Clinical Outcomes of Adults With Diagnosed HIV Living in Ending the HIV Epidemic Priority Areas, Medical Monitoring Project, 2018.

OBJECTIVES: The Ending the HIV Epidemic (EHE) initiative prioritizes treatment and prevention efforts in counties where most new HIV diagnoses occur and states with substantial incidence of new HIV diagnoses in rural areas. Understanding the characteristics of adults with HIV living in EHE priority areas, and how these characteristics compare with adults with HIV living in non-EHE priority areas, can inform EHE efforts. METHODS: We analyzed data from the 2018 Medical Monitoring Project (MMP) to understand the characteristics of adults with HIV living in 36 of 48 EHE priority counties; San Juan, Puerto Rico; and 1 of 7 EHE priority states. We calculated weighted percentages of sociodemographic characteristics, behaviors, and clinical outcomes of adults with diagnosed HIV living in MMP EHE priority areas and compared them with characteristics of adults who did not live in MMP EHE priority areas using prevalence ratios (PRs) with predicted marginal means. RESULTS: Living in an MMP EHE priority area was more common among adults who were non-Hispanic Black or Hispanic, experienced homelessness, or were food insecure compared with adults who were non-Hispanic White (59.3% and 58.4% vs 41.0%), not experiencing homelessness (60.9% vs 51.9%), or not food insecure (59.8% vs 51.0%). Adults who lived in MMP EHE priority areas were significantly less likely to be adherent to their HIV medications (PR = 0.95; 95% CI, 0.91-0.99) and durably virally suppressed (PR = 0.94; 95% CI, 0.91-0.97), and more likely to miss scheduled appointments for HIV care (PR = 1.31; 95% CI, 1.10-1.56) than adults who did not live in MMP EHE priority areas. CONCLUSION: To increase viral suppression and reduce HIV transmission, it is essential to strengthen public health efforts to improve medication and appointment adherence in this population.

Assessing concordance of HIV risk behaviors collected by different surveillance systems.

OBJECTIVES: Assess concordance of assigned transmission category between National HIV Surveillance System (NHSS) and Medical Monitoring Project (MMP); assess persistence of behaviors by comparing transmission category to current behavior. DESIGN: Retrospective analysis of HIV surveillance data. METHODS: For 4034 participants in the 2016 MMP cycle, transmission category was assigned in NHSS and MMP by applying a hierarchy to acquisition risk behaviors and selecting the most likely risk behavior that led to HIV acquisition. We assessed concordance of transmission category between systems, the number of persons with an updated transmission category in NHSS after incorporating MMP data, and concordance of transmission category and current behavior. RESULTS: Concordance of transmission category between NHSS and MMP was 87% for men with evidence of male-to-male sexual contact and ranged from 27% to 62% in persons with other transmission categories. Transmission category in NHSS was updated for 9% of persons after incorporating MMP data, mostly affecting those with no identified risk in NHSS. Current behavior aligned with updated NHSS transmission category in 56% of men with a transmission category of male-to-male sexual contact. However, only 8% of men and 5% of women with a transmission category of injection drug use had recently injected drugs. CONCLUSION: HIV surveillance systems can better inform prevention efforts with more complete risk information. Sexual behaviors are more persistent over time than injection drug use. In addition to promoting viral suppression, routinely assessing risk and tailoring prevention activities accordingly can improve health outcomes.

Estimated Annual Number of HIV Infections ─ United States, 1981-2019.

