Core Indicators for Monitoring the Ending the HIV Epidemic Initiative (Preliminary Data)

Technical Notes

The Ending the HIV Epidemic in the U.S. (EHE) initiative leverages critical scientific advances in HIV prevention, diagnosis, treatment, and outbreak response [1]. The goal of the initiative is to reduce new HIV infections by 75% by 2025 and then by at least 90% by 2030. The Centers for Disease Control and Prevention (CDC) routinely releases HIV Surveillance Data Tables on the core indicators for EHE to allow for more timely monitoring of progress. The full list of EHE core indicators and their definitions can be found in the Technical Notes of the Core Indicators for Monitoring the Ending the HIV Epidemic Initiative report at https://www.cdc.gov/hiv/pdf/library/reports/surveillance-data-tables/vol-1-no-1/cdc-hiv-surveillance-tables-vol-1-no-1.pdf [PDF – 1.4 MB].

The tables included in this report provide preliminary data on HIV diagnoses and linkage to HIV medical care reported to CDC as of September 2022 for the years 2021 and 2022, and data on preexposure prophylaxis (PrEP) coverage for the years 2019, 2020, 2021, and 2022 (preliminary). Data for the 3 indicators are provided at the national, state, and county levels (EHE Phase I jurisdictions only). See Tabulation and Presentation of Data for details on how the indicators are calculated.

Tabulation and Presentation of Data

Diagnoses of HIV Infection

Diagnoses of HIV infection are the numbers of per­sons aged ≥13 years with HIV diagnosed during Janu­ary 2021 through September 2022 (Tables 1a–d). Data presented were reported (after the removal of person­ally identifiable information) to CDC.

An evaluation of surveillance data (2015–2019 diagnoses) found that, on average, approximately 75% of HIV diagnoses are reported to CDC during the year of diagnosis and approximately 95% of HIV diagnoses are reported to CDC by the end of the fol­lowing year. Data reported to the National HIV Sur­veillance System (NHSS) are considered preliminary until a 12-month reporting delay has been reached and should be interpreted with caution.

More information on counting diagnoses of HIV infection can be found at https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-33/ (HIV Surveillance Report, 2020).

Linkage to HIV Medical Care

Linkage to HIV medical care within 1 month of HIV diagnosis is measured for persons aged ≥ 13 years whose infection was diagnosed during January 2021 through June 2022 and who resided in any of the jurisdictions (including EHE Phase I jurisdictions) with complete reporting of laboratory data to CDC at the time of diagnosis (Tables 2a–c). The numerator is the number of persons aged ≥ 13 years whose HIV infection was diagnosed during January 2021 through June 2022 and who had ≥ 1 CD4 T-lymphocyte (CD4) or viral load (VL) tests within 1 month of HIV diagnosis. The denominator is the number of persons aged ≥ 13 years whose HIV infection was diagnosed during January 2021 through June 2022. Reporting of linkage to HIV medical care data requires a minimum 3-month reporting delay to account for delays in reporting of laboratory results to NHSS; therefore, data on linkage to HIV medical care in these surveillance tables are for persons whose HIV infection was diagnosed during January 2021 through June 2022 and was reported to NHSS through September 2022. Data are not provided for states and associated jurisdictions that do not have laws requiring reporting of all CD4 and viral loads, or that have incomplete reporting of laboratory data to CDC. Area without laws: Idaho. Areas with incomplete reporting: Kentucky, New Jersey, Pennsylvania (excluding Philadelphia), Puerto Rico, and Vermont.

Data reported to NHSS are considered preliminary until a 12-month reporting delay has been reached and should be interpreted with caution.

More information on calculating linkage to care can be found at https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-27-no-3 (Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2020 [PDF – 11 MB]).

Preexposure Prophylaxis (PrEP) Coverage

Preexposure prophylaxis (PrEP) coverage, reported as a percentage, is defined as the number of persons aged ≥ 16 years classified as having been prescribed PrEP during the specified year divided by the estimated number of persons aged ≥ 16 years who had indications for PrEP during the specified year (Tables 3a–c). PrEP coverage is an EHE indicator that is not a reportable disease or condition and is not reported to NHSS. Multiple data sources, described below, are used to calculate PrEP coverage.

Please use caution when interpreting PrEP data. Different data sources were used in the numerator and denominator to calculate PrEP coverage.

