Immediate Initiation of HIV Treatment
Immediate initiation of antiretroviral therapy by people newly diagnosed with HIV improves patient health and reduces onward transmission. The recommended standard of HIV care in New York is to initiate antiretroviral therapy on the day of diagnosis or first clinic visit.
Offer immediate antiretroviral therapy to:
- Patients newly diagnosed with HIV based on either a lab test or a point-of-care HIV test
- Patients previously diagnosed with HIV who never received antiretroviral therapy or previously took HIV treatment medicines but never experienced treatment failure
Do not provide immediate antiretroviral therapy to:
- Patients for whom immediate antiretroviral therapy might be medically dangerous, including those with clinical signs or symptoms of cryptococcal meningitis, tubercular meningitis or cytomegalovirus retinitis
- Patients who are likely to have multiple mutations to antiretroviral medicines from prior irregular use of HIV medicines
New HIV cases must be reported to the Health Department. For more information on reporting and eliciting contacts, visit Reporting a Diagnosis of HIV or AIDS.
Guidelines
Benefits of Immediate HIV Treatment
A range of randomized clinical trials found that initiating antiretroviral therapy on the day of HIV diagnosis increases the proportion of patients who were virally suppressed and remained engaged in care after 12 months. Immediate treatment allows patients to engage in HIV care without delay and can empower them to disclose their status to partners, friends and family.
Barriers to Care
On the day of antiretroviral therapy initiation, assess patients for issues that can affect continuity in HIV care, including housing status, social and psychological stability, mental health and substance use.
Encourage patients to contact the clinic right away if they struggle to take HIV medicines every day or if they want to stop treatment. New York City HIV Care Coordination programs provide support to patients who struggle to take their HIV medicines or stay in care and who are eligible for Ryan White Part A services and receive care in participating clinics.
Coverage of Care
HIV treatment is available to all New Yorkers. Assess patients for insurance coverage and connect them to any needed financial support for immediate antiretroviral therapy.
For uninsured and underinsured patients:
- The New York State Uninsured Care Programs provide access to free health care and medicines to New Yorkers with HIV. An expedited application (PDF) process allows same-day enrollment into the AIDS Drug Assistance Program (ADAP) and ADAP-Plus, which cover services and medicines provided by ADAP-enrolled clinicians and pharmacies up to 30 days prior to enrollment.
- The New York State RapidTx program supports clinics that regularly diagnose HIV to provide a one-month supply of medicines to uninsured or underinsured patients on the day of diagnosis. Check with your administrator to see if your clinic is part of RapidTx.
- Patients with lower incomes can also apply for Medicaid or a New York State of Health Essential Plan.
For insured patients:
- Patients enrolled in fee-for-service or managed care Medicaid can access immediate antiretroviral therapy.
- Patients with commercial health insurance should receive coverage for HIV treatment but may also benefit from pharmacy coupons or drug manufacturers’ patient assistance programs that help cover the costs of medicines.
Drug manufacturer support for patients:
- Patient assistance programs and pharmacy coupons can help cover the costs of medicines.