Implementation of an Immediate HIV Treatment Initiation Program in a Public/Academic Medical Center in the U.S. South: The Miami Test and Treat Rapid Response Program

  • Allan E. RodriguezEmail author
  • Andrew J. Wawrzyniak
  • Hansel E. Tookes
  • Marcia G. Vidal
  • Manasi Soni
  • Rita Nwanyanwu
  • David Goldberg
  • Rachel Freeman
  • Kira Villamizar
  • Maria L. Alcaide
  • Michael A. Kolber
Original Paper


Test and Rapid Response Treatment (TRRT) linkage programs have demonstrated improved HIV suppression rates. This paper describes the design and implementation of the Miami TRRT initiative and its clinical impact. Assisted by a dedicated care navigator, patients receiving a reactive HIV rapid test at the Florida Department of Health STD Clinic were offered same-day HIV care at the University of Miami/Jackson Memorial Medical Center Adult HIV Outpatient Clinic. Patient retention and labs were tracked for 12 months. Of the 2337 individuals tested, 46 had a reactive HIV test; 41 (89%) consented to participate. For the 36 patients in continued care for a year, 33 (91.7%) achieved virological suppression (< 200 copies/mL) within 70 days of their reactive HIV rapid test; at 12 months, 35 (97.2%) remained suppressed, and mean CD4 T cell counts increased from 452 ± 266 to 597 ± 322 cells/mm3. The Miami TRRT initiative demonstrated that immediate linkage to care is feasible and improves retention and suppression in a public/academic medical center in the U.S. South.


Linkage Retention Rapid treatment Suppression 


Los programas de Respuesta Rápida con Vinculación y Tratamiento a pruebas positivas (TRRT, Por sus siglas en inglés) han demostrado mejorar las tasas de supresión del VIH. Este artículo describe el diseño y la implementación de la iniciativa del programa TRRT y su impacto clínico. Con la ayuda de un navegador de pacientes, aquellos quienes recibieron un resultado reactivo por medio de una prueba rápida del VIH en la Clínica de Enfermedades de Transmisión Sexual del Departamento de Salud de la Florida, se les fue ofrecido cuidado médico para el VIH ese mismo día en la Clínica Ambulatoria para Adultos con VIH del Centro Médico de la Universidad de Miami/Jackson Memorial. La retención al cuidado médico y los laboratorios fueron monitoreados durante 12 meses. De los 2337 individuos a quienes se les realizó la prueba del VIH en un año, 46 obtuvieron una prueba de VIH reactiva; 41 (89%) accedieron a participar en el programa. Treinta y seis pacientes permanecieron en atención continua durante un año, 33 (91.7%) lograron la supresión de la carga viral (< 200 copias/ml) en un plazo de 70 días de su prueba rápida reactiva de VIH; a los 12 meses, 35 (97.2%) permanecieron suprimidos, y el recuento medio de células T CD4 aumentó de 452 ± 266 a 597 ± 322 células/mm3. La iniciativa de Respuesta Rápida a pruebas positivas de Miami demostró que la vinculación inmediata al cuidado médico es factible y mejora la retención y supresión viral en un centro médico público/académico en el sur de los EE. UU.



Activities were conducted with the support of the University of Miami Miller School of Medicine Center for AIDS Research, funded by an NIH Grant, P30AI073961. Additionally, this project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under Grant #H97HA27433, Special Projects of National Significance, (Total Awarded: $1,199,153, 0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

Compliance with Ethical Standards

Conflict of interest

None of the authors have any conflict of interest or financial relationships to disclose.


