Geographic Differences in Reaching Selected National HIV Strategic Targets Among People With Diagnosed HIV: 16 US States and Puerto Rico, 2017-2020.

Objectives. To assess geographic differences in reaching national targets for viral suppression, homelessness, and HIV-related stigma among people with HIV and key factors associated with these targets. Methods. We used data from the Medical Monitoring Project (2017-2020) and the National HIV Surveillance System (2019) to report estimates nationally and for 17 US jurisdictions. Results. Viral suppression (range = 55.3%-74.7%) and estimates for homelessness (range = 3.6%-11.9%) and HIV-related stigma (range for median score = 27.5-34.4) varied widely by jurisdiction. No jurisdiction met any of the national 2025 targets, except for Puerto Rico, which exceeded the target for homelessness (3.6% vs 4.6%). Viral suppression and antiretroviral therapy dose adherence were lowest, and certain social determinants of health (i.e., housing instability, HIV-related stigma, and HIV health care discrimination) were highest in Midwestern states. Conclusions. Jurisdictions have room for improvement in reaching the national 2025 targets for ending the HIV epidemic and in addressing other measures associated with adverse HIV outcomes-especially in the Midwest. Working with local partners will help jurisdictions determine a tailored approach for addressing barriers to meeting national targets. (Am J Public Health. 2022;112(7):1059-1067. https://doi.org/10.2105/AJPH.2022.306843).

Evidence of an Association of Increases in Pre-exposure Prophylaxis Coverage With Decreases in Human Immunodeficiency Virus Diagnosis Rates in the United States, 2012-2016.

BACKGROUND: Annual human immunodeficiency virus (HIV) diagnoses in the United States (US) have plateaued since 2013. We assessed whether there is an association between uptake of pre-exposure prophylaxis (PrEP) and decreases in HIV diagnoses. METHODS: We used 2012-2016 data from the US National HIV Surveillance System to estimate viral suppression (VS) and annual percentage change in diagnosis rate (EAPC) in 33 jurisdictions, and data from a national pharmacy database to estimate PrEP uptake. We used Poisson regression with random effects for state and year to estimate the association between PrEP coverage and EAPC: within jurisdictional quintiles grouped by changes in PrEP coverage, regressing EAPC on time; and among all jurisdictions, regressing EAPC on both time and jurisdictional changes in PrEP coverage with and without accounting for changes in VS. RESULTS: From 2012 to 2016, across the 10 states with the greatest increases in PrEP coverage, the EAPC decreased 4.0% (95% confidence interval [CI], -5.2% to -2.9%). On average, across the states and District of Columbia, EAPC for a given year decreased by 1.1% (95% CI, -1.77% to -.49%) for an increase in PrEP coverage of 1 per 100 persons with indications. When controlling for VS, the state-specific EAPC for a given year decreased by 1.3% (95% CI, -2.12% to -.57%) for an increase in PrEP coverage of 1 per 100 persons with indications. CONCLUSIONS: We found statistically significant associations between jurisdictional increases in PrEP coverage and decreases in EAPC independent of changes in VS, which supports bringing PrEP use to scale in the US to accelerate reductions in HIV infections.

Trends in HIV Testing Among US Adults, Aged 18-64 Years, 2011-2017.

In 2006, Centers for Disease Control and Prevention (CDC) recommended HIV screening in healthcare or clinical settings for all persons aged 13-64 years and annual rescreening for populations at high risk for HIV. We used the Behavioral Risk Factor Surveillance System to describe the prevalence and trends of ever tested for HIV and tested for HIV in the past 12 months among US adults. The percentage of ever tested increased from 42.9% in 2011 to 45.9% in 2017; testing in the past 12 months increased from 13.2% in 2011 to 14.8% in 2017. Despite these increases, less than half of US adults have ever been tested for HIV over ten years after CDC's recommendations. Increasing the prevalence of routine HIV screening and rescreening among individuals at high risk will reduce the number of undiagnosed persons with HIV infection and thus prevent new HIV infections-a key strategy in the Ending the HIV Epidemic initiative.

Vital Signs: Status of Human Immunodeficiency Virus Testing, Viral Suppression, and HIV Preexposure Prophylaxis - United States, 2013-2018.

