Background: Very high rates of patient attrition from HIV care between HIV testing and ART initiation have been documented in sub-Saharan Africa. Accelerating the steps required for ART initiation has been proposed as a way to reduce attrition and achieve earlier treatment initiation. Methods: The RapIT randomized controlled trial evaluated the effect of immediate ART initiation on ART uptake in two public sector clinics in South Africa. Adult, non-pregnant patients receiving a positive HIV test or first CD4 count were randomized to standard or immediate (rapid) initiation. On the day of HIV test or first CD4 count, patients in the rapid arm received a point-of-care CD4 count if needed; those ART eligible then received a rapid TB test if symptomatic, rapid blood tests, physical exam, accelerated education and counseling, and ARV dispensing. Rapid procedures were conducted by nurses and counselors comparable to clinic staff. Patients in the control arm followed standard clinic procedures (3-4 clinic visits over 2-4 weeks prior to ARV dispensing). Here we report ART uptake and early retention 6 months follow-up and documented viral load, 91% and 77% were virally suppressed in the rapid and standard arms respectively. Conclusions: Immediate ART initiation reduces loss of patients between treatment eligibility and treatment initiation significantly and is feasible and acceptable in a public health clinic setting. It should be considered for adoption in high-volume clinics in the public sector in Africa. (Table Presented).
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