  1. 1.
    Nakagawa F, Lodwick RK, Smith CJ, et al. Projected life expectancy of people with HIV according to timing of diagnosis. AIDS. 2012;26(3):335–43.CrossRefGoogle Scholar
  2. 2.
    Walker BD, Hirsch MS. Antiretroviral therapy in early HIV infection. N Engl J Med. 2013;368(3):279–81.CrossRefGoogle Scholar
  3. 3.
    Farnham PG, Gopalappa C, Sansom SL, et al. Updates of lifetime costs of care and quality-of-life estimates for HIV-infected persons in the United States: late versus early diagnosis and entry into care. J Acquir Immune Defic Syndr. 2013;64(2):183–9.CrossRefGoogle Scholar
  4. 4.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.CrossRefGoogle Scholar
  5. 5.
    Dieffenbach CW, Fauci AS. Universal voluntary testing and treatment for prevention of HIV transmission. JAMA. 2009;301(22):2380–2.CrossRefGoogle Scholar
  6. 6.
    Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373(9657):48–57.CrossRefGoogle Scholar
  7. 7.
    Colasanti J, Sumitani J, Mehta CC, et al. Implementation of a rapid entry program decreases time to viral suppression among vulnerable persons living with HIV in the Southern United States. Open Forum Infect Dis. 2018;5(6):ofy104.Google Scholar
  8. 8.
    Halperin J, Butler I, Conner K, et al. Linkage and antiretroviral therapy within 72 hours at a federally qualified health center in New Orleans. AIDS Patient Care STDS. 2018;32(2):39–41.CrossRefGoogle Scholar
  9. 9.
    Pilcher CD, Ospina-Norvell C, Dasgupta A, et al. The effect of same-day observed initiation of antiretroviral therapy on HIV viral load and treatment outcomes in a US public health setting. J Acquir Immune Defic Syndr. 2017;74(1):44–51.CrossRefGoogle Scholar
  10. 10.
    Hoenigl M, Chaillon A, Moore DJ, et al. Rapid HIV viral load suppression in those initiating antiretroviral therapy at first visit after HIV diagnosis. Sci Rep. 2016;6:32947.CrossRefGoogle Scholar
  11. 11.
    Group ISS, Lundgren JD, Babiker AG, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795–807.CrossRefGoogle Scholar
  12. 12.
    Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375(9):830–9.CrossRefGoogle Scholar
  13. 13.
    Castel AD, Kuo I, Mikre M, et al. Feasibility of using HIV care-continuum outcomes to identify geographic areas for targeted HIV testing. J Acquir Immune Defic Syndr. 2017;74(Suppl 2):S96–103.CrossRefGoogle Scholar
  14. 14.
    Dailey AF, Hoots BE, Hall HI, et al. Vital signs: human immunodeficiency virus testing and diagnosis delays—United States. MMWR Morb Mortal Wkly Rep. 2017;66(47):1300–6.CrossRefGoogle Scholar
  15. 15.
    Koenig SP, Dorvil N, Devieux JG, et al. Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: a randomized unblinded trial. PLoS Med. 2017;14(7):e1002357.CrossRefGoogle Scholar
  16. 16.
    McNairy ML, Gachuhi AB, Lamb MR, et al. The Link4Health study to evaluate the effectiveness of a combination intervention strategy for linkage to and retention in HIV care in Swaziland: protocol for a cluster randomized trial. Implement Sci. 2015;10:101.CrossRefGoogle Scholar
  17. 17.
    Rosen S, Maskew M, Fox MP, et al. Initiating antiretroviral therapy for HIV at a patient’s first clinic visit: the RapIT randomized controlled trial. PLoS Med. 2016;13(5):e1002015.CrossRefGoogle Scholar
  18. 18.
    Reif S, Pence BW, Hall I, Hu X, Whetten K, Wilson E. HIV diagnoses, prevalence and outcomes in nine Southern states. J Community Health. 2015;40(4):642–51.CrossRefGoogle Scholar
  19. 19.
    Reif S, Safley D, McAllaster C, Wilson E, Whetten K. State of HIV in the US deep South. J Community Health. 2017;42(5):844–53.CrossRefGoogle Scholar
  20. 20.
    Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV epidemic: a plan for the United States. JAMA. 2019;321(9):844–5.CrossRefGoogle Scholar
  21. 21.
    Darlington CK, Hutson SP. Understanding HIV-related stigma among women in the Southern United States: a literature review. AIDS Behav. 2017;21(1):12–26.CrossRefGoogle Scholar
