This web page provides sample materials and guidelines for Oregon’s Federally Qualified Health Center (FQHC) employees and is provided for educational and informational purposes only. The content shared here does not constitute providing medical advice. Those seeking professional or clinical advice should consult with our clinical faculty.
Immediate antiretroviral therapy (ART) or “Rapid Start” is a change in the standard of care decreasing the amount of time from diagnosis to initiation of treatment. Rapid start is shown to improve linkage to care, initiation of ART, and viral load suppression for persons with HIV (PWH). Rapid start refers to “starting HIV treatment as soon as possible after the diagnosis of HIV infection, preferably on the first clinic visit (and even on the same day the HIV diagnosis is made).”
The purpose of this page is to provide resources to help providers, administrators and support staff at Federally Qualified Healthcare Centers implement effective rapid start programs using best practices and clinical guidance. The resources below were created and published prior to the current administration and may be subject to change in the future. We will update resources that have changed, as they become available.
We recommend that you review the definition of HIV Rapid Start, clinical guidelines; and then view the Clinical Introduction to Rapid Start and explore the Rapid Start Protocols from the Special Projects of National Significance (SPNS) below.
Clinical Guidelines
Starting antiretroviral therapy (ART) immediately after HIV diagnosis is recommended by U.S. federal guidelines. See Clinical Guidelines below.
Clinical Intro to Rapid Start
Get the slides: JD Clinical Intro to Rapid Start – 10/29/24
Get Rapid Start Protocols from the Special Projects of National Significance (SPNS)
The Rapid Start Protocols from the Special Projects of National Significance SPNS are evidence-based approaches that promote starting antiretroviral therapy (ART) as quickly as possible after an HIV diagnosis. Typically, these protocols support ART within the same day or within 7 days, to improve patient outcomes by accelerating viral suppression and enhancing retention in care. Rapid start not only benefits individual health by preventing disease progression and transmission but also supports public health goals to end the HIV epidemic through timely and coordinated care. These protocols include steps and processes for health care providers to initiate and monitor ART making them a key strategy in national HIV care efforts.
What are Order Sets?
Order sets are predefined orders or options a provider can select to efficiently provide evidence-based care (these are also referred to as smart sets). Order sets are called smart sets in EPIC. Smart sets are order sets in an electronic health record (EHR) like EPIC. They are a combination of standing orders and order sets. They provide guidance using evidence-based medicine. See samples from OCHIN-EPIC below.
What are SmartPhrases?
SmartPhrases are pre–populated or created shortcuts within an EHR, that can input data into the chart note. SmartPhrases can be included in EHRs to provide patient instructions or education. They can also be created to a specific diagnosis to help refine charting. See examples from OCHIN EPIC below:
- .LAST3WEIGHTS
- .NEXTVISIT
- .VPGINTAKE
- .VPGdoxypep
SmartPhrases have also been used by emergency departments to access ART Eligibility Checklists for the safe initiation of ART in ED patients with a new/preliminary positive HIV diagnosis and for those living with HIV but not currently on ART. See a sample SmartPhrase in EPIC shared by Dr. Doug White following the 2025 Continuum of Care Conference:
HIV Provider List
Our HIV Provider List is a moderated list of providers in Oregon and SW Washington that provide care to people living with HIV, including newly diagnosed patients. Providers who offer rapid start are indicated. If there is a provider who is not listed in the directory, please submit a listing.
Join Our Rapid Start Community of Practice
We invite you to join our rapid start community of practice – a collaborative space for those who are actively integrating or considering integrating HIV rapid start into their clinical services and workflows.
Contact Us
We encourage you to contact us for more information about education, technical assistance, clinical mentorship, and preceptorship opportunities to support the successful implementation of rapid start at your clinic. We also invite you to join our rapid start community of practice – a collaborative space for those who are actively integrating or considering integrating HIV rapid start into their clinical services and workflows.
Contact: Rayna Appenzeller, JD | Rappenzeller@orpca.org | Practice Transformation Sr. Manager | Oregon Primary Care Association
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