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Set the Instant Pot to Sauté (Normal). Add the Italian sausage and cook, breaking it up with a wooden spoon, until browned and no longer pink, about 6–8 minutes. Use a spoon to tilt the pot and spoon off all but about 1 tablespoon of rendered fat.
Add the onion to the pot and cook, stirring occasionally, until softened and translucent, about 4 minutes. Add the garlic and tomato paste and cook, stirring constantly, until the garlic is fragrant and the paste has darkened slightly, about 1–2 minutes.
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