DNP Scholarly Projects

Abstract

ABSTRACT

BACKGROUND: Initiation of antiretroviral therapy (ART) within twenty-four hours of an HIV diagnosis is safe, shortens time to viral suppression, improves retention in care, and contributes to reduced HIV transmission at the community level (Bacon et al., 2021). Despite this evidence, patients across the United States do not universally receive timely HIV care (Bertolino et al., 2023). Barriers to early ART initiation include lack of staff buy-in, logistical challenges, and socioeconomic factors affecting patients (Doshi et al., 2023).

LOCAL PROBLEM: A small HIV care clinic in the southern United States observed a similar discrepancy, noting inconsistent timely initiation of ART among its patients. Barriers to early ART initiation were identified as: a lack of collaboration and a need for role clarification across disciplines.

INTERVENTION: This project aimed to strengthen clinical services and promote health equity through the interdisciplinary co-creation of an HIV testing-to-treatment algorithm.

METHODS: A mixed-methods convergent Quality Improvement (QI) design was utilized. Following the co-creation and implementation of the testing-to-treatment algorithm, quantitative data were collected on time-to-treatment for all newly diagnosed HIV-positive patients over a two-month period. Concurrently, anonymous surveys were distributed to staff involved in HIV testing, treatment, and case management. Staff surveys included questions on algorithm design and use.

RESULTS: During the project period, ART was initiated within 30 days of diagnosis in 83% of new HIV-positive cases. Qualitative survey findings demonstrated strong support for standardized protocols to facilitate timely ART initiation, with 100% of staff reporting that such processes improve access to care.

CONCLUSION: Identification of a streamlined and stepwise approach to HIV care can be a collaborative experience, with input from clinicians, case managers, and unlicensed community health workers. A lack of interdisciplinary collaboration remains a key barrier to evidence-based HIV care delivery.

Keywords: Human Immunodeficiency Virus (HIV), antiretroviral therapy (ART), interdisciplinary collaboration, barriers, algorithm, standardized process

References

Bacon, O., Chin, J., Cohen, S. E., Hessol, N. A., Sachdev, D., Coffey, S., Scheer, S., Buchbinder, S., Havlir, D. V., & Hsu, L. (2021). Decreased time from human immunodeficiency virus diagnosis to care, antiretroviral therapy initiation, and virologic suppression during the citywide RAPID initiative in San Francisco. Clinical Infectious Diseases: An Official Publication of The Infectious Diseases Society of America, 73(1), e122–e128. https://doi.org/10.1093/cid/ciaa620

Bertolino, D., Baim-Lance, A., D'Aquila, E., Coren, F., & Abraham, B. (2023). Immediate initiation of antiretroviral treatment: Knowledge, attitudes, and practices among clinic staff in New York City. BMC Health Services Research, 23(1), 1039. https://doi.org/10.1186/s12913-023-09896-5

Doshi, R. K., Hull, S., Broun, A., Boyani, S., Moch, D., Visconti, A. J., Castel, A. D., Baral, S., Colasanti, J., Rodriguez, A. E., Jones, J., Coffey, S., & Monroe, A. K. (2023). Lessons learned from U.S. rapid antiretroviral therapy initiation programs. International Journal of STD & AIDS, 34(13), 945–955. https://doi.org/10.1177/09564624231185622

Streaming Media

Date

12-3-2025

First Advisor

Kaylyn Bourne, DNP

Scholarly Project Team Member

David Phillippi, PhD

Department

Nursing, School of

College

Health Sciences & Nursing, Gordon E. Inman College of

Document Type

Scholarly Project

Degree

Doctorate of Nursing Practice (DNP)

Degree Level

Doctoral

Degree Grantor

Belmont University

Keywords

Human Immunodeficiency Virus (HIV); antiretroviral therapy (ART); interdisciplinary collaboration; barriers; algorithm; standardized process

Additional Files
DNP Poster CGH TRUE FINAL.pdf (590 kB)
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