RAPID and PHAST Programs

The Positive Health Access to Services and Treatment (PHAST) team is a rapid response team that has championed HIV testing and linkage to care across the ZSFG campus since 2002.

Our mission is to meet the goals of the US National AIDS Strategy and CDC HIV Testing Guidelines by:

• Identifying undiagnosed HIV infection in all patients who have contact with the SFDPH system
• Providing rapid linkage to care for individuals who are newly diagnosed or have barriers to engagement in care
• Initiating antiretroviral therapy (ART) as soon as possible (same day as diagnosis, if possible) in all patients who are accepting of treatment
• Supporting vulnerable patients by providing nursing care coordination and psychosocial stabilization throughout the linkage to care process

RAPID (Rapid ART Program Initiative for HIV Diagnoses) is a clinical program that provides immediate ART to all HIV-infected patients to benefit their health. The ZSFGH RAPID program was established at ZSFGH in 2013 and now is a component of the city-wide RAPID initiative launched in 2015 as part of the San Francisco Getting to Zero consortium. Read more about Ward 86's RAPID clinical procedures.

The RAPID team consists of a registered nurse, nurse practitioner and social work associate. This team supports over 500 patients at risk for poor linkage to care. Patients are primarily persons of color with high rates of homelessness, mental illness and active substance use. The average age of participants in RAPID is 39 and 11% are under the age of 25. At entry into the RAPID program, 21% of patients are taking ART. Within one year of participation in RAPID, 71% of patients are taking ART and a majority of participants have undetectable HIV viral load. The lost.to.follow.up rate for RAPID patients is <10%.

Key components of the RAPID model include:

• Interdisciplinary skill set that includes nursing, social work, and bridging to primary care
• A single team that tracks patients from initial HIV diagnosis through successful linkage to care
• Rapid response to new HIV diagnoses that assists clinicians with disclosure of positive results and supports patients with counseling, education, partner services and self.disclosure to family and friends
• Initiation of ART on the same day of diagnosis when possible (the “RAPID program”)
• Expedited clinic intake (within 1.4 days from initial diagnosis and first medical appointment within 10 days) with a focus on identifying barriers to successful linkage to care
• Initial medical stabilization and careful matching to a primary care provider
• Psycho-social stabilization: benefits, housing, mental health, addiction referrals
• Intensive HIV education and orientation and mentoring on navigating the health care system
• Appointment tracking: reminders and follow up on missed appointments