The first cases of Pneumocystis carinii (jirovecii) pneumonia among young men, which were subsequently linked to HIV infection, were reported in the MMWR on June 5, 1981 (1). At year-end 2019, an estimated 1.2 million persons in the United States were living with HIV infection (2). Using data reported to the National HIV Surveillance System, CDC estimated the annual number of new HIV infections (incidence) among persons aged ≥13 years in the United States during 1981-2019. Estimated annual HIV incidence increased from 20,000 infections in 1981 to a peak of 130,400 infections in 1984 and 1985. Incidence was relatively stable during 1991-2007, with approximately 50,000-58,000 infections annually, and then decreased in recent years to 34,800 infections in 2019. The majority of infections continue to be attributable to male-to-male sexual contact (63% in 1981 and 66% in 2019). Over time, the proportion of HIV infections has increased among Black/African American (Black) persons (from 29% in 1981 to 41% in 2019) and among Hispanic/Latino persons (from 16% in 1981 to 29% in 2019). Despite the lack of a cure or a vaccine, today's HIV prevention tools, including HIV testing, prompt and sustained treatment, preexposure prophylaxis, and comprehensive syringe service programs, provide an opportunity to substantially decrease new HIV infections. Intensifying efforts to implement these strategies equitably could accelerate declines in HIV transmission, morbidity, and mortality and reduce disparities.

Vital Signs: Deaths Among Persons with Diagnosed HIV Infection, United States, 2010-2018.

BACKGROUND: Life expectancy for persons with human immunodeficiency virus (HIV) infection who receive recommended treatment can approach that of the general population, yet HIV remains among the 10 leading causes of death among certain populations. Using surveillance data, CDC assessed progress toward reducing deaths among persons with diagnosed HIV (PWDH). METHODS: CDC analyzed National HIV Surveillance System data for persons aged ≥13 years to determine age-adjusted death rates per 1,000 PWDH during 2010-2018. Using the International Classification of Diseases, Tenth Revision, deaths with a nonmissing underlying cause were classified as HIV-related or non-HIV-related. Temporal changes in total deaths during 2010-2018 and deaths by cause during 2010-2017 (2018 excluded because of delays in reporting), by demographic characteristics, transmission category, and U.S. Census region of residence at time of death were calculated. RESULTS: During 2010-2018, rates of death decreased by 36.6% overall (from 19.4 to 12.3 per 1,000 PWDH). During 2010-2017, HIV-related death rates decreased 48.4% (from 9.1 to 4.7), whereas non-HIV-related death rates decreased 8.6% (from 9.3 to 8.5). Rates of HIV-related deaths during 2017 were highest by race/ethnicity among persons of multiple races (7.0) and Black/African American persons (5.6), followed by White persons (3.9) and Hispanic/Latino persons (3.9). The HIV-related death rate was highest in the South (6.0) and lowest in the Northeast (3.2). CONCLUSION: Early diagnosis, prompt treatment, and maintaining access to high-quality care and treatment have been successful in reducing HIV-related deaths and remain necessary for continuing reductions in HIV-related deaths.

Informing Data to Care: Contacting Persons Sampled for the Medical Monitoring Project.

BACKGROUND: Data to care (D2C) is a public health strategy that uses HIV surveillance and other data to identify persons in need of HIV medical care. The Medical Monitoring Project (MMP), which uses similar methods to contact and recruit HIV-positive persons, may inform predictors of successful contact for D2C programs. SETTING: MMP is a Centers for Disease Control and Prevention-funded surveillance system that collects nationally representative data on adults with diagnosed HIV in the United States and Puerto Rico. METHODS: Using MMP's 2016 data collection cycle, we present contact rates (ie, proportion of HIV-positive persons successfully contacted for MMP) by the age of contact information and age of laboratory test results available from HIV surveillance data. RESULTS: Nationally, 27.6% of eligible persons did not have a recorded laboratory test performed within the past year (project area range: 10.8%-54.6%). The national contact rate among persons with laboratory tests older than 1 year was 37.0% (project area range: 16.5%-67.1%). Higher contact rates were found among persons with more recent laboratory tests. Similar results were found by the age of contact information. Nationally, the most common reason for MMP ineligibility was that the person was deceased; the most common reason for not being contacted was lack of correct contact information. CONCLUSIONS: MMP findings suggest that D2C programs would benefit from efforts to improve the quality of HIV surveillance data and local surveillance practices-in particular, death ascertainment, the completeness of laboratory reporting, and the routine updating of contact information. Strengthening collaboration and integration with existing MMP programs may be beneficial.

Human Immunodeficiency Virus Epidemic Control in the United States: An Assessment of Proposed UNAIDS Metrics, 2010-2015.

