Immediate treatment of acute HIV in a tertiary healthcare center: bridging gaps in communication using smartphones

Objectives Early initiation of antiretroviral therapy (ART) during acute HIV infection is associated with favourable clinical and epidemiological outcomes. Barriers to prompt treatment initiation limit the benefits of universal access to ART in Mexico. We sought to create an algorithm for the immedi...

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Bibliographic Details
Published in:HIV medicine 2019-05, Vol.20 (5), p.308-316
Main Authors: Perez‐Patrigeon, S, Camiro‐Zúñiga, A, Jaramillo‐Jante, MR, Belaunzarán‐Zamudio, PF, Crabtree‐Ramírez, B, Soto‐Ramírez, LE, Calva, JJ, Hernández‐León, C, Mosqueda‐Gómez, JL, Navarro‐Alvarez, S, Sierra‐Madero, JG
Format: Article
Language:English
Subjects:
acute HIV infection
Adult
Algorithms
Anti-HIV Agents - administration & dosage
Anti-HIV Agents - therapeutic use
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Cellular telephones
Chronic infection
Cohort Studies
Epidemiology
Female
Health care
HIV
HIV Infections - drug therapy
Human immunodeficiency virus
Humans
Infections
Male
Mexico
Middle Aged
Patients
Physician-Patient Relations
Rank tests
Smartphone
Smartphones
Survival Analysis
Tertiary Care Centers
tertiary health care
Time-to-Treatment
Treatment Outcome
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Summary:Objectives Early initiation of antiretroviral therapy (ART) during acute HIV infection is associated with favourable clinical and epidemiological outcomes. Barriers to prompt treatment initiation limit the benefits of universal access to ART in Mexico. We sought to create an algorithm for the immediate detection and treatment of patients with acute HIV infection. Methods A nationwide cohort of patients with acute HIV infection was created in 2015. In order to identify cases and treat them promptly at our centre, an interdisciplinary group coordinated through an instant‐messaging tool using smart phones was established. When a probable case was detected, a discussion was initiated to confirm the diagnosis and facilitate the administrative processes to initiate ART as soon as possible. We compared time to ART initiation with that in a comparison group of patients with chronic HIV infection enrolled during the same period (May 2015 to February 2017) through routine care, using survival analysis estimators and log‐rank tests. Results We recruited 29 patients with acute HIV infection. The median time to ART initiation was 2 days in these patients, in contrast to 21 days for patients with chronic infection. There were no significant differences in the percentages of patients engaged in care, on treatment or virologically suppressed at 1 year of follow‐up. Conclusions Implementing immediate ART initiation programmes is feasible in Mexico, in spite of the substantial administrative barriers that exist in the country. More extensive replication of this model in other centres and in patients with chronic infection is warranted to evaluate its effect on the continuum of care.
ISSN:1464-2662
1468-1293
DOI:10.1111/hiv.12713