We welcome and serve all ethnicities and populations while also honoring our Latino roots with a

tradition of providing compassionate and patient-centered care designed to provide high quality,
culturally and linguistically appropriate integrated primary care services to meet the unique needs of
Latinx.

Created by Robert Maldonado in collobration with SFDPH

Overview
 Clinica Esperanza

Has been providing continuous HIV medical services since 1989, the overall goal of Clínica Esperanza is
to continually improve the multi-disciplinary approach to HIV care which helps people with HIV become
 RAPID
The overall goal of the RAPID (Rapid ART Program Initiative for HIV Diagnoses)
program is for a smooth transition for persons newly diagnosed with HIV (or out of care), to
rapidly access antiretroviral therapy (ART) and engage in care. These recommendations follow
2017 World Health Organization recommendations to start at least 7 days within diagnosis of
HIV, with an emphasis to start on the same day diagnosis. The World Health Organization
guidance in turn is based on randomized clinical trials in resource-limited settings showing that
provision of immediate ART improved ART uptake, retention in care, virologic suppression,
and, in one study, mortality rates. In the United States, pilot studies in several cities have shown
that the offer of immediate ART after diagnosis led to substantially earlier linkage to care, earlier
ART initiation, and a shorter time to HIV RNA suppression.
 RAPID Protocol for LWC

1. A client with a reactive HIV test will receive post-test counseling and information on
RAPID from the Latino Wellness Center Outreach team. The client will be escorted by
Latino Wellness Center Outreach team member for same day Confirmatory Blood
Draw and a warm hand-off to Recruitment and Retention Coordinator or the
Treatment Link Specialist. Latino Wellness Center Outreach team member will
provide the Phlebotomist with a completed San Francisco Department of Public Health
Laboratory form and a copy of client’s photo ID for creation of a B#.

2. Recruitment and Retention Coordinator or the Treatment Link Specialist will inform
client of all required documents for Clinica Esperanza intake. Recruitment and
Retention Coordinator or the Treatment Link Specialist will complete Clinica
Esperanza intake, including MNHC registration, Ryan White Verification, and
referrals for insurance and ADAP. Please note that intake may occur on day of
referral from outside organization if confirmatory results are available and client has
required documents. Client must provide a Letter of Diagnosis.

3. If applicable, Patient Navigator, Health Educator, or the Treatment Link Specialist will
complete a TAP/ADAP application with the client for immediate approval. The
provider will provide a confirmation letter (if necessary), and the client will provide
identification, proof of income, proof of residency, and proof of insurance. Please note
laboratory results must be submitted within 30 days of application. ADAP registration
may occur on the day of referral from an outside organization if confirmatory results
are available and the client has required documents.

4. The provider visit will be a 30-minute slot. The provider will screen for
appropriateness and contraindications for RAPID. For ADAP eligible clients, any
resulting prescriptions from this initial visit will be sent to Mission Neighborhood
Health Center Pharmacy. For other insurences, any resulting prescription will be sent
to Mission Wellness Pharmacy. The nurse will communicate with the pharmacy
regarding prescription and will ensure insurance/ADAP information was received.
Clients may choose to change where they pick up medications after this visit.
5. A genotype will be performed at initial blood draw. The provider will communicate
with the phlebotomist for additional lab work. Confirmatory Blood Draw results will
faxed to Recruitment and Retention Coordinator or the Treatment Link Specialist

6. Follow-up visits to be scheduled include follow-up with the provider two weeks after
the initial visit, initial case management, health education and behavioral health.
7. The Treatment Health Educator will document follow-up phone calls, check for
adherence, utilize post-RAPID follow-up guidelines. The Treatment Health Educator
will remind the client of upcoming initial case management and clinic visits (may
require more than one phone call). The Treatment Health Educator will work with
Nurse Clinic Manager to ensure there are no problems with medication access via
pharmacy.

8. The client will meet with the case manager (note that the client may have already
briefly met with case manager earlier in the RAPID process).

9. The client will meet with the provider to review lab results, discuss adherence,
medication, and general questions two weeks after the initial visit.
 RAPID Protocol for Internal MNHC Patient

1. When a new HIV positive result is identified within Mission Neighborhood

Health Center clinics, the primary provider will contact the patient to schedule an
appointment for disclosure.

2. The primary provider will notify Recruitment and Retention Coordinator or the
Treatment Link Specialist, the time and date of the patient disclosure appointment
to coordinate “warm hand-off”. Clinica Esperanza RAPID team will be on stand-
by to initiate linkage to care.

3. The patient’s primary care provider will disclose results to their patient. Clinica
Esperanza Behavioral Health staff member will be present or nearby to provide
supportive counseling to the patient and review care options immediately after
disclosure.

4. With the patient’s consent, the Recruitment and Retention Coordinator or the
Treatment Link Specialist, in tandem with the Treatment Health Educator, will
complete a comprehensive transition to Clínica Esperanza/HIV Services
following RAPID procedures. This ideally includes same-day provider evaluation
and blood draw as well as linkage to Clinica Esperanza psychosocial services.
RAPID Work Flow
 RAPID Phase 1

1. A Latino Wellness Center Outreach team member will provide the Phlebotomist with a
completed San Francisco Department of Public Health Laboratory form and a copy of
client’s photo ID for creation of a B#. The San Francisco Department of Public Health
Laboratory form should be legible.
 RAPID Checklist Clínica Esperanza
Please use this checklist as a tool to communicate with all other RAPID team members.
Document your contact with client in the client’s chart.

Day of Intake:
MNHC registration
ADAP/TAP registration
PCP Visit
Initial Blood Draw, Confirmatory and Genotype
Prescription & ADAP # to Pharmacy
CM introduction and schedule initial CM visit
THE follow-up scheduled

Follow Up:
The Health Educator will follow-up with a phone call 1 day after ART initiation
The Health Educator will follow-up with a phone call 1 week after ART initiation
A Follow-up with PCP two weeks after ART initiation
 RAPID Test Tube

To ensure an accurate confirmatory test, please make sure you use the test tube identified below.
San Francisco DPH Linkage Integration Navigation Comprehensive Services( LINCS)

The Overall goal of LINCS

1. Linkage to care and Partner Services for newly diagnosed HIV+

2. Navigation for known HIV+ • Goal: Provide appropriate HIV –related medical and social
services to optimize individual health and prevent HIV transmission

New Diagnosis will be reported to SF DPH LINCS by Recruitment and Retention

Coordinator for internal diagnosis and by the Treatment Link Specialist for Latino Wellness
Center diagnosis.

 Erin Antunez (LINCS Program Coordinator)

SF City Clinic- SFDPH
D: 415.487.5506