Persons prescribed PrEP

National pharmacy data from the IQVIA Real World Data—Longitudinal Prescriptions database (hereafter, IQVIA database) are used to classify persons aged ≥ 16 years who have been prescribed PrEP in the specific year. The IQVIA database captures prescriptions from all payers and represents approximately 93% of all prescriptions from retail pharmacies and 77% from mail-order outlets in the United States. The database does not include prescriptions from some closed health care systems that do not make their prescription data available to IQVIA. Therefore, these are minimum estimates of PrEP coverage. The annual number of persons classified as having been prescribed PrEP was based on a validated algorithm that discerns whether tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) was prescribed for PrEP after excluding prescriptions for HIV treatment, hepatitis B treatment, or HIV postexposure prophylaxis [2–4]. Tenofovir alafenamide and emtricitabine (TAF/FTC) was approved as an alternative drug for PrEP by the U.S. Food and Drug Administration (FDA) in October 2019. Starting in 2019, TAF/FTC was included in the algorithm to classify the number of persons prescribed PrEP.

The number of persons classified as having been prescribed PrEP is reported by sex, age group, and race/ethnicity. Transmission category data are not available in the IQVIA database, and race/ethnicity data are available for < 40% of persons with PrEP prescriptions. Please use caution when interpreting PrEP data by race/ethnicity. Race/ethnicity categories available in the IQVIA database include White, Black/African American, Hispanic/Latino, and other. The number of persons prescribed PrEP for each racial/ethnic group presented in this report was extrapolated by applying the racial/ethnic distribution of known records to those for which data on race/ethnicity were unknown.

Geographic Designations

In the IQVIA database, a person’s location is reported as a 3-digit ZIP code prefix (hereafter, ZIP3) assigned by the U.S. Postal Service. To estimate the number of persons prescribed PrEP at the state or county level, a probability-based approach is used to crosswalk between ZIP3s and states/counties by using data from (a) the U.S. Census Bureau’s American Community Survey (ACS) 5-year estimates by ZIP Code Tabulation Areas (ZCTAs) [5], and (b) the U.S Department of Housing and Urban Development’s ZIP Code Crosswalk Files [6]. Because of reliability concerns, subnational estimates of < 40 are not included.

Persons with PrEP indications

U.S. Census Bureau files and their ACS were used to estimate the number of men who have sex with men (MSM) in a jurisdiction [7, 8]. Next, behavioral data from the National Health and Nutrition Examination Survey (NHANES) were used to estimate the proportion of HIV-negative MSM with indications for PrEP [9].

The number of HIV-negative MSM with indications for PrEP was multiplied by the ratio of percentage of diagnoses during the specified year attributed to other major transmission risk groups compared to the percentage among MSM in a given state or county. The estimated numbers of persons with indications for PrEP in the 3 major transmission risk groups (MSM, heterosexuals, persons who inject drugs) in each jurisdiction were then summed to yield a state- or county-specific estimate. State estimates were then summed for a national total of persons with indications for PrEP [7]. Jurisdictional estimates were rounded to the nearest 10.

The tables included in this report provide updated data on PrEP coverage for the years 2019–June 2022 by using the IQVIA data reported through June 2022. IQVIA conducts data quality assurance activities. As a result, the number of persons classified as having been prescribed PrEP in a given year might change from time to time. The impact of the changes may vary by demographic category nationally and by jurisdiction. The data sources used to estimate the number of persons with indications for PrEP have different schedules of availability. Consequently, the availability of a denominator lags the availability of a numerator by approximately 1 year. PrEP coverage data with a lagged denominator are considered preliminary.

For this release of HIV Surveillance Data Tables, 2018 denominators were used for 2019, 2020, 2021, and 2022 PrEP coverage data; consequently, 2019 through June 2022 PrEP coverage data are considered preliminary. In addition to being preliminary, data for the year 2020 should be interpreted with awareness of the impact of the COVID-19 pandemic on filling PrEP prescriptions in state/local jurisdictions [10].

More information on calculating PrEP coverage can be found at https://www.cdc.gov/hiv/library/reports/ hiv-surveillance/vol-27-no-3/ (Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2020 [PDF – 11 MB]).