Epidemic control is necessary to eliminate human immunodeficiency virus infections. We assessed epidemic control in the United States by applying 4 proposed UNAIDS metrics to national surveillance data collected between 2010 and 2015. Although epidemic control in the United States is possible, progress by UNAIDS metrics has been mixed.

Linking HIV and Viral Hepatitis Surveillance Data: Evaluating a Standard, Deterministic Matching Algorithm Using Data From 6 US Health Jurisdictions.

Accurate interpretations and comparisons of record linkage results across jurisdictions require valid and reliable matching methods. We compared existing matching methods used by 6 US state and local health departments (Houston, Texas; Louisiana; Michigan; New York, New York; North Dakota; and Wisconsin) to link human immunodeficiency virus and viral hepatitis surveillance data with a 14-key automated, hierarchical deterministic matching method. Applicable years of study varied by disease and jurisdiction, ranging from 1979 to 2016. We calculated percentage agreement and Cohen's κ coefficient to compare the matching methods used within each jurisdiction. We calculated sensitivity, specificity, and positive predictive value for each matching method, as compared with a new standard that included manual review of discrepant cases. Agreement between the existing matching method and the deterministic matching method was 99.6% or higher in all jurisdictions; Cohen's κ values ranged from 0.87 to 0.98. The sensitivity of the deterministic matching method ranged from 97.4% to 100% in the 6 jurisdictions; specificity ranged from 99.7% to 100%; and positive predictive value ranged from 97.4% to 100%. Although no gold standard exists, prior assessments of existing methods and review of discrepant classifications suggest good accuracy and reliability of our deterministic matching method, with the advantage that our method reduces the need for manual review and allows for standard comparisons across jurisdictions when linking human immunodeficiency virus and viral hepatitis data.

Survival After HIV Infection Stage 3 (AIDS) Diagnosis, by Population Density Areas, United States, 2005-2010.

OBJECTIVES: We examined the survival rates after diagnosis of HIV infection stage 3 (AIDS) in the United States by population density area of residence at diagnosis. METHODS: We used data from the National HIV Surveillance System to calculate survival rates among people aged ≥13 with HIV infection stage 3 (AIDS) diagnosed from 2005 through 2010. We determined survival rates for more than 12, 24, and 36 months after diagnosis; overall and by demographic characteristics; and across 3 population density area categories (large metropolitan statistical areas [MSAs, ≥500 000 people], small-to-medium MSAs [50 000 to 499 999 people], and nonmetropolitan areas [<50 000 people]). RESULTS: The survival rates for more than 12, 24, and 36 months after diagnosis were highest among people residing in large MSAs (90.2%, 87.2%, and 84.9%, respectively) and lowest among people residing in nonmetropolitan areas (87.3%, 84.1%, and 81.4%, respectively). With a few exceptions, survival rates were lower in those residing in nonmetropolitan areas than those residing in large MSAs and small-to-medium MSAs across most subgroups by age at diagnosis, race/ethnicity, sex, transmission category, region of residence, and year of diagnosis. Between 2005 and 2010, significant year-to-year increases occurred in the proportion of people surviving more than 36 months after diagnosis across all 3 population density area categories (estimated annual percentage change: large MSAs [0.88; 95% confidence interval (CI), 0.56-1.20]; small-to-medium MSAs [0.94; 95% CI, 0.06-1.83]; and nonmetropolitan areas [1.26; 95% CI, 0.07-2.46]). CONCLUSIONS: Although survival rates for those with HIV infection stage 3 (AIDS) improved in all 3 population density area categories, efforts to remove barriers to care and promote treatment adherence in nonmetropolitan areas will be necessary to eliminate survival disparities.

Lifetime and age-conditional risk of human immunodeficiency virus diagnosis, Missouri, 1998-2007.

Lifetime and age-conditional probabilities of human immunodeficiency virus (HIV) diagnosis risk in Missouri were assessed using cross-sectional HIV diagnosis and mortality rates. An increased lifetime risk of HIV diagnosis was associated with males, blacks, and persons residing in metropolitan areas. The estimates emphasize the disparity in risk by race/ethnicity and area of residence.