Positive Health Access to Services and Treatment (PHAST)

Sponsor: City and County of San Francisco

Location(s): United States


The Positive Health Access to Services and Treatment (PHAST) team is a rapid response team that has championed HIV testing and linkage to care across the SFGH campus since 2002.

Our mission is to meet the goals of the US National AIDS Strategy and CDC HIV Testing Guidelines by:

  • Identifying undiagnosed HIV infection in all patients who have contact with the SFGH system
  • Providing rapid linkage to care for individuals who are newly diagnosed or have barriers to engagement in care
  • Initiating antiretroviral therapy (ART) as soon as possible in all patients who are accepting of treatment
  • Supporting vulnerable patients by providing nursing care coordination and psychosocial stabilization throughout the linkage to care process


The PHAST team consists of a part.time registered nurse, part.time nurse practitioner and full.time social work associate. This team supports over 500 patients at risk for poor linkage to care and who are primarily persons of color with high rates of homelessness, mental illness and active substance use. The average age of participants in PHAST is 39 and 11% are under the age of 25. At entry into the PHAST program, 21% of patients are taking ART. Within one year of participation in PHAST, 71% of patients are taking ART and 52% have undetectable HIV viral load. The lost.to.follow.up rate for PHAST patients is <10%.

Key components of the PHAST model include:

  • Interdisciplinary skill set that includes nursing, social work, and bridging to primary care
  • A single team that tracks patients from initial HIV diagnosis through successful linkage to care
  • Rapid response to new HIV diagnoses that assists clinicians with disclosure of positive results and supports patients with counseling, education, partner services and self.disclosure to family and friends
  • Expedited clinic intake (within 1.4 days from initial diagnosis and first medical appointment within 10 days) with a focus on identifying barriers to successful linkage to care
  • Initial medical stabilization and careful matching to a primary care provider
  • Psychosocial stabilization: benefits, housing, mental health, addiction referrals
  • Intensive HIV education and orientation and mentoring on navigating the health care system
  • Appointment tracking: reminders and follow up on missed appointments