The San Francisco Rapid ART initiative, which aims to quickly start people with HIV on antiretroviral (ARV) treatment following their diagnosis, has shown considerable progress in narrowing the time between an HIV diagnosis and the achievement of an undetectable viral load.

The plan, launched citywide in 2015, defines rapid initiation as having a first medical appointment within five days of being diagnosed with HIV and starting ARV treatment the same day as that appointment. The ultimate goal of the initiative is to get HIV-positive people to start treatment the same day as their diagnosis.

Researchers analyzed data on 1,354 people newly diagnosed with HIV in the Bay Area city between 2013 and 2017. Eighty-nine percent were men, and the majority were people of color.

During the study period, the median time between an HIV diagnosis and the first visit to a clinician for medical care for the virus declined by 44%, from nine days in 2013 to five days in 2017. The median time between that first medical visit and the initiation of ARV treatment declined by 96%, from 28 days to just one day. By 2017, 28% of those newly diagnosed with HIV started treatment rapidly.

The median time between an HIV diagnosis and the first undetectable viral load test result declined by 48%, from 145 days to 76 days.

“[ARV treatment] at diagnosis can and should be offered to everyone newly diagnosed with HIV,” says the study’s lead author, Oliver Bacon, MD, MPH, of the San Francisco Department of Public Health. “Not doing so perpetuates widening inequity in outcomes.”