EACS2023: 303 Impact of Rapid ART initiation amongst people newly diagnosed with HIV on retention in care and time to HIV viral load suppression in a diverse London cohort J. Shaw , I. Mallik , M. Anil , R. Dhairyawan , N. Matin , J. Thornhill Barts Health NHS Trust, Infection & Immunity, London, United Kingdom General data Abstract category: Access and delivery of care Abstract body Purpose: Rapid initiation of antiretroviral therapy (ART) is a strategy to improve clinical outcomes for people with HIV (PWH). Data supporting this model of care in high resource settings is lacking. We present comparisons of outcomes of newly diagnosed PWH before and after introducing a new outpatient Rapid ART Pathway, to delineate impact of ART initiation timing on retention in care and time to HIV viral load (VL) suppression. Method: Clinical data was collected using electronic records for all newly diagnosed PWH from February 2018-February 2022. Rapid ART defined as ART initiation within 7 days of confirmed HIV diagnosis. Retention in care was defined as a composite of HIV VL <200/ml and attendance between 1-2 years from initiation of ART. Non-parametric tests were used for comparisons. Time to and Cox regression analysis explored factors associated with time to undetectable VL. Data analysed with SSPS. Results: 215 people were newly diagnosed with HIV in outpatient setting in London, UK: 52 prior to the Rapid ART Pathway (02/2018-02/2019) and 164 after (02/2019-02/2022). Clinical characteristics shown in Table1 and Figure1. Comparing pre and post Rapid ART Pathway, median (IQR) time from diagnosis to ART offer was 18 (8,40) and 7 (2,14) days (p <0.001) respectively, with 25% compared to 61% starting as per rapid ART definition. Reasons for delayed ART initiation in Rapid ART Pathway group included logistical/administrative (44%), clinical OI concerns (20%) and patient disengagement (20%). Median time (IQR) from diagnosis to VL suppression <200 copies/ml was shorter in the Rapid ART Pathway group: 42 (29, 99) compared to 81 (44,120) days (p 0.009). Similar proportion of PWH were retained in care pre- and post-introduction of rapid ART (87% and 84%; P=0.8, respectively). TABLE 1. Overall n (%) or (IQR) Pre- Rapid ART Pathway Group (02/2018-02/2019) n (%) or (IQR) Post – Rapid ART Pathway Group (02/2019 – 02/2022) n (%) or (IQR) P Value Median Age at diagnosis (IQR) 36 (27,48) 40 (29, 51) 34 (27, 47) 0.45 Gender: Male at birth Transfemale 171 (80%) 2 (1%) 41 (80%) 1 (2%) 130 (80%) 1 (0.5%) 0.85 0.40 MSM 116 (54%) 32 (62%) 84 (52%) 0.26 Median Baseline CD4 (IQR) 391 (233,622) 375 (253, 622) 393 (253,622) 0.63 Baseline HIV VL Log (IQR) 4.6 (3.9, 5.3) 4.6 (3.6, 5.1) 4.7 (3.9, 5.4) 0.29 Clade B 76 (35%) 15 (29%) 61 (37%) 0.32 Evidence of Transmitted Drug Resistance 44 (21%) 9 (18%) 35 (22%) 0.56 Evidence of HIV Seroconversion 32 (15%) 4 (8%) 28 (13%) 0.12 HIV-2 8 (4%) 2 (4%) 6 (4%) 1.00 Offered ART 212 (99%) 52 (100%) 160 (98%) 1.00 Accepted ART 203 (94%) 49 (94%) 154 (95%) 1.00 Rapid ART (<7d from confirmed diagnosis) 112 (52%) 13 (25%) 99 (61%) <0.05 Median Time to HIV VL<50 (IQR) 88 (38,165) 105 (54,190) 81 (36,149) 0.58 Median Time to HIV VL<200 (IQR) 48 (31, 102) 81 (44, 120) 42 (29, 99) <0.05 CD4<200 42 (20%) 16 (31%) 26 (16%) <0.05 CD4<350 92 (43%) 23 (44%) 69 (42%) 0.87 Retained in care 182 (85%) 45 (87%) 137 (84%) 0.8 Achieved VL<50 197 (92%) 47 (90%) 150 (92%) 0.77 Achieved VL<200 205 (95%) 51 (98%) 154 (95%) 0.46 TABLE 1. (CONT) Overall n (%) or (IQR) Pre- Rapid ART Pathway Group (02/2018-02/2019) n (%) or (IQR) Post – Rapid ART Pathway Group (02/2019 – 02/2022) n (%) or (IQR) P Value eGFR<60 11 (5%) 3 (6%) 8 (5%) 0.73 ALT X4 Upper limit of Normal 4 (2%) 1 (2%) 3 (2%) 1.00 TB IGRA positive 11 (6%) 2 (6%) 9 (5%) 0.59 HBsAg positive 11 (5%) 1 (2%) 10 (6%) 0.30 Syphilis Serology: RPR ≥ 1:8 17 (8%) 6 (12%) 11 (7%) 0.25 Initiated on 2-drug regimen ART 12 (6%) 1 (0.5%) 11 (7%) 0.3 Initiated Integrase inhibitor as third ART agent 134 (62%) 31 (60%) 103 (63%) 1.0 Initiated Protease inhibitor as third ART agent 57 (27%) 13 (25%) 44 (27%) 1.0 Initiated on 4-drug ART regimen 9 (15%) 68 (15%) 1 (0.5%) <0.05 Conclusions: Rapid ART Pathway led to faster time to ART initiation and VL suppression. However, no improvement in retention in care was observed. General conditions 1. I confirm that I previewed this abstract and that all information is correct. 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