BACKGROUND: Approximately 38,000 new human immunodeficiency virus (HIV) infections occur in the United States each year; these infections can be prevented. A proposed national initiative, Ending the HIV Epidemic: A Plan for America, incorporates three strategies (diagnose, treat, and prevent HIV infection) and seeks to leverage testing, treatment, and preexposure prophylaxis (PrEP) to reduce new HIV infections in the United States by at least 90% by 2030. Targets to reach this goal include that at least 95% of persons with HIV receive a diagnosis, 95% of persons with diagnosed HIV infection have a suppressed viral load, and 50% of those at increased risk for acquiring HIV are prescribed PrEP. Using surveillance, pharmacy, and other data, CDC determined the current status of these three initiative strategies. METHODS: CDC analyzed HIV surveillance data to estimate annual number of new HIV infections (2013-2017); estimate the percentage of infections that were diagnosed (2017); and determine the percentage of persons with diagnosed HIV infection with viral load suppression (2017). CDC analyzed surveillance, pharmacy, and other data to estimate PrEP coverage, reported as a percentage and calculated as the number of persons who were prescribed PrEP divided by the estimated number of persons with indications for PrEP. RESULTS: The number of new HIV infections remained stable from 2013 (38,500) to 2017 (37,500) (p = 0.448). In 2017, an estimated 85.8% of infections were diagnosed. Among 854,206 persons with diagnosed HIV infection in 42 jurisdictions with complete reporting of laboratory data, 62.7% had a suppressed viral load. Among an estimated 1.2 million persons with indications for use of PrEP, 18.1% had been prescribed PrEP in 2018. CONCLUSION: Accelerated efforts to diagnose, treat, and prevent HIV infection are needed to achieve the U.S. goal of at least 90% reduction in the number of new HIV infections by 2030.

HIV Preexposure Prophylaxis, by Race and Ethnicity - United States, 2014-2016.

Preexposure prophylaxis (PrEP) with a daily, oral pill containing antiretroviral drugs is highly effective in preventing acquisition of human immunodeficiency virus (HIV) infection (1-4). The combination of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) is the only medication approved by the Food and Drug Administration (FDA) for PrEP. PrEP is indicated for men and women with sexual or injection drug use behaviors that increase their risk for acquiring HIV (5). CDC analyzed 2014-2016 data from the IQVIA Real World Data - Longitudinal Prescriptions (IQVIA database) to estimate the number of persons prescribed PrEP (users) in the United States and to describe their demographic characteristics, including sex and race/ethnicity. From 2014 to 2016, the annual number of PrEP users aged ≥16 years increased by 470%, from 13,748 to 78,360. In 2016, among 32,853 (41.9%) PrEP users for whom race/ethnicity data were available, 68.7% were white, 11.2% were African American or black (black), 13.1% were Hispanic, and 4.5% were Asian. Approximately 7% of the estimated 1.1 million persons who had indications for PrEP were prescribed PrEP in 2016, including 2.1% of women with PrEP indications (6). Although black men and women accounted for approximately 40% of persons with PrEP indications (6), this study found that nearly six times as many white men and women were prescribed PrEP as were black men and women. The findings of this study highlight gaps in effective PrEP implementation efforts in the United States.

A programmatic approach to address increasing HIV diagnoses among Hispanic/Latino MSM, 2010-2014.

From 2010 to 2015, young (13-24 years) Hispanic/Latino gay, bisexual and other men who have sex with men (MSM) experienced the largest increase (18%) in numbers of HIV diagnoses among all racial/ethnic groups. In 2016, the Centers for Disease Control and Prevention (CDC) assembled a team of scientists and public health analysts to develop a programmatic approach for addressing the increasing HIV diagnosis among Hispanic/Latino MSM. The team used a data driven review process, i.e., comprehensive review of surveillance, epidemiologic, and programmatic data, to explore key questions from the literature on factors associated with HIV diagnoses among Hispanic/Latino MSM and to inform the approach. This paper describes key findings from the review and discusses the approach. The approach includes the following activities: increase awareness and support testing by expanding existing campaigns targeting Hispanic/Latino MSM to jurisdictions where diagnoses are increasing; strengthen existing efforts that support treatment as prevention and increase engagement in care and viral suppression among Hispanic/Latino MSM living with HIV and promote prevention, e.g., PrEP uptake and condom use, among Hispanic/Latino MSM who are at high-risk for HIV infection.

