral Load Threshold | Rapid Start Achievement | Significance |
|---|---|---|
| < 200 copies/mL | 100% of participants | Meets standard for "untransmittable" status (U=U) |
| < 50 copies/mL | 95.6% of participants | Typical clinical standard for virologic suppression |
The stunning reduction in time to viral suppression—from nearly six months to just over one month—represents a paradigm shift in HIV management. Perhaps equally noteworthy was the finding that 100% of study participants accepted treatment at their first visit when offered through the RSA model 1 2 .
Qualitative feedback from participants revealed high acceptance and positive responses to the rapid start model. Patients reported appreciating the immediate sense of control over their health and the reduced anxiety that came from taking concrete action against the virus on the very day of diagnosis 1 2 .
The success of rapid start programs depends heavily on the choice of antiretroviral regimen. The single-tablet combination of bictegravir, emtricitabine, and tenofovir alafenamide (B/F/TAF)—marketed as Biktarvy®—possesses several attributes that make it particularly suitable for same-day initiation:
Unlike some regimens, B/F/TAF can be started without waiting for resistance genotype results
The medication is generally well-tolerated with low discontinuation rates due to side effects
Simpler adherence with just one pill per day
Eliminates the waiting period for genetic testing required by some other regimens
Provides appropriate coverage for patients with HIV-HBV coinfection, even before HBV test results return
International research has corroborated the effectiveness of this approach. A study conducted in China comparing B/F/TAF with an older regimen (TDF + 3TC + EFV) in men who have sex with men newly diagnosed with HIV found significantly higher viral suppression rates with B/F/TAF (95.9% vs. 79.2% at 48 weeks) and better side effect profiles 5 .
| Component | Function | Implementation Example |
|---|---|---|
| B/F/TAF Single-Tablet Regimen | Complete antiretroviral treatment in one daily pill | Biktarvy® combines bictegravir (integrase inhibitor), emtricitabine (NRTI), and tenofovir alafenamide (NRTI) |
| Point-of-Care HIV Testing | Rapid preliminary diagnosis | Fourth-generation Determineâ„¢ HIV-1/2 Ag/Ab Combo immunoassay |
| Viral Load Quantification | Monitoring treatment response | COBAS 8800 system (Roche Diagnostics) |
| Multidisciplinary Care Team | Address medical and psychosocial needs | Providers, care managers, pharmacists, and testing specialists collaborating |
| In-House Pharmacy Services | Ensure immediate medication access | Same-day prescription fulfillment with mailing/delivery options |
The benefits of rapid start antiretroviral therapy extend far beyond the individual patient. From a public health perspective, rapidly achieving an undetectable viral load has profound implications for HIV transmission at the community level.
The landmark U=U (Undetectable=Untransmittable) concept, firmly established by extensive scientific evidence, confirms that people with HIV who maintain an undetectable viral load cannot sexually transmit the virus to others. By shortening the time to viral suppression from months to weeks, rapid start programs potentially prevent new HIV infections.
An economic analysis conducted in Spain projected that implementing rapid ART initiation with B/F/TAF could prevent 992 new HIV infections over 20 years, resulting in approximately €323 million in savings for the healthcare system and society. Similar benefits would likely apply to other settings, making rapid start not just a clinical improvement but a smart economic investment 6 .
The evidence supporting rapid start antiretroviral therapy continues to accumulate across multiple studies and settings. The RoCHaCHa study contributes real-world validation of this approach in a community health center, demonstrating that the benefits observed in controlled trials can translate to everyday clinical practice.
As we look toward the goal of ending the HIV epidemic, rapid start protocols represent one of our most promising tools. By transforming the diagnosis experience from one of anxiety and uncertainty to one of immediate empowerment and action, we not only improve individual outcomes but move closer to interrupting the chain of transmission in our communities.
The success of these programs hinges on overcoming systemic barriers—ensuring access to appropriate medications, training healthcare teams in rapid start protocols, addressing social determinants of health that might impact adherence, and fighting the stigma that still discourages some from seeking testing and treatment.
When it comes to HIV treatment, starting quickly is starting smart. The era of waiting weeks or months to begin life-saving therapy should be firmly in our past.