References

1. HHS. What is Ending the HIV Epidemic in the U.S.? https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview. Updated July 2, 2022. Accessed November 9, 2022.
2. Wu H, Mendoza MC, Huang YA, Hayes T, Smith DK, Hoover KW. Uptake of HIV preexposure prophylaxis among commercially insured persons—United States, 2010–2014. Clin Infect Dis 2017;64(2):144–149. doi:10.1093/cid/ciw701
3. CDC [Huang YA, Zhu W, Smith DK, Harris N, Hoover KW]. HIV preexposure prophylaxis, by race and ethnicity—United States, 2014–2016. MMWR 2018;67(41):1147–1150. doi:10.15585/mmwr.mm6741a3
4. Furukawa NW, Smith DK, Gonzalez CJ, et al. Evaluation of algorithms used for PrEP surveillance using a reference population from New York City, July 2016–June 2018. Public Health Rep 2020;135(2):202–210. doi:10.1177/0033354920904085
5. U.S. Census Bureau. American Community Survey 5-year data (2009–2020). https://www.census.gov/data/developers/data-sets/acs-5year.2019.html. Published March 2022. Accessed November 9, 2022.
6. U.S. Department of Housing and Urban Development (HUD). HUD USPS ZIP code crosswalk files. https://www.huduser.gov/portal/datasets/usps_crosswalk.html. Updated August 2022. Accessed November 9, 2022.
7. Grey JA, Bernstein KT, Sullivan PS, et al. Estimating the population sizes of men who have sex with men in US states and counties using data from the American Community Survey. JMIR Public Health Surveill 2016;2(1):e14. doi:10.2196/publichealth.5365
8. Purcell DW, Johnson CH, Lansky A, et al. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. Open AIDS J 2012;6:98–107. doi:10.2174/1874613601206010098
9. CDC [Smith DK, Van Handel M, Wolitski RJ, et al]. Vital Signs: Estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV acquisition—United States, 2015. MMWR 2015;64(46):1291–1295. doi:10.15585/mmwr.mm6446a4
10. Huang YA, Zhu W, Wiener J, Kourtis AP, Hall HI, Hoover KW. Impact of COVID-19 on HIV preexposure prophylaxis prescriptions in the United States—a time series analysis. Clin Infect Dis 2022:ciac038. doi:10.1093/cid/ciac038

Suggested Citation

Centers for Disease Control and Prevention. Core indicators for monitoring the Ending the HIV Epidemic initiative (preliminary data): National HIV Surveillance System data reported through September 2022; and preexposure prophylaxis (PrEP) data reported through June 2022. HIV Surveillance Data Tables 2022;3(4). https://www.cdc.gov/hiv/library/reports/surveillance-data-tables/. Published December 2022. Accessed [date].

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Acknowledgments

HIV Surveillance Data Tables was prepared by the following staff and contractors of the Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC: Anna Satcher Johnson, Zanetta Gant, Ya-lin Huang, Weiming Zhu, Dawn Smith, Jianmin Li, Xiaohong Hu, Hao Chang, Pei Hou, Chelsea Walker, Emily Zhu, Lei Yu, Ishwarya Ravichandran, Avery Smithson, Wei Wei, Iddrisu Abdallah, Norma Harris, and Michael Friend (editing and desktop publishing).

The Web and Consumer Services Team of the Prevention Communications Branch are acknowledged for their contributions to the report website.

Publication of HIV Surveillance Data Tables was made possible by the contributions of the state and territorial health departments and the HIV surveillance programs that provided surveillance data to CDC.

Abbreviation: CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data are for cases reported to CDC through September 2022. Data are considered preliminary until a 12-month reporting delay has been reached and should be interpreted with caution.

^a“Transgender woman” includes individuals who were assigned “male” sex at birth but have ever identified as “female” gender. “Transgender man” includes individuals who were assigned “female” sex at birth but have ever identified as “male” gender.
^bAdditional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
^cHispanic/Latino persons can be of any race.
^dTransmission category is classified based on a hierarchy of the risk factors most likely responsible for HIV transmission; classification is determined based on the person’s assigned sex at birth. Data have been statistically adjusted to account for missing transmission category; therefore values may not sum to column totals. Data include transgender and additional gender identity persons.
^eSexual contact with a person known to have, or with a risk factor for, HIV infection.
^fOther risk factors, including hemophilia, blood transfusion, and risk factor not reported or not identified.
^gData are based on residence at time of diagnosis of HIV infection.

Abbreviation: CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data are for cases reported to CDC through September 2022. Data are considered preliminary until a 12-month reporting delay has been reached and should be interpreted with caution.