Changes in the Disparity of HIV Diagnosis Rates Among Black Women - United States, 2010-2014.

In 2015, black women represented 61% of human immunodeficiency virus (HIV) diagnoses among women (1). HIV diagnosis rates among women declined during 2010-2014 (1); however, whether the decline resulted in a decrease in the disparities between black women and Hispanic and white women was unknown. To assess whether a change in disparities occurred, CDC used three different measures of disparity: 1) the absolute rate difference (the difference between the group with the lowest rate and the group with the highest rate) (2); 2) the diagnosis disparity ratio* (the ratio of the difference between the group rate and the overall population rate to the overall rate); and 3) the Index of Disparity (the average of the differences between rates for specific groups and the total rate divided by the total rate, expressed as a percentage) (3). The absolute rate difference between black women and white women decreased annually, from 36.9 in 2010 to 28.3 in 2014. The diagnosis disparity ratio for black women decreased from 1.7 in 2010 to 1.2 in 2014. The Index of Disparity increased during 2010-2011, and then decreased each year during 2012-2014. Although disparities still exist, these findings indicate improvement. Expanding access to biomedical and behavioral interventions and research guided by social and structural determinants frameworks could close the remaining gap.

Self-rated health and HIV outcomes among adults with diagnosed HIV - Medical Monitoring Project, United States.

OBJECTIVES: To evaluate associations between self-rated health (SRH) and care outcomes among United States adults with diagnosed HIV infection. DESIGN: We analyzed interview and medical record data collected during June 2020-May 2021 from the Medical Monitoring Project, a complex, nationally representative sample of 3692 people with HIV (PWH). Respondents reported SRH on a 5-point Likert type scale (poor to excellent), which we dichotomized into "good or better" and "poor or fair". We computed weighted percentages with 95% confidence intervals (CIs) and age-adjusted prevalence ratios (aPRs) to investigate associations between SRH and HIV outcomes and demographic, psychosocial, and behavioral characteristics. RESULTS: Nationally, 72% of PWH reported "good or better" SRH. PWH with the following characteristics had a lower prevalence of "good or better" SRH, compared with those without: any missed HIV care appointment in the last 12 months (aPR 0.86, 95% CI: 0.81-0.91), symptoms of moderate or severe depression (aPR 0.51, 95% CI: 0.43-0.59) and anxiety (aPR 0.60, 95% CI: 0.54-0.68), unstable housing or homelessness (aPR 0.77, 95% CI: 0.71-0.82), and hunger or food insecurity (aPR 0.74, 95% CI: 0.69-0.80), as well as having a mean CD4 count <200 cells/mm 3 vs. CD4 + >500 cells/mm 3 (aPR 0.70, 95% CI: 0.57-0.86). CONCLUSIONS: Though SRH is a holistic measure reflective of HIV outcomes, integrated approaches addressing needs beyond physical health are necessary to improve SRH among PWH in the United States. Modifiable factors like mental health, unstable housing or homelessness, and food insecurity warrant further study as potential high-yield targets for clinical and policy interventions to improve SRH among PWH.

E-Cigarette Use Among persons With Diagnosed HIV in the U.S.

Introduction: E-cigarettes emerged in the U.S. market in the late 2000s. In 2017, E-cigarette use among U.S. adults was 2.8%, with higher use among some population groups. Limited studies have assessed E-cigarette use among persons with diagnosed HIV. The purpose of this study is to describe the national prevalence estimates of E-cigarette use among persons with diagnosed HIV by selected sociodemographic, behavioral, and clinical characteristics. Methods: Data were collected between June 2018 and May 2019 as part of the Medical Monitoring Project, an annual cross-sectional survey that produces nationally representative estimates of behavioral and clinical characteristics of persons with diagnosed HIV in the U.S. Statistically significant differences (p<0.05) were determined using chi-square tests. Data were analyzed in 2021. Results: Among persons with diagnosed HIV, 5.9% reported currently using E-cigarettes, 27.1% had ever used them but were not using them currently, and 72.9% had never used them. Current use of E-cigarettes was highest among persons with diagnosed HIV who currently smoke conventional cigarettes (11.1%), those with major depression (10.8%), those aged 25-34 years (10.5%), those who reported injectable and noninjectable drug use in the past 12 months (9.7%), those diagnosed <5 years ago (9.5%), those who self-reported sexual orientation as other (9.2%), and non-Hispanic White people (8.4%). Conclusions: Overall, findings suggest that a greater proportion of persons with diagnosed HIV used E-cigarettes than the overall U.S. adult population and that higher rates were observed among certain subgroups, including those who currently smoke cigarettes. E-cigarette use among persons with diagnosed HIV warrants continued attention because of its potential impact on HIV-related morbidity and mortality.

