{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T03:25:44Z","timestamp":1787109944889,"version":"build-2736575974"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","award":["Health Resources and Services Administration"],"award-info":[{"award-number":["Health Resources and Services Administration"]}],"id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["AIDS Behav"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Antiretroviral treatment (ART) initiation within days of HIV diagnosis, also known as \u201cRapid Start\u201d, improves linkage to care, virologic suppression and retention in care. However, data on the costs of Rapid Start implementation in the United States are limited. We aimed to estimate the costs and cost-effectiveness of Rapid Start among seven geographically diverse Ryan White-funded programs with broad variability in populations served and services offered. Each site estimated the costs of ART initiation services, management, and Rapid Start planning activities in three 12-month periods: pre-, initial, and sustained implementation. We estimated quality-adjusted life years (QALY) saved, incremental costs per-person and incremental cost per QALY saved during implementation. We considered an intervention cost-effective if it cost &lt;$76,399 USD per QALY saved (US per capita GDP, 2021). The number of persons initiating ART increased at most sites during implementation, which, together with assumed shorter times to viral suppression contributed to QALYs saved. Pre-implementation, the per-person cost of ART initiation and Rapid Start planning ranged from $549-$30,626, which declined at most sites during implementation. Incremental costs per-person ranged from a cost savings of -$21,284 up to $23,850 additional costs during the initial year and from $24,303 savings up to $11,774 additional costs during sustained implementation. The cost-effectiveness threshold was met by five sites during initial implementation and by all seven during sustained implementation. In conclusion, we demonstrated that Rapid Start was cost effective across a wide range of clinical settings, further bolstering this model\u2019s importance in ending the HIV epidemic.<\/jats:p>","DOI":"10.1007\/s10461-026-05069-7","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T02:37:28Z","timestamp":1777343848000},"page":"2442-2451","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost Considerations for Rapid Start Implementation: Analysis from Seven Rapid Start Provider Sites"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3773-5831","authenticated-orcid":false,"given":"Pamela M.","family":"Murnane","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Starley B.","family":"Shade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Damle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Donohoe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn","family":"Middleton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Friedman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Jimenez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendall","family":"Brooks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Senter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"issue":"9","key":"5069_CR1","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1056\/NEJMoa1506816","volume":"373","author":"The INSIGHT START Study Group","year":"2015","unstructured":"The INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795\u2013807. https:\/\/doi.org\/10.1056\/NEJMoa1506816.","journal-title":"N Engl J Med"},{"issue":"9","key":"5069_CR2","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1056\/NEJMoa1507198","volume":"373","author":"The TEMPRANO ANRS 12136 Study Group","year":"2015","unstructured":"The TEMPRANO ANRS 12136 Study Group. A trial of early antiretrovirals and Isoniazid preventive therapy in Africa. N Engl J Med. 2015;373(9):808\u201322. https:\/\/doi.org\/10.1056\/NEJMoa1507198.","journal-title":"N Engl J Med"},{"issue":"4","key":"5069_CR3","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/S1473-3099(13)70692-3","volume":"14","author":"B Grinsztejn","year":"2014","unstructured":"Grinsztejn B, Hosseinipour MC, Ribaudo HJ, et al. Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial. Lancet Infect Dis. 2014;14(4):281\u201390. https:\/\/doi.org\/10.1016\/S1473-3099(13)70692-3.","journal-title":"Lancet Infect Dis"},{"issue":"6","key":"5069_CR4","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1056\/NEJMoa1105243","volume":"365","author":"MS Cohen","year":"2011","unstructured":"Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493\u2013505. https:\/\/doi.org\/10.1056\/NEJMoa1105243.","journal-title":"N Engl J Med"},{"key":"5069_CR5","unstructured":"World Health Organization. Guideline on When to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV. World Health Organization. 