^a“Transgender woman” includes individuals who were assigned “male” sex at birth but have ever identified as “female” gender. “Transgender man” includes individuals who were assigned “female” sex at birth but have ever identified as “male” gender.
^bAdditional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
^cHispanic/Latino persons can be of any race.
^dTransmission category is classified based on a hierarchy of the risk factors most likely responsible for HIV transmission; classification is determined based on the person’s assigned sex at birth. Data have been statistically adjusted to account for missing transmission category; therefore, values may not sum to column totals. Data include transgender and additional gender identity persons.
^eSexual contact with a person known to have, or with a risk factor for, HIV infection.
^fOther risk factors, including hemophilia, blood transfusion, and risk factor not reported or not identified.
^gData are based on residence at time of diagnosis of HIV infection.

Abbreviation: CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data are based on residence at diagnosis of HIV infection. Data are for cases reported to CDC through September 2022. Data are considered preliminary until a 12-month reporting delay has been reached and should be interpreted with caution.

Abbreviation: CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data are based on residence at diagnosis of HIV infection. Data are for cases reported to CDC through September 2022. Data are considered preliminary until a 12-month reporting delay has been reached and should be interpreted with caution.

Abbreviations: CD4, CD4+ T-lymphocyte count (cells/µL) or percentage; VL, viral load (copies/mL); CDC, the Centers for Disease Control and Prevention [footnotes only]; NHSS, National HIV Surveillance System [footnotes only].

Note. Data are based on residence at diagnosis of HIV infection. Data are for cases reported to CDC through September 2022, are considered preliminary until a 12-month reporting delay has been reached and should be interpreted with caution. Linkage to HIV medical care was measured by documentation of ≥ 1 CD4 or VL tests ≤ 1 month after HIV diagnosis. Reporting of linkage to HIV medical care data requires a minimum 3-month reporting delay to account for delays in reporting of laboratory results to NHSS; therefore, data on linkage to HIV medical care in these surveillance tables are for persons with HIV diagnosed during January 2021 through June 2022 and reported to NHSS through September 2022. Data are not provided for states and associated counties that do not have laws requiring reporting of all CD4 and viral loads, or that have incomplete reporting of laboratory data to CDC. Areas without laws: Idaho. Areas with incomplete reporting: Kentucky, New Jersey, Pennsylvania (excluding Philadelphia), and Vermont.

^a“Transgender woman” includes individuals who were assigned “male” sex at birth but have ever identified as “female” gender. “Transgender man” includes individuals who were assigned “female” sex at birth but have ever identified as “male” gender.
^bAdditional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
^cHispanic/Latino persons can be of any race.
^dTransmission category is classified based on a hierarchy of the risk factors most likely responsible for HIV transmission; classification is determined based on the person’s assigned sex at birth. Data have been statistically adjusted to account for missing transmission category; therefore, values may not sum to column totals. Data include transgender and additional gender identity persons.
^eSexual contact with a person known to have, or with a risk factor for, HIV infection.
^fIncludes persons whose infection was attributed to other risk factors including hemophilia, blood transfusion, and risk factor not reported or not identified. Data not displayed because the numbers were too small to be meaningful.

Abbreviations: CD4, CD4+ T-lymphocyte count (cells/µL) or percentage; VL, viral load (copies/mL); CDC, the Centers for Disease Control and Prevention [footnotes only]; NHSS, National HIV Surveillance System [footnotes only].

Note. Data are based on residence at diagnosis of HIV infection. Data are for cases reported to CDC through September 2022, are considered preliminary until a 12-month reporting delay has been reached and should be interpreted with caution. Linkage to HIV medical care was measured by documentation of ≥1 CD4 or VL tests ≤1 month after HIV diagnosis. Reporting of linkage to HIV medical care data requires a minimum 3-month reporting delay to account for delays in reporting of laboratory results to NHSS; therefore, data on linkage to HIV medical care in these surveillance tables are for persons with HIV diagnosed during January 2021 through June 2022 and reported to NHSS through September 2022. Data not provided for states and associated counties that do not have laws requiring reporting of all CD4 and viral loads, or that have incomplete reporting of laboratory data to CDC. Areas without laws: Idaho. Areas with incomplete reporting: Kentucky, New Jersey, Pennsylvania, Puerto Rico, and Vermont.

Abbreviations: CD4, CD4+ T-lymphocyte count (cells/µL) or percentage; VL, viral load (copies/mL); CDC, the Centers for Disease Control and Prevention [footnotes only]; NHSS, National HIV Surveillance System [footnotes only].