State Trends in HIV Testing Among US Adults Aged 18-64 Years, 2011-2017.

OBJECTIVES: HIV testing identifies persons living with HIV and can lead to treatment, decreased risk behaviors, and reduced transmission. The objective of our study was to describe state-level trends in HIV testing in the general US adult population aged 18-64 years, for both ever tested for HIV and tested for HIV in the previous 12 months. METHODS: Using 2011-2017 Behavioral Risk Factor Surveillance System data, we estimated the percentage of the state population, plus the District of Columbia, aged 18-64 years ever tested for HIV and tested for HIV in the previous 12 months. The 50 states and the District of Columbia were grouped according to the estimated prevalence of HIV in 2011. We used orthogonal contrasts to calculate P values for linear trends. RESULTS: The percentage of the population ever tested for HIV increased significantly in 23 states during 2011-2017, whereas the percentage tested for HIV in the previous 12 months increased significantly in 8 states. In 2017, the mean percentage ever tested for HIV in states with a high prevalence of HIV was 8.6 percentage points higher than the mean percentage in states with a low prevalence of HIV (48.5% vs 39.9%); the mean increase in the percentage ever tested was highest (11.4%) in states with a low prevalence of HIV. CONCLUSION: Enhanced efforts by states to make HIV testing simple, accessible, and routine are needed to reduce the number of persons who are not aware of their infection.

Use of enhanced perinatal human immunodeficiency virus surveillance methods to assess antiretroviral use and perinatal human immunodeficiency virus transmission in the United States, 1999-2001.

OBJECTIVE: Significant reductions in perinatal human immunodeficiency virus (HIV) transmission have been demonstrated in which the HIV-infected mothers and their HIV-exposed infants receive prenatal, intrapartum, and neonatal antiretroviral therapy. STUDY DESIGN: We used data that were collected through the Enhanced Perinatal Surveillance system for HIV-exposed singleton births that occurred 1999-2001 in 24 sites. RESULTS: The overall infant infection rate for the 3 years was 4.7%. Compared with zidovudine monotherapy, those patients who received zidovudine with other drugs that included a protease inhibitor and those who received zidovudine and other drugs with no protease inhibitor were less likely to have an infected infant (adjusted odds ratio, 0.4 [95% CI, 0.3-0.07]; adjusted odds ratio, 0.5 [95% CI, 0.3-0.8], respectively). CONCLUSION: These data support the current treatment recommendations and show that infants were less likely to be infected when the mothers were given a prenatal antiretroviral therapy regimen that contained zidovudine with additional antiretroviral drugs with or without a protease inhibitor in addition to receiving antiretrovirals during delivery and neonatally.

Toward elimination of perinatal human immunodeficiency virus transmission in the United States: effectiveness of funded prevention programs, 1999-2001.

The objective of the study was to assess the effectiveness of federal funds in preventing perinatal human immunodeficiency virus (HIV) transmission in the United States. We used surveillance data from 1999 and 2001 in 6 funded areas to estimate the proportion of HIV-infected women prescribed perinatal prophylaxis and whose infants were HIV infected. We compared outcomes with 5 unfunded areas in which surveillance data were available. The proportion of funded-area women prescribed prophylaxis increased from 80.1% to 85.9% (P < .01), compared with a decline in unfunded areas from 95.1% to 86.7% (P < .01); the difference in trends between groups was P < .01. The perinatal HIV transmission rate for funded areas declined from 6.5% (105 cases) in 1999 to 3.4% (46 cases) in 2001 (P < .01), compared with a decline in unfunded areas from 4.3% (19 cases) to 3.4% (13 cases) (P = .59); the difference in trends between groups was P = .24). The number of perinatal HIV infections in the funded areas decreased by 56%, achieving the Centers for Disease Control and Prevention's goal of a 50% reduction in incidence by 2005.

