Resum

Background : In Argentina, HIV diagnosis is confirmed through RNA-HIV (VL), usually performed in specialized referral laboratories. People need a second appointment to receive HIV confirmation (HIV-C), which is required to initiate antiretroviral therapy (ART). Time to HIV-C depends on laboratory and administrative factors. Shortening the diagnostic process is the first step towards implementing test and treat strategies. We hypothesized that point-of-care (POC) technologies would reduce the time to results, the proportion of undelivered results, and the time to ART initiation compared with standard of care (SOC) in a middle-income country setting. Methods : We conducted a pilot study at 2 HIV testing centers in Buenos Aires: an NGO and a public hospital. People with a preliminary HIV diagnosis (HIV-PD) after a reactive HIV rapid test were enrolled. Phase 1 mimics SOC: blood samples for VL were sent to the laboratory for RT-PCR and HIV-C delivered in a second appointment. In phase2, POC, VL were locally processed with m-PIMA™ HIV-1/2 VL and HIV-C delivered subsequently. We evaluated time from HIV-PD to HIV-C and ART initiation as a continuous variable with Wilcoxon sum rank test. Categorical variables were tested with Chi-squared test or Fisher’s exact test. Linear regression models were fitted with an interaction term between center and strategy to evaluate whether the effect on time to HIV-C or ART initiation differs for each strategy between centers. Results : Between May 2023 and July 2024, 44 people with HIV-PD were enrolled in SOC and 47 in POC: median age 30 years (IQR: 26-36), 84% cisgender men, 9% transgender women, and 7% cisgender women. One person did not receive HIV-C in SOC vs none in POC. Median time to HIV-C was 16 days (14-23) in SOC vs 4 hours (3-34) in POC (p<0.001) (Fig. 1). ART was initiated in 80% (64-90) in SOC vs. 87% (74-95) in POC (p=0.5). ART initiation within the first 30 days was 66% (48-80) in SOC vs 85% (70-94) in POC (p=0.045). The interaction between strategy and center was not significant (p=0.0681) suggesting that time differences between SOC and POC do not differ between centers. Conclusions :In this pilot study, POC implementation was feasible and adequate to reduce time to HIV-C and ART initiation. However, site-specific practices should be considered when implementing POC technologies in clinical settings. Healthcare systems need to adapt to facilitate the rapid ART initiation strategy. This study was supported by Abbott Rapid Diagnostics Argentina S.A.