HIV Screening, Diagnosis, and Rapid Antiretroviral Therapy Start

In the United States, there are approximately 1.2 million people aged 13 and older living with HIV and an estimated 34,800 new HIV infections every year. Addiction medicine specialists play a central role in taking care of people who are at higher risk for HIV infections because substance use disorders are associated with HIV acquisition through both injection use and sexual exposures. Additionally, people living with HIV have higher rates of substance use disorder than people without HIV. In 2019, people who inject drugs (PWID) accounted for 7% of new HIV infections in the United States. Furthermore, about 13% of people with HIV in the United States are not aware of their HIV status. It is important for addiction medicine specialists to understand potential barriers to screening testing, the window period of HIV testing, and factors contributing to false-negative/positive HIV tests. During our lecture, we will teach screening strategies through cases to help providers appropriately conduct screening tests and interpret testing results in the practical setting. Initiating antiretroviral therapy (ART) in a timely manner improves patient outcomes. A World Health Organization released guidelines to support rapid initiation of ART. A 2019 Cochrane database systematic review showed that rapid initiation of ART can result in greater viral suppression (RR 1.18, 95% CI 1.10-1.27), better ART uptake (RR 1.09, 95% CI 1.06-1.12), and better retention in care at 12 months (RR 1.22, 95% CI 1.11-1.35). Access to HIV providers varies in the clinical setting, and the access to care can become challenges for patients, primary care physicians, and addiction medicine providers due to the shortage of HIV workforce. Our lecture offers a list of helpful resources which would guide participants how to initiate ART when diagnosing patients with HIV. We present our lecture through a case-based session with didactic interspersed with clinical cases and polling questions to the audience. Our lecture focuses on HIV screening, diagnosis, and rapid start of ART. Lecture contents will be based on up to date guidelines from the CDC and Department of Health and Human Services, with expert advice from our focus group members, two of which are certified HIV specialists. We will focus on patient care and medical knowledge necessary for addiction medicine providers with minimal or no experience on HIV care. During the lecture, we will introduce a variety of helpful resources for HIV care for participants to access after this session. At the completion of this session, participants should be able to 1) apply HIV screening tests into clinical practice 2) interpret HIV diagnostic test results 3) identify resources for starting ART immediately after the diagnosis of HIV.