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Accelerating HIV Care: Lessons from Implementing the Rapid Start Initiative into an HIV Prevention Focused Clinic Program in South Florida
Location: 64
Mentor: Dr. Suzanne Doblecki-Lewis
R. Syed1, G. Foz1, A. Johnson2, S. Butts1, S. Doblecki-Lewis1
1University of Miami, Medicine – Division of Infectious Disease, Miami, United States
2University of Miami, Public Health Sciences, Miami, United States
Background
The Rapid Start (RS) initiative aims to address delays in antiretroviral therapy initiation, which are critical to improving viral suppression and long-term health outcomes in people living with HIV. This study examines how RS was implemented within a sexual health clinic program in South Florida, serving a predominantly underserved population.
Methods
A qualitative, intrinsic case study was conducted across two South Florida clinics, the RAW and Mobile PrEP clinics, from September 2021 to August 2024. Using the Consolidated Framework for Implementation Research (CFIR), we examined organizational and external factors influencing RS implementation. Data were collected through semi-structured interviews with managerial staff (n=2), clinic staff (n=8), and clients (n=16), and analyzed using thematic coding to identify barriers and facilitators.
Results
The client sample (n=16) had a mean age of 38.4 years (SD = 10.3); 37.5% identified as Black or African American, 56.3% as Hispanic/Latinx, and 12.5% as Trans-Feminine. The staff sample (n=10) had a mean age of 36.0 years (SD = 9.07) and, on average, had 2.18 years of experience with the RS initiative. Key themes emerged across the inner and outer settings of the CFIR framework. Organizational facilitators included resource availability and collaborative workflows that supported RS uptake, while barriers such as understaffing, communication gaps, and HIV-related stigma hindered implementation. Clients emphasized the importance of navigators and culturally sensitive care in overcoming soft barriers. Clients and staff believed the mobile clinic and streamlined processes greatly reduced logistical hurdles, which enhanced client engagement.
Conclusions
The RS initiative demonstrates that individualized, context-centered implementation strategies can improve HIV care delivery in underserved settings. Addressing communication gaps, expanding navigator programs, and combating stigma through targeted outreach may be critical to scaling the RS program. A sustained focus on these strategies will be essential for reducing disparities in HIV care and achieving long-term health equity in diverse communities.