HIV Trends in the United States: Diagnoses and Estimated Incidence.

BACKGROUND: The best indicator of the impact of human immunodeficiency virus (HIV) prevention programs is the incidence of infection; however, HIV is a chronic infection and HIV diagnoses may include infections that occurred years before diagnosis. Alternative methods to estimate incidence use diagnoses, stage of disease, and laboratory assays of infection recency. Using a consistent, accurate method would allow for timely interpretation of HIV trends. OBJECTIVE: The objective of our study was to assess the recent progress toward reducing HIV infections in the United States overall and among selected population segments with available incidence estimation methods. METHODS: Data on cases of HIV infection reported to national surveillance for 2008-2013 were used to compare trends in HIV diagnoses, unadjusted and adjusted for reporting delay, and model-based incidence for the US population aged ≥13 years. Incidence was estimated using a biomarker for recency of infection (stratified extrapolation approach) and 2 back-calculation models (CD4 and Bayesian hierarchical models). HIV testing trends were determined from behavioral surveys for persons aged ≥18 years. Analyses were stratified by sex, race or ethnicity (black, Hispanic or Latino, and white), and transmission category (men who have sex with men, MSM). RESULTS: On average, HIV diagnoses decreased 4.0% per year from 48,309 in 2008 to 39,270 in 2013 (P<.001). Adjusting for reporting delays, diagnoses decreased 3.1% per year (P<.001). The CD4 model estimated an annual decrease in incidence of 4.6% (P<.001) and the Bayesian hierarchical model 2.6% (P<.001); the stratified extrapolation approach estimated a stable incidence. During these years, overall, the percentage of persons who ever had received an HIV test or had had a test within the past year remained stable; among MSM testing increased. For women, all 3 incidence models corroborated the decreasing trend in HIV diagnoses, and HIV diagnoses and 2 incidence models indicated decreases among blacks and whites. The CD4 and Bayesian hierarchical models, but not the stratified extrapolation approach, indicated decreases in incidence among MSM. CONCLUSIONS: HIV diagnoses and CD4 and Bayesian hierarchical model estimates indicated decreases in HIV incidence overall, among both sexes and all race or ethnicity groups. Further progress depends on effectively reducing HIV incidence among MSM, among whom the majority of new infections occur.

Characteristics of adults and adolescents who have migrated from place of AIDS diagnosis to place of death, United States, 1993-2001.

This study compared demographic characteristics of adults and adolescents who received an AIDS diagnosis in one state and died in a different state. We analyzed reports of deaths among persons (> or = 13 years old) with AIDS whose state of residence at diagnosis and state of occurrence of death were different (migrants). Between January 1993 and December 2001, 251,441 deaths of adults and adolescents with AIDS occurred. Of these, 13,860 (5.4%) migrated. Migrants were more likely to be male than female, white than black, and men who have sex with men than persons with heterosexual contact. A small proportion of persons with AIDS migrated between residence at AIDS diagnosis and place of death, suggesting that the effect of migration on destination health care services is likely to be small.

Predictors of influenza vaccination in HIV-infected patients in the United States, 1990-2002.

BACKGROUND: Although annual influenza vaccination of human immunodeficiency virus (HIV)-infected patients has been recommended in the United States since the early 1990s, vaccine coverage in this population is reported to be low. The objectives of the present study were to assess trends in influenza vaccination coverage in HIV-infected patients and to determine predictors of influenza vaccination. METHODS: We analyzed data from the medical records of 51,021 HIV-infected patients from 10 US cities observed in a longitudinal cohort study between 1990 and 2002. Using multivariate logistic regression, we determined predictors of influenza vaccination for both the pre-highly active antiretroviral therapy (HAART) and HAART eras. RESULTS: Vaccination coverage increased from 28.5% in the 1990 to 41.6% in the 2002 influenza season. Vaccine coverage increased with increasing age and frequency of medical visits. In the HAART era, persons prescribed antiretroviral therapy were more likely and those with higher viral loads and lower CD4 T cell counts were less likely to have received influenza vaccine. CONCLUSIONS: Although influenza vaccination coverage in this population has increased in recent years, it is well below the Healthy People 2010 target of 60%. Efforts should be undertaken to increase influenza vaccination in HIV-infected persons.

