In the ongoing global fight against HIV, clinicians, advocates, and researchers have long recognized that testing is only the first step. Getting people into care quickly after diagnosis, known as linkage to care, plays a pivotal role in both individual health outcomes and public health goals, such as reducing HIV transmission and achieving durable viral suppression.
A recently published randomized clinical trial in JAMA Network Open investigated a simple but potentially powerful idea: what if we could deliver HIV viral load results faster, specifically the next day, and would that lead to better linkage to care for people living with HIV or those at risk? The answer, based on this rigorous research, is not as straightforward as many had hoped.
Before diving into the study, it is important to understand the context. When someone is diagnosed with HIV, the goals of modern HIV care are clear.
First, starting antiretroviral therapy (ART) as soon as possible is crucial, ideally the same day or within a few days of diagnosis.
Second, achieving viral suppression, meaning the amount of HIV in the blood becomes undetectable, is a key step for health and preventing onward transmission.
Third, for people at ongoing risk who test HIV negative, linkage to prevention tools such as pre-exposure prophylaxis (PrEP) is equally important.
Linkage to care is the bridge between diagnosis and these next steps. In the United States, national public health goals such as the 95-95-95 targets, which aim for 95 percent of people to know their status, 95 percent of those diagnosed to be linked to care, and 95 percent of those in care to achieve viral suppression, emphasize rapid and efficient linkage. The End the HIV Epidemic Initiative, aiming for 2030, also highlights the importance of fast linkage.
Barriers such as transportation, stigma, and limited access to clinics can delay the receipt of test results and the initiation of care. These barriers can make a real difference in outcomes.
Traditional HIV testing in many settings involves an HIV antigen/antibody test. This type of test indicates the presence of HIV infection but does not quantify viral load, the amount of HIV in the blood.
A viral load test measures how much virus is present. It is a key tool in monitoring ART effectiveness or guiding clinical decisions. In many clinical settings, viral load tests are sent to centralized laboratories, and results often take several days.
The hypothesis behind this study was simple. If people received their viral load test results by the next day, they might be more likely to engage with care more quickly. This could include starting ART if they test HIV positive or beginning PrEP if they are at risk and test negative.
This idea was tested in a real-world setting.
The randomized clinical trial, known as the EHPOC trial, recruited adults from an academic medical center’s emergency department in Baltimore and via social media advertising.
Participants were adults 18 years or older who either lived with HIV but had an unsuppressed viral load or were not currently taking ART, or were at risk of HIV infection and were not taking PrEP.
People who were already stable on ART or already engaged in regular care were not the primary focus. The study focused on individuals with unmet needs or potential disengagement from care.
Participants were randomly assigned to two groups. The intervention group received a laboratory viral load test with next-day results, in addition to the standard HIV antigen/antibody test. The control group received only the standard HIV antigen/antibody test.
The trial followed participants for 12 weeks to determine whether they became linked to care. Linkage to care was defined as attending a first visit with a clinician to begin or resume ART for those with HIV or begin PrEP for those at risk.
The final enrollment included 195 adults. Approximately 17 percent of participants were people living with HIV, and the rest were individuals at risk of acquiring HIV. The group was diverse in age and background, with a median age of 36 years.
After 12 weeks of follow-up, only about one-third, 35.4 percent, of participants achieved linkage to care within the study period.
When comparing the intervention and control groups, there was no statistically significant difference in linkage to care overall. Providing a next-day viral load result did not significantly improve linkage rates compared to standard testing alone.
More technically, the hazard ratio for linkage to care comparing the intervention group to the control group was 1.28, but this was not statistically significant, with a P value of 0.31.
This means that although there was a slight suggestion of higher linkage in the group with next-day results, the difference could have been due to chance.
However, in a secondary analysis focusing specifically on participants living with HIV, the intervention group did show faster time to linkage, though the overall numbers were small.
At first glance, the headline result of no significant difference overall might seem disappointing. Many had hoped that faster results could act as a catalyst for quicker engagement in care.
However, there are several important nuances and lessons to consider.
Receiving test results is only one step in the chain of care. Even when people know their result, barriers such as difficulty navigating the healthcare system, lack of insurance or stable housing, transportation challenges, competing life priorities, and fear or stigma surrounding HIV can still delay or prevent linkage to care. Simply speeding up result delivery does not automatically fix these larger barriers.
This study used next-day results from a central lab, which approximates faster results but is not the same as truly same-day point-of-care testing conducted on the spot.
Experts have noted that truly immediate point-of-care viral load tests, which can be completed during the same clinic visit, might have a different impact on linkage to care than next-day tests.
At the time of this publication, point-of-care viral load tests are not widely available or approved for routine use in the United States. This underscores the need for further research and technological innovation.
While overall linkage to care did not significantly improve, participants living with HIV in the intervention group did show faster linkage in some secondary analyses. This suggests that rapid result delivery may have value for specific populations. More research with larger samples is needed to explore these subgroup effects more clearly.
The broader HIV care continuum, from testing to viral suppression, has seen remarkable progress over the past few decades. However, studies like this remind us how sticky linkage to care can be.
National benchmarks emphasize rapid linkage. Federal targets aim for linkage to a medical provider within 30 days of a positive HIV diagnosis.
In real-world settings, delays persist, with many people waiting weeks or longer before connecting to care. For people at risk who test negative, getting into PrEP services can be equally challenging.
The take-home message is that faster test results are helpful but not sufficient on their own. Linkage to care requires coordinated efforts across clinical systems, community outreach, case management and patient navigation, transportation and structural support services, and insurance and financial assistance programs.
Only by addressing both clinical and non-clinical barriers can the gap between testing and care be closed.
This study does not close the door on faster testing but refines expectations and charts a more targeted path forward.
First, developing and evaluating same-day viral load testing remains a priority. Point-of-care viral load tests that provide results during the same patient visit could be game changers if they speed up care decisions and engagement.
Second, integrating rapid results with active linkage strategies, such as patient navigators, peer support, or immediate ART starter packs, could increase impact.
Third, approaches should be tailored to different communities. People living with HIV, newly diagnosed individuals, and those at risk may respond differently to testing strategies. Tailored linkage models could improve outcomes.
Finally, structural barriers must be addressed. Expanding insurance coverage, improving transportation access, reducing stigma, and increasing community support can have a profound impact on timely linkage to care.
The JAMA Network Open study on next-day HIV viral load results represents an important and rigorous examination of a practical question in HIV care: can speeding up test result delivery help people get into care sooner?
The evidence suggests that next-day results alone are not a silver bullet for improving linkage to care across a diverse group of participants.
However, rapid testing, especially when paired with stronger linkage supports and potentially point-of-care technology, may still hold real promise. This is particularly true for people living with HIV who need quick clinical engagement.
Improving linkage to care remains an urgent priority on the path to ending the HIV epidemic. This study adds to the evidence base and helps refine the tools used to get there.
Source: M. M. Hamill et al., “Next-Day HIV Viral Load Test Result and Linkage to Care Among Persons Living With or at Risk of HIV,” JAMA Network Open, vol. 8, no. 12, pp. e2548380–e2548380, Dec. 2025,
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