Background: Ending the HIV Epidemic strategies include rapid ART Initiation (R-ART), rapid pre-exposure prophylaxis (R-PrEP), and status neutral approaches (status neutral), but implementation across heterogeneous settings in the United States is not well characterized.

Setting: Ryan White (RW)-funded HIV treatment clinics located in select Ending the HIV Epidemic priority areas in the United States.

Methods: Clinics were sent a survey to assess experiences offering R-ART, R-PrEP, and status neutral (collectively called "rapid START"). Primary outcomes were rapid START adoption and characteristics of implementing vs. nonimplementing clinics. Secondary outcomes included perceptions, barriers, and facilitators of R-ART and R-PrEP.

Results: The response rate was 48% (40 of 83). The 40 respondents represented 57 clinics who reported providing HIV-related services to more than 70,000 individuals annually. R-ART uptake was 85% (range 43%-100%), status neutral 65% (range 57%-75%), and R-PrEP 60% (range 0%-88%). No rural-identifying organizations reported offering R-ART or R-PrEP compared with 96% and 76% of urban-identifying organizations, respectively. Positive perceptions of acceptability, appropriateness, and feasibility for R-ART and R-PrEP were high among all levels of implementation and strongest among those offering R-ART and R-PrEP. The most frequent barriers to R-ART were provider- and clinic-level and for R-PrEP were system-level (lack of insurance coverage) followed by patient-, provider-, and clinic-level issues.

Conclusion: This survey of diverse RW-funded clinics shows high uptake of R-ART and significant if less consistent uptake of R-PrEP and status neutral. Future research should focus on identifying broadly implementable strategies to expand adoption along with tailored approaches, especially in areas with lower health care access.