Evaluating gaps and improving immediate linkage and ART initiation in the Bay Area
San Francisco and Alameda counties carry the largest burden of HIV in the Bay Area and are 2 of the 48 counties with the highest number of new HIV diagnoses in the US. Rapid initiation of HIV treatment is a key pillar ("Treat") of the Ending the Epidemic initiative and one of the central strategies of Getting to Zero efforts in the Bay Area. While both San Francisco and Alameda counties have launched programs to support rapid linkage and treatment in some clinics, efforts to implement RAPID in the Bay Area have been siloed, with little collaboration between counties. With a high level of migration throughout the region, tracking HIV patients across testing and care settings has been challenging, leading to delays in linkage and care initiation. This CFAR supplement will focus on developing a regional approach to improving rapid linkage and HIV treatment initiation in the Bay Area. This planning grant will build on our team's work through the Bay Area HIV Regional Working Group, a cross-county collaboration to develop a regional approach to addressing HIV disparities in the Bay Area. We will first identify gaps in monitoring and implementing rapid linkage and treatment initiation in people newly diagnosed with HIV across the 2 jurisdictions. This work will include developing a common set of RAPID metrics which can be used to track RAPID outcomes across counties. We will then conduct stakeholder engagement with local providers, navigators, and administrators to elicit barriers and facilitators to successful implementation of RAPID using the Consolidated Framework for Implementation Research. Building on these aims, we will identify innovative, region-wide RAPID implementation strategies which can be tested in a future implementation science study in the Bay Area. This model of a regional approach to RAPID implementation can be disseminated more broadly to other high burden regions throughout the US with the goal of ending the HIV epidemic by 2030.