2015. Accessed September 30, 2024. https:\/\/iris.who.int\/handle\/10665\/186275"},{"key":"5069_CR6","unstructured":"Panel on Antiretroviral Guidelines for Adults and Adolescents, Department of Health and Human Services. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Accessed December 3. 2025. https:\/\/clinicalinfo.hiv.gov\/en\/guidelines\/hiv-clinical-guidelines-adult-and-adolescent-arv\/whats-new"},{"key":"5069_CR7","unstructured":"CDC. Ending the HIV Epidemic in the US Goals. Ending the HIV Epidemic in the US (EHE). September 22, 2025. Accessed January 5. 2026. https:\/\/www.cdc.gov\/ehe\/php\/about\/goals.html"},{"issue":"1","key":"5069_CR8","doi-asserted-by":"publisher","first-page":"e122","DOI":"10.1093\/cid\/ciaa620","volume":"73","author":"O Bacon","year":"2021","unstructured":"Bacon O, Chin J, Cohen SE, et al. Decreased time from human immunodeficiency virus diagnosis to care, antiretroviral therapy initiation, and virologic suppression during the citywide RAPID initiative in San Francisco. Clin Infect Dis. 2021;73(1):e122\u20138. https:\/\/doi.org\/10.1093\/cid\/ciaa620.","journal-title":"Clin Infect Dis"},{"issue":"7","key":"5069_CR9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001056","volume":"8","author":"S Rosen","year":"2011","unstructured":"Rosen S, Fox MP. Retention in HIV care between testing and treatment in sub-Saharan Africa: a systematic review. PLoS Med. 2011;8(7):e1001056. https:\/\/doi.org\/10.1371\/journal.pmed.1001056.","journal-title":"PLoS Med"},{"issue":"6","key":"5069_CR10","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofy104","volume":"5","author":"J Colasanti","year":"2018","unstructured":"Colasanti J, Sumitani J, Mehta CC, et al. Implementation of a rapid entry program decreases time to viral suppression among vulnerable persons living with HIV in the Southern United States. Open Forum Infect Dis. 2018;5(6):ofy104. https:\/\/doi.org\/10.1093\/ofid\/ofy104.","journal-title":"Open Forum Infect Dis"},{"issue":"1","key":"5069_CR11","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-90043-7","volume":"11","author":"N Bogdani\u0107","year":"2021","unstructured":"Bogdani\u0107 N, Bendig L, Lukas D, Zekan \u0160, Begovac J. Timeliness of antiretroviral therapy initiation in the era before universal treatment. Sci Rep. 2021;11(1):10508. https:\/\/doi.org\/10.1038\/s41598-021-90043-7.","journal-title":"Sci Rep"},{"issue":"5","key":"5069_CR12","doi-asserted-by":"publisher","DOI":"10.1007\/s11908-021-00750-5","volume":"23","author":"SM Michienzi","year":"2021","unstructured":"Michienzi SM, Barrios M, Badowski ME. Evidence regarding rapid initiation of antiretroviral therapy in patients living with HIV. Curr Infect Dis Rep. 2021;23(5):7. https:\/\/doi.org\/10.1007\/s11908-021-00750-5.","journal-title":"Curr Infect Dis Rep"},{"issue":"7","key":"5069_CR13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002357","volume":"14","author":"SP Koenig","year":"2017","unstructured":"Koenig SP, Dorvil N, D\u00e9vieux JG, et al. Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: a randomized unblinded trial. PLoS Med. 2017;14(7):e1002357. https:\/\/doi.org\/10.1371\/journal.pmed.1002357.","journal-title":"PLoS Med"},{"issue":"5","key":"5069_CR14","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1097\/QAD.0000000000002124","volume":"33","author":"S Coffey","year":"2019","unstructured":"Coffey S, Bacchetti P, Sachdev D, et al. RAPID antiretroviral therapy: high virologic suppression rates with immediate antiretroviral therapy initiation in a vulnerable urban clinic population. AIDS. 2019;33(5):825\u201332. https:\/\/doi.org\/10.1097\/QAD.0000000000002124.","journal-title":"AIDS"},{"issue":"11","key":"5069_CR15","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1097\/QAD.0000000000001528","volume":"31","author":"LC Long","year":"2017","unstructured":"Long LC, Maskew M, Brennan AT, et al. Initiating antiretroviral therapy for HIV at a patient\u2019s first clinic visit: a cost-effectiveness analysis of the rapid initiation of treatment randomized controlled trial. AIDS. 2017;31(11):1611\u20139. https:\/\/doi.org\/10.1097\/QAD.0000000000001528.","journal-title":"AIDS"},{"issue":"8","key":"5069_CR16","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1097\/CM9.0000000000002659","volume":"136","author":"Y Guan","year":"2023","unstructured":"Guan Y, Tang Q, Zhu H, et al. Cost-effectiveness evaluation of rapid initiation of antiretroviral therapy based on decision-tree Markov model. Chin Med J (Engl). 2023;136(8):986\u20138. https:\/\/doi.org\/10.1097\/CM9.0000000000002659.","journal-title":"Chin Med J (Engl)"},{"issue":"2","key":"5069_CR17","doi-asserted-by":"publisher","first-page":"117","DOI":"10.18553\/jmcp.2019.19174","volume":"26","author":"C Benson","year":"2020","unstructured":"Benson C, Emond B, Romdhani H, et al. Long-term benefits of rapid antiretroviral therapy initiation in reducing medical and overall health care costs among Medicaid-covered patients with Human Immunodeficiency Virus. Journal of Managed Care & Specialty Pharmacy. 