# Immediate Fast-Track versus Standard Care for Persons Living with HIV in Haiti: A Randomized Pilot Study

> **NIH NIH R34** · BRIGHAM AND WOMEN'S HOSPITAL · 2020 · $117,745

## Abstract

Project Abstract
In order to effectively implement universal antiretroviral therapy (ART) for all people living with HIV, new
models of care with greater efficiencies in service delivery are needed. A differentiated care framework is
being widely recommended, with services tailored to patient needs. However, current models of differentiated
care provide expedited services for patients after they have demonstrated several months of timely visits with
high adherence. This strategy does not reduce time in clinic during the first few months of care, when most
attrition occurs. The principles of behavioral economics suggest that immediate fast-track care will provide
superior outcomes, if it is conditional on timely visits. According to the behavioral economics framework,
people's choices are affected by systematic and predictable biases. One of these biases is the tendency to
perceive losses (loss of fast-track care) as more significant than equivalent gains (the possibility of gaining
fast-track care with timely visit attendance). Another is the tendency to exhibit present-biased time preferences,
which make it less likely that patients with minimal HIV symptoms will prioritize activities to obtain ART. These
biases will be exacerbated in the presence of scarcity of resources. In the proposed R34 grant, we will develop
and test a strategy of immediate fast-track care. The study population will include adult patients with WHO
Stage 1 or 2 disease. Participants will be randomized to immediate fast-track or standard (deferred fast-track)
care. All participants will receive same-day HIV testing and ART initiation prior to study enrollment. The
intervention group will receive immediate fast-track care, which is conditional upon timely visits, and after 24
weeks in care, an undetectable viral load (HIV-1 RNA <200 copies/ml). The standard group will be eligible to
start fast-track care at 24 weeks, if they have an undetectable viral load. Participants in either group who are
>5 days late for any fast-track visit will lose fast-track care for that visit; those in either group with detectable
viremia on their 24-week viral load test will be evaluated by a physician, with frequent follow-up visits until they
have an undetectable viral load. Three specific aims are proposed. The first aim is to conduct formative
research including focus groups with patients and providers to further refine our understanding of facilitators
and barriers to retention and ART adherence with fast-track care. The second aim is to develop and test
manuals, measures, and procedures for immediate and standard care. The third aim is to conduct a
randomized pilot trial of immediate fast-track vs. standard care to assess the feasibility and preliminary
effectiveness of immediate fast-track care. Assessments will include viral load testing, self-reported measures
of psychosocial correlates of adherence and retention in care as well as perceived value of fast-track care,
consideration of fu...

## Key facts

- **NIH application ID:** 9840519
- **Project number:** 5R34MH114739-03
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** SERENA Patricia KOENIG
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $117,745
- **Award type:** 5
- **Project period:** 2018-01-01 → 2020-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9840519

## Citation

> US National Institutes of Health, RePORTER application 9840519, Immediate Fast-Track versus Standard Care for Persons Living with HIV in Haiti: A Randomized Pilot Study (5R34MH114739-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9840519. Licensed CC0.

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