November 27, 2018

CONTACT: Johan Marulanda /


WASHINGTON (Nov. 27, 2018) – An architect of the first National HIV/AIDS Strategy for the U.S. says it is time for some bold and major shifts in the delivery of HIV care that could make a dramatic impact on the epidemic.

The recommendation comes ahead of World AIDS Day (December 1) and is supported by two policy briefs, titled State and Local ‘End the Epidemic’ Plans Can Drive HIV Progress and Leveraging the Ryan White HIV/AIDS Program to Make Rapid Start of HIV Therapy Standard Practice, issued today by the O’Neill Institute for National and Global Health Law at Georgetown Law.

“People diagnosed with HIV should start antiretroviral therapy (ART) immediately,” advocates Jeffrey S. Crowley, Distinguished Scholar and Director of Infectious Disease Initiatives at the O’Neill Institute. “Research increasingly shows that by initiating treatment at the same time as receiving a diagnosis—perhaps allowing the person to take the first pill with their health care provider present for support, and given a starter pack of medication—they achieve viral suppression faster.”

He adds, “Many clinicians who were initially skeptical of this approach appear to quickly embrace it once they see the transformative impact on just one or two patients.”

Crowley, a former director of the White House Office of National AIDS Policy in the Obama Administration, acknowledges the challenges in making this a routine part of treating HIV.

“Without a doubt, this will be a tough goal to achieve, but one with a high return on investment,” says Crowley. “We know our health system isn’t set up for this ‘rapid start’ approach, so to drive this vision forward we need to put in place tailored approaches at the state and community level. We believe the Ryan White HIV/AIDS Program, the federal program that provides support for uninsured and underinsured people with HIV, can do even more to highlight this issue and address barriers to ‘rapid start’ and also show Medicaid, Medicare, and private insurers how to get it done.”

Making the Case

Addressing this issue and encouraging more states and local jurisdictions to develop plans to “End the HIV Epidemic” in their communities are outlined in two reports written by Crowley and Sean Bland, a Senior Associate at the O’Neill Institute.

Big Ideas: Leveraging the Ryan White HIV/AIDS Program to Make Rapid Start of HIV Therapy Standard Practice

The report offers recommendations for the HIV/AIDS Bureau (a part of the Health Resources & Services Administration) that administers the Ryan White Program in three key areas to support the adoption of rapid start: providing critical leadership by prioritizing rapid start, expediting eligibility for the AIDS Drug Assistance Program (which provides affordable access to antiretroviral therapy or ART) and offering immediate starter courses of medication, and supporting practice transformation to facilitate clinics offering rapid start.

Big Ideas: State and Local ‘End the Epidemic’ Plans Can Drive HIV Progress

This brief encourages states and local jurisdictions to develop ‘End the Epidemic’ plans, by highlighting innovative features of leading state and local efforts.  This report spotlights four elements of effective HIV plans: partnerships between governments and communities, strategic responses with a small number of clear objectives, metrics to push states and communities to achieve tough goals and be held accountable for results, and innovation to keep improving on the tools available to better support people living with HIV and to prevent new HIV infections.

Additional recommendations include ensuring access to PrEP (Pre-exposure Prophylaxis) and PEP (Post-exposure Prophylaxis), along with new efforts to promote rapid start of treatment and improve retention and re-engagement in HIV care.

“Last week’s announcement by the US Preventive Services Task Force recommending that all at risk of HIV receive PrEP, bolsters a common thrust of many of these plans to expand access to PrEP to communities who could benefit from it,” says Sean Bland.

The reports were developed with financial support from Gilead Sciences. Crowley and Bland report no potential financial conflict of interests related to the reports.

The O’Neill Institute for National and Global Health Law at Georgetown University is the premier center for health law, scholarship, and policy.  Celebrating its 10th year in 2017, its mission is to contribute to a more powerful and deeper understanding of the multiple ways in which law can be used to improve the public’s health, using objective evidence as a measure.  The O’Neill Institute seeks to advance scholarship, science, research, and teaching that will encourage key decision-makers in the public, private, and civil society to employ the law as a positive tool for enabling more people in the United States and throughout the world to lead healthier lives.