As a resident advisor at Tulane University, a former student frequently talked with his peers about the importance of getting tested frequently for sexually transmitted infections.
He went to Essence Fest last July with a group of friends and saw that a free testing site had been set up. Already used to getting tested, he decided, why not?
Perhaps it was because of his experience working as an RA and being familiar with the true ramifications of a life with HIV, that he was able to accept his HIV-positive test results calmly.
“Everyone else was freaking out. I thought, ‘Well this is inconvenient,'” said the young man, who is now 23. He asked not to be named in this article because his family does not know about his HIV status.
The day he got tested, the Tulane graduate was given medicine that could counteract the virus – and within a week, he said the virus was undetectable.
“I caught it early,” he said.
The treatment of HIV has dramatically changed and health workers, including in New Orleans, are pushing to expand access to testing sites as medication becomes more accessible and easier to take. HIV specialists say that the quicker a patient is consistently taking anti-retrovirals, the quicker they will be able to lower their viral load to the point where HIV is undetectable in their blood stream.
The Mid-City health center CrescentCare partnered with the New Orleans Office of Health Policy on an initiative to start treating newly diagnosed patients with those retroviral drugs within 72 hours of testing positive for HIV. So far, 131 patients diagnosed with HIV have been placed on rapid treatment as part of that initiative, called Rapid Start, since it launched in December 2016.
Putting HIV patients on a consistent treatment plan, early in their diagnosis, so that the virus is suppressed and unable to spread is an essential part of the fight against the HIV epidemic. Louisiana was second in the country in 2016 for the highest number of AIDS cases and third for new HIV cases, according to the Centers for Disease Control and Prevention.
“There is data that shows if your viral load is undectable you can’t transmit the virus,” said Dr. Jason Halperin an infectious disease specialist with CrescentCare. “That’s why we are trying to get patients on treatment the day of (diagnosis).”
The time between testing and treatment for newly diagnosed HIV patients has typically been 90 days to allow time for necessary lab work. But in New Orleans, where the rate of new HIV cases has consistently kept the city in the top five in the country for several years, 90 days is precious time.
The Rapid Start initiative was based on studies that have been conducted in places like San Francisco, Haiti, and South Africa that showed that immediate treatment with antiretroviral therapy leads to quicker suppression of the virus, retention in care and a decrease in the death rate, according to a study published by Halperin and his team of researchers at CrescentCare.
“It’s harder to keep people in care when there is a longer gap in treatment,” said Halperin.
Louisiana ranked No. 2 in chlamydia, gonorrhea, syphilis rates
Louisiana ranked No. 2 in chlamydia, gonorrhea, syphilis rates
The state is also ranked No. 2 for HIV diagnoses.
Patients in the Rapid Start program get set up with same-day appointments. The initial visits are streamlined so that the patient can quickly get their medication. Rapid Start covers the cost of medication for the first 30 days, while the clinic evaluates other insurance options.
Patients also get connected quickly to an HIV specialist for ongoing management, and get follow-up appointments within four weeks.
“We don’t want to lose patients, retention is very important,” Halperin said.
As of noon on March 14, the clinic has 131 patients on the Rapid Start initiative. Ten other patients had left the clinic since they got connected to Rapid Start in December 2016.
“The vast majority we have confirmed are in care in another state or local clinic,” said Halperin. “92.3 percent of our patients provided care through the initiative remain at CrescentCare.”
The STD/HIV Program for the state’s health department is battling HIV rates in Louisiana with a combination of prevention and treatment tactics. This includes marketing and making preventative medication called PrEP (pre exposure prophylactics) more available to high-risk candidates. Those include men who have sex with men; transgender women; intravenous drug users; people who engage in risky sexual behavior, such as having sex with multiple partners in a span of six months; or are with a partner who is HIV positive and not being treated effectively.
Additionally, they are looking at working with clinics to try to establish more places that provide testing and rapid treatment, according to DeAnn Gruber, the director of the program.
In Baton Rouge, the Open Health Clinic is offering same-day referrals to a medical appointment but has not yet implemented same-day treatment, according to Gruber.
In New Orleans, Dr. Sue Ellen Abdalian, a specialist in adolescent medicine, also offers test and treat for newly diagnosed HIV patients. She works out of several locations, including the Drop-In Center at Covenant House, the infectious disease clinic at University Medical Center and Tulane’s T-Cell Clinic.
Abdalian is currently conducting a study that will focus on 750 HIV-negative high-risk MSM (men who have sex with men) and transgender women between the ages of 14 and 24. The study will offer free sexually transmitted infection screenings every four months. The participants will be assigned to groups receiving a combination of support either through a peer support group, a life coach or through text messages offering health tips. In New Orleans, this age group accounted for 32 percent of all new HIV diagnoses in 2015, according to the state health department.
“We are hoping that none of them become HIV-positive,” she said. If they do, a key part of the study will be implementing rapid treatment after diagnosis.
Teens also have much more immune resiliency and she believes the study will show that, through test and treatment, patients will be likelier to remain in treatment and have suppressed viral loads to where they won’t be able to infect another person.
“We don’t want them walking out without medication in their hands if not in their mouths,” she said.