Strategies to Minimize Time From HIV Acquisition to ART Initiation: The Barcelona Early-cART Program

Area of Science:

• Immunology
• Virology
• Public Health

Background:

• Targeted referral systems can accelerate linkage to care and antiretroviral treatment (ART) initiation for individuals at high risk of HIV transmission.
• Early initiation of ART is crucial for reducing onward HIV transmission and improving patient outcomes.

Purpose of the Study:

• To evaluate the effectiveness of the Early-cART program, a targeted referral system for newly diagnosed HIV-positive adults.
• To assess the impact of rapid linkage to care and ART initiation on immunovirological responses and time to treatment.

Main Methods:

• Established the Early-cART cohort (2014-2022) of adults newly diagnosed with HIV, initiating ART within 6 months of estimated acquisition.
• Collected clinical data and biological samples, measuring total HIV-1 DNA in a subset of participants.
• Defined and tracked link-to-care and HIV-to-ART times.

Main Results:

• The program enrolled 340 individuals, primarily men who have sex with men.
• Median link-to-care time decreased from 11 to 3 days, and HIV-to-ART time decreased from 73 to 27 days.
• 48% achieved a CD4/CD8 ratio >1 within two years of ART initiation; HIV-1 DNA levels correlated with early ART initiation.

Conclusions:

• The Early-cART program successfully achieved rapid linkage to care and ART initiation.
• The program demonstrated robust immunovirological responses, indicating its potential to reduce HIV transmission.