# Implementation Lessons and Policy Implications of Same-Day Antiretroviral Therapy Initiation: Insights from the ART Same-Day Counselling and Initiation (ASCI) SOP in South Africa

## TL;DR

This study shows that same-day ART initiation with added support improves HIV treatment outcomes in South Africa.

## Contribution

The study evaluates the ASCI SOP model, showing how structured support improves ART retention and viral suppression.

## Key findings

- ASCI SOP improved retention in care to 83% compared to 72% with standard models.
- Viral suppression increased to 81% with ASCI SOP versus 69% with standard models.
- Community and psychosocial support reduced loss to follow-up and addressed treatment barriers.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Same-day ART initiation is recommended globally as a strategy to improve linkage to treatment in high-burden settings such as South Africa.Retention in care and viral HIV viral load suppression remain suboptimal, highlighting the need for a fortified patient-centered initiation model in South Africa.

Same-day ART initiation is recommended globally as a strategy to improve linkage to treatment in high-burden settings such as South Africa.

Retention in care and viral HIV viral load suppression remain suboptimal, highlighting the need for a fortified patient-centered initiation model in South Africa.

Public health significance—Why is this work of significance to public health?
The ASCI SOP improved retention in care (83% vs. 72%) and viral suppression (81% vs. 69%) compared with the standard FTIC model.Integrating patient navigation, psychosocial support, and community follow-up addresses readiness, stigma, disclosure, and system-level barriers affecting treatment outcomes.

The ASCI SOP improved retention in care (83% vs. 72%) and viral suppression (81% vs. 69%) compared with the standard FTIC model.

Integrating patient navigation, psychosocial support, and community follow-up addresses readiness, stigma, disclosure, and system-level barriers affecting treatment outcomes.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Scaling up structured same-day initiation models that include navigation, psychosocial and community-based support can strengthen HIV treatment outcomes nationally.Policymakers should integrate standardized readiness assessments and multidisciplinary support teams into routine HIV service delivery to minimize early disengagement of treatment.

Scaling up structured same-day initiation models that include navigation, psychosocial and community-based support can strengthen HIV treatment outcomes nationally.

Policymakers should integrate standardized readiness assessments and multidisciplinary support teams into routine HIV service delivery to minimize early disengagement of treatment.

Same-day antiretroviral therapy (ART) initiation (SDI) is globally recommended to improve ART uptake. However, retention in care and viral suppression in South Africa remain suboptimal. This study evaluated the experiences of healthcare providers, patients, and community stakeholders in implementing the ART Same-day Counselling and Initiation (ASCI) Standard Operating Procedure (SOP), focusing on facilitators, barriers, and policy implications for improving HIV treatment outcomes. Using implementation frameworks, qualitative data from providers, patients, and community structures were analyzed alongside findings from a randomized controlled trial involving 142 newly diagnosed individuals initiated on ART on the same day as diagnosis. Evaluation of the ASCI SOP demonstrated improved six-month outcomes compared with standard initiation: retention in care (83% vs. 72%), viral suppression (81% vs. 69%, p = 0.04), and reduced loss to follow-up (17% vs. 28%, p = 0.05), with no significant mortality difference. These gains were linked to structured psychosocial support, patient navigation, and community follow-up. Key facilitators included multidisciplinary collaboration, psychosocial support, and community engagement, while major barriers involved healthcare system overload, patient-level challenges, and lack of standardized tools to assess treatment readiness. Policy reform to scale up the ASCI SOP should emphasize interdisciplinary support, consistent monitoring, and integration within national health systems. Overall, the preliminary evidence suggests that implementing the ASCI SOP model improved same-day ART uptake, retention, and viral suppression. Expanding this model to other provinces could strengthen HIV program performance and accelerate progress toward South Africa’s treatment goals.