2020;26(2):117\u201328. https:\/\/doi.org\/10.18553\/jmcp.2019.19174.","journal-title":"Journal of Managed Care & Specialty Pharmacy"},{"key":"5069_CR18","unstructured":"Cicatelli Associates Inc. Compendium of Best Practices in Provision of Rapid Start Services for People with HIV: For Ryan White HIV\/AIDS Program Funded Providers. 2023. Accessed December 3, 2025. https:\/\/targethiv.org\/sites\/default\/files\/media\/documents\/2023-03\/Rapid-DAP_Best_Practices_for_Rapid_ART.pdf"},{"issue":"7","key":"5069_CR19","first-page":"1022","volume":"54","author":"P Graham","year":"2008","unstructured":"Graham P, Evitts T, Thomas-MacLean R. Environmental scans: how useful are they for primary care research? Can Fam Physician. 2008;54(7):1022\u20133.","journal-title":"Can Fam Physician"},{"issue":"1","key":"5069_CR20","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1093\/cid\/ciad530","volume":"78","author":"L Cuzin","year":"2024","unstructured":"Cuzin L, Morisot A, Allavena C, Lert F, Pugliese P. Drastic reduction in time to controlled viral load in people with Human Immunodeficiency Virus in France, 2009\u20132019: a longitudinal cohort study. Clin Infect Dis. 2024;78(1):111\u20137.","journal-title":"Clin Infect Dis"},{"issue":"7","key":"5069_CR21","doi-asserted-by":"publisher","first-page":"e470","DOI":"10.1016\/S2352-3018(24)00118-8","volume":"11","author":"AG de Garc\u00eda-Ruiz","year":"2024","unstructured":"de Garc\u00eda-Ruiz AG, Vivancos MJ, de Lagarde M, et al. Transition times across the HIV care continuum in Spain from 2005 to 2022: a longitudinal cohort study. Lancet HIV. 2024;11(7):e470\u20138. https:\/\/doi.org\/10.1016\/S2352-3018(24)00118-8.","journal-title":"Lancet HIV"},{"issue":"6","key":"5069_CR22","doi-asserted-by":"publisher","first-page":"1653","DOI":"10.1007\/s11136-021-02771-y","volume":"30","author":"A Ahmed","year":"2021","unstructured":"Ahmed A, Saqlain M, Bashir N, et al. Health-related quality of life and its predictors among adults living with HIV\/AIDS and receiving antiretroviral therapy in Pakistan. Qual Life Res. 2021;30(6):1653\u201364. https:\/\/doi.org\/10.1007\/s11136-021-02771-y.","journal-title":"Qual Life Res"},{"issue":"12","key":"5069_CR23","doi-asserted-by":"publisher","first-page":"925","DOI":"10.2471\/BLT.15.164418","volume":"94","author":"MY Bertram","year":"2016","unstructured":"Bertram MY, Lauer JA, De Joncheere K, et al. Cost\u2013effectiveness thresholds: pros and cons. Bull World Health Organ. 2016;94(12):925\u201330. https:\/\/doi.org\/10.2471\/BLT.15.164418.","journal-title":"Bull World Health Organ"},{"issue":"2","key":"5069_CR24","doi-asserted-by":"publisher","first-page":"e276","DOI":"10.1016\/S2214-109X(19)30534-0","volume":"8","author":"K Dovel","year":"2020","unstructured":"Dovel K, Shaba F, Offorjebe OA, et al. Effect of facility-based HIV self-testing on uptake of testing among outpatients in Malawi: a cluster-randomised trial. Lancet Glob Health. 2020;8(2):e276\u201387. https:\/\/doi.org\/10.1016\/S2214-109X(19)30534-0.","journal-title":"Lancet Glob Health"},{"issue":"4","key":"5069_CR25","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1097\/GRF.0000000000000070","volume":"57","author":"C Mcnicholas","year":"2014","unstructured":"Mcnicholas C, Madden T, Secura G, Peipert JF. The contraceptive CHOICE project round up: what we did and what we learned. Clin Obstet Gynecol. 2014;57(4):635\u201343. https:\/\/doi.org\/10.1097\/GRF.0000000000000070.","journal-title":"Clin Obstet Gynecol"},{"issue":"8","key":"5069_CR26","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1097\/CM9.0000000000002648","volume":"136","author":"G Jin","year":"2023","unstructured":"Jin G, Ma H, Shen H, Hu Z. Cost-effectiveness evaluation of rapid initiation of antiretroviral therapy based on decision-tree Markov model. Chin Med J. 2023;136(8):883\u20135. https:\/\/doi.org\/10.1097\/CM9.0000000000002648.","journal-title":"Chin Med J"}],"container-title":["AIDS and Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10461-026-05069-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10461-026-05069-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10461-026-05069-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T02:39:41Z","timestamp":1787107181000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10461-026-05069-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":26,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["5069"],"URL":"https:\/\/doi.org\/10.1007\/s10461-026-05069-7","relation":{},"ISSN":["1090-7165","1573-3254"],"issn-type":[{"value":"1090-7165","type":"print"},{"value":"1573-3254","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]},"assertion":[{"value":"4 February 2026","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 April 2026","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors have none to declare.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}