Preconception and interconception health status of women who recently gave birth to a live-born infant--Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 reporting areas, 2004.

PROBLEM/CONDITION: In 2006, CDC published recommendations to improve health and health care for women before pregnancy and between pregnancies (CDC. Recommendations to improve preconception health and health care--United States: a report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR 2006;55[No. RR-6]). The Pregnancy Risk Assessment Monitoring System (PRAMS) provides data concerning maternal behaviors, health conditions, and experiences for women in the United States who have delivered a live birth. REPORTING PERIOD COVERED: 2004. DESCRIPTION OF SYSTEM: PRAMS is an ongoing, state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver live-born infants in selected states and cities in the United States. PRAMS employs a mixed mode data-collection methodology; up to three self-administered questionnaires are mailed to a sample of mothers, and nonresponders are followed up with telephone interviews. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets that can be used to produce statewide estimates of perinatal health behaviors and experiences among women delivering live infants. This report summarizes data from 26 PRAMS reporting areas that collected data during 2004 and that had achieved overall weighted response rates of > or =70% and had weighted data available by the time the analysis was conducted in January 2007. Data are reported on indicators regarding 18 behaviors and conditions that are relevant to preconception (i.e., prepregnancy) health and health care and 10 that are relevant to interconception (i.e., postpartum) health and health care. The number of questions that were administered varied by site; certain questions were not asked for all reporting areas. RESULTS: With respect to preconception maternal behaviors and experiences, mean overall prevalence was 23.2% for tobacco use, 50.1% for alcohol use, 35.1% for multivitamin use at least four times a week, 53.1% for nonuse of contraception among women who were not trying to become pregnant, 77.8% for ever having a dental visit before pregnancy, 30.3% for receiving prepregnancy health counseling, 3.6% for experiencing physical abuse, and 18.5% for experiencing at least four stressors before pregnancy. With respect to preconception maternal health conditions, mean overall prevalence was 13.2% for women being underweight (body mass index [BMI]: <19.8), 13.1% for being overweight (BMI: 26.0-29.0), and 21.9% for being obese (BMI: > or =29.0). Mean overall prevalence was 1.8% for having diabetes, 6.9% for asthma, 2.2% for hypertension, 1.2% for heart problems, and 10.2% for anemia. Among women with a previous live birth, the mean overall prevalence of having a previous low birth weight infant was 11.6% and of having a previous preterm infant was 11.9%. With respect to interconception maternal behaviors and experiences, mean overall prevalence was 17.9% for tobacco use, 85.1% for contraceptive use, 15.7% for having symptoms of depression, and 84.8% for having social support. Mean overall prevalence was 7.5% for the most recent infant being born low birth weight, 10.4% for having a recent preterm infant, 89.3% for having a check-up, 89.0% for receiving contraceptive use counseling, 30.4% for having a dental visit, and 48.6% for receiving services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Results varied by maternal age, race/ethnicity, pregnancy intention, and health insurance status. For certain risk behaviors and health conditions, mean overall prevalence was higher among women aged <20 years, black women, women whose pregnancies were unintended, and women receiving Medicaid; however, no single subgroup was consistently at highest risk for all the indicators examined in this report. INTERPRETATION: PRAMS results varied among reporting areas. The prevalence estimates in the majority of reporting areas and for the majority of indicators suggest that a substantial number of women would benefit from preconception interventions to ensure that they enter pregnancy in optimal health. The results also demonstrate disparities among age and racial/ethnic subpopulations, especially with respect to prepregnancy medical conditions and access to health care both before conception and postpartum. Differences also exist in health behaviors between women who reported intended and unintended pregnancies. PUBLIC HEALTH ACTION: Maternal and child health programs can use PRAMS data to monitor improvements in maternal preconception and interconception behaviors and health status. The data presented in this report, which were collected before publication of CDC's recommendations to improve preconception health and health care in the United States, can be used as a baseline to monitor progress toward improvements in preconception and interconception health following publication of the recommendations. These data also can be used to identify specific groups at high risk that would benefit from targeted interventions and to plan and evaluate programs aimed at promoting positive maternal and infant health behaviors, experiences, and reproductive outcomes. In addition, the data can be used to inform policy decisions that affect the health of women and infants.