Recent studies suggest that rapid, within a few days, initiation of anti-retroviral therapies (ART) is associated with improved short-term adherence and virological suppression. As a result, there has been a national and international movement towards implementing rapid ART initiation in HIV clinics. A rapid ART initiation program is potentially an important HIV treatment as well as prevention intervention in South Carolina, a deep-south state where HIV incidence, morbidity and mortality remain high despite overall national trends in improved HIV outcomes and decreasing incidence. However, differences in health care systems, transportation challenges, local resources and structural barriers can influence the health outcomes of rapid ART initiation. Therefore, the goal of this project is to evaluate the effectiveness of a rapid ART program and the impact of structural barriers on a rapid ART engagement program at the Palmetto Health USC Immunology clinic (PHUS ICC).