HIV Testing in 50 Local Jurisdictions Accounting for the Majority of New HIV Diagnoses and Seven States with Disproportionate Occurrence of HIV in Rural Areas, 2016-2017

Abstract

Since 2006, CDC has recommended universal screening for human immunodeficiency virus (HIV) infection at least once in health care settings and at least annual rescreening of persons at increased risk for infection (1,2), but data from national surveys and HIV surveillance demonstrate that these recommendations have not been fully implemented (3,4). The national Ending the HIV Epidemic initiative* is intended to reduce the number of new infections by 90% from 2020 to 2030. The initiative focuses first on 50 local jurisdictions (48 counties, the District of Columbia, and San Juan, Puerto Rico) where the majority of new diagnoses of HIV infection in 2016 and 2017 were concentrated and seven states with a disproportionate occurrence of HIV in rural areas relative to other states (i.e., states with at least 75 reported HIV diagnoses in rural areas that accounted for ≥10% of all diagnoses in the state).^† This initial geographic focus will be followed by wider implementation of the initiative within the United States. An important goal of the initiative is the timely identification of all persons with HIV infection as soon as possible after infection (5). CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS)^§ to assess the percentage of adults tested for HIV in the United States nationwide (38.9%), in the 50 local jurisdictions (46.9%), and in the seven states (35.5%). Testing percentages varied widely by jurisdiction but were suboptimal and generally low in jurisdictions with low rates of diagnosis of HIV infection. To achieve national goals and end the HIV epidemic in the United States, strategies must be tailored to meet local needs. Novel screening approaches might be needed to reach segments of the population that have never been tested for HIV.

FIGURE

Percentage of adults aged ≥18 years ever tested for human immunodeficiency virus (HIV) infection and HIV diagnosis rate among persons aged ≥13 years — Behavioral Risk Factor Surveillance System and National HIV Surveillance System (NHSS), 50 local jurisdictions accounting for the majority of new HIV diagnoses and seven states with disproportionate occurrence of HIV in rural areas, 2016–2017 * HIV diagnosis rates per 100,000 population among persons aged ≥13 years during 2016–2017 were calculated from HIV diagnoses reported to NHSS through December 2018 and Census population estimates for 2016 and 2017. ^† The 50 local jurisdictions (48 counties, the District of Columbia, and San Juan, Puerto Rico) accounted for the majority of new HIV diagnoses, and the seven states (Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina) experienced disproportionate occurrence of HIV in rural areas, as identified from HIV diagnoses made during 2016–2017 and reported to NHSS through June 2018. Diagnosis data from 2017 were considered preliminary/ ^§ Pearson’s correlation coefficient = 0.71; p<0.01.