  22. 22.
    Kerr JC, Valois RF, Diclemente RJ, et al. HIV-related stigma among African–American youth in the Northeast and Southeast US. AIDS Behav. 2014;18(6):1063–7.CrossRefGoogle Scholar
  23. 23.
    Lopes BLW, Eron JJ Jr, Mugavero MJ, Miller WC, Napravnik S. HIV care initiation delay among rural residents in the Southeastern United States, 1996 to 2012. J Acquir Immune Defic Syndr. 2017;76(2):171–6.CrossRefGoogle Scholar
  24. 24.
    Schafer KR, Albrecht H, Dillingham R, et al. The continuum of HIV care in rural communities in the United States and Canada: what is known and future research directions. J Acquir Immune Defic Syndr. 2017;75(1):35–44.CrossRefGoogle Scholar
  25. 25.
    U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau. Improving Health Outcomes: Moving Patients Along the HIV Care Continuum and Beyond. Rockville, Maryland: U.S. Department of Health and Human Services; 2017. Accessed 20 June 2019.
  26. 26.
    Emory University, Rollins School of Public Health. AIDSVu. Available at: Accessed 22 June 2019.
  27. 27.
    Florida Department of Health in Miami-Dade County. 2017 HIV/AIDS Surveillance. Accessed 1 May 2019.
  28. 28.
    Halperin J, Katz M, Pathmanathan I, et al. Early HIV diagnosis leads to significantly decreased costs in the first 2 years of HIV care in an urban charity hospital in New Orleans. J Int Assoc Provid AIDS Care. 2017;16(6):527–30.CrossRefGoogle Scholar
  29. 29.
    Gardner LI, Giordano TP, Marks G, et al. Enhanced personal contact with HIV patients improves retention in primary care: a randomized trial in 6 US HIV clinics. Clin Infect Dis. 2014;59(5):725–34.CrossRefGoogle Scholar
  30. 30.
    Gardner LI, Metsch LR, Anderson-Mahoney P, et al. Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS. 2005;19(4):423–31.CrossRefGoogle Scholar
  31. 31.
    Irvine MK, Chamberlin SA, Robbins RS, et al. Improvements in HIV care engagement and viral load suppression following enrollment in a comprehensive HIV care coordination program. Clin Infect Dis. 2015;60(2):298–310.CrossRefGoogle Scholar
  32. 32.
    Liau A, Crepaz N, Lyles CM, et al. Interventions to promote linkage to and utilization of HIV medical care among HIV-diagnosed persons: a qualitative systematic review, 1996–2011. AIDS Behav. 2013;17(6):1941–62.CrossRefGoogle Scholar
  33. 33.
    Mizuno Y, Higa DH, Leighton CA, Roland KB, Deluca JB, Koenig LJ. Is HIV patient navigation associated with HIV care continuum outcomes? A systematic review. AIDS. 2018;32(17):2557–71.Google Scholar
  34. 34.
    Torian LV, Wiewel EW. Continuity of HIV-related medical care, New York City, 2005–2009: do patients who initiate care stay in care? AIDS Patient Care STDS. 2011;25(2):79–88.CrossRefGoogle Scholar
  35. 35.
    Mugavero MJ, Lin HY, Allison JJ, et al. Failure to establish HIV care: characterizing the “no show” phenomenon. Clin Infect Dis. 2007;45(1):127–30.CrossRefGoogle Scholar
  36. 36.
    Tedaldi EM, Richardson JT, Debes R, et al. Retention in care within 1 year of initial HIV care visit in a multisite US cohort: who’s in and who’s out? J Int Assoc Provid AIDS Care. 2014;13(3):232–41.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Allan E. Rodriguez
    • 1
    Email author
  • Andrew J. Wawrzyniak
    • 2
  • Hansel E. Tookes
    • 1
  • Marcia G. Vidal
    • 1
  • Manasi Soni
    • 1
  • Rita Nwanyanwu
    • 3
  • David Goldberg
    • 4
  • Rachel Freeman
    • 3
  • Kira Villamizar
    • 4
  • Maria L. Alcaide
    • 1
  • Michael A. Kolber
    • 1
  1. 1.Division of Infectious Diseases, Department of MedicineUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of Psychiatry and Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiUSA
  3. 3.Jackson Memorial Medical CenterMiamiUSA
  4. 4.Florida Department of Health in Miami-Dade CountyMiamiUSA

Personalised recommendations