Note. Data are based on residence at diagnosis of HIV infection. Data are for cases reported to CDC through September 2022, are considered preliminary until a 12-month reporting delay has been reached and should be interpreted with caution. Linkage to HIV medical care was measured by documentation of ≥ 1 CD4 or VL tests ≤ 1 month after HIV diagnosis. Reporting of linkage to HIV medical care data requires a minimum 3-month reporting delay to account for delays in reporting of laboratory results to NHSS; therefore, data on linkage to HIV medical care in these surveillance tables are for persons with HIV diagnosed during January 2021 through June 2022 and reported to NHSS through September 2022. Data not provided for states and associated counties that do not have laws requiring reporting of all CD4 and viral loads, or that have incomplete reporting of laboratory data to CDC. Areas without law: Idaho. Areas with incomplete reporting: Kentucky, New Jersey, Pennsylvania (excluding Philadelphia), Puerto Rico, and Vermont.

Abbreviations: PrEP, preexposure propphylaxis; n/a, not available.

Note. Data for years 2020 and 2021 should be interpreted with caution due to the impact of the COVID-19 pandemic on filling PrEP prescriptions in state/local jurisdictions.

^aEstimated using data from IQVIA pharmacy database reported through June 2022 based on an algorithm that included FDA approved drugs for PrEP. Data for which values are unknown were not reported thus values may not sum to column total.
^bEstimated using 2018 data from National HIV Surveilance System, National Health and Nutrition Examination Survey, and U.S. Census Bureau’s American Community Survey. Data are rounded to the nearest 10. Data for which values are unknown were not reported thus values may not sum to column total. The data sources used to estimate the number of persons with indications for PrEP have different schedules of data availability. Consequently, the availability of a denominator may lag the availability of a numerator.
^cPrEP coverage, reported as a percentage, was calculated as the number who have been prescribed PrEP divided by the estimated number of persons who had indications for PrEP.
^dRace/ethnicity data were only available for <40% of persons prescribed PrEP each year. Number prescribed PrEP and PrEP coverage for race/ethnicity reported in the table were adjusted applying the distribution of records with known race/ethnicity to records with missing race/ethnicity.
^eHispanic/Latino can be of any race.

Abbreviations: PrEP, preexposure propphylaxis; n/a, not available.

Note. Data for years 2020 and 2021 should be interpreted with caution due to the impact of the COVID-19 pandemic on filling PrEP prescriptions in state/local jurisdictions

^aEstimated using data from IQVIA pharmacy database reported through June 2022 based on an algorithm that included FDA approved drugs for PrEP. Data for which values are unknown were not reported thus values may not sum to column total.
^bEstimated using 2018 data from National HIV Surveilance System, National Health and Nutrition Examination Survey, and U.S. Census Bureau’s American Community Survey. Data are rounded to the nearest 10. Data for which values are unknown were not reported thus values may not sum to column total. The data sources used to estimate the number of persons with indications for PrEP have different schedules of data availability. Consequently, the availability of a denominator may lag the availability of a numerator.
^cPrEP coverage, reported as a percentage, was calculated as the number who have been prescribed PrEP divided by the estimated number of persons who had indications for PrEP.

^aEstimated using data from IQVIA pharmacy database reported through June 2022 based on an algorithm that included FDA approved drugs for PrEP. Data for which values are unknown were not reported thus values may not sum to column total.
^bEstimated using 2018 data from National HIV Surveilance System, National Health and Nutrition Examination Survey, and U.S. Census Bureau’s American Community Survey. Data are rounded to the nearest 10. Data for which values are unknown were not reported thus values may not sum to column total. The data sources used to estimate the number of persons with indications for PrEP have different schedules of data availability. Consequently, the availability of a denominator may lag the availability of a numerator.
^cPrEP coverage, reported as a percentage, was calculated as the number who have been prescribed PrEP divided by the estimated number of persons who had indications for PrEP.
^dData value <40 was not reported due to unreliability.

Abbreviations: CDC, the Centers for Disease Control and Prevention [footnotes only]; PrEP, preexposure prophylaxis [footnotes only]; CD4, CD4+ T-lymphocyte count (cells/μL) or percentage [footnotes only].

Note. For more information on the Ending the HIV Epidemic in the U.S. initiative, see https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview.

^aLinkage to care and viral suppression data are not provided for states and associated counties that have incomplete reporting of laboratory data to CDC: Kentucky, New Jersey, Pennsylvania (excluding Philadelphia), and Puerto Rico.