Today, the Centers for Disease Control and Prevention (CDC) published new HIV care continuum estimates showing that nearly half (49%) of Americans living with HIV now have the virus under control. (Using a different methodology, CDC previously estimated that, in 2010, only 28% of people living with HIV were virally suppressed.) While the new estimates are encouraging, too many people living with HIV are still not getting the care and treatment they need.
The latest HIV surveillance supplemental report: Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2015, also published today, serves as a source document for the continuum, which is now based entirely on the National HIV Surveillance System (NHSS). Because the NHSS now contains data that are substantially more complete and timely than they were just a few years ago, this, together with improved methodology, provides more reliable measures of progress toward the national goal of achieving viral suppression. CDC will continue to use data from the Monitoring Report to track the HIV care continuum in two different ways, both of which are essential to gauging progress and directing HIV prevention resources most effectively.
The prevalence-based continuum—which monitors progress among all people living with HIV in the U.S., whether their infection has been diagnosed or they are unaware of their infection—enables CDC to monitor overall national progress. In this continuum, the denominator of total HIV prevalence is based, for the first time, on an improved estimation method that relies on a person’s first CD4 count.
The prevalence-based continuum data show us that, in 2014, of the 1.1 million people living with HIV:
85% had their infection diagnosed (2020 national goal: 90%)
62% were receiving HIV medical care (≥1 CD4 or VL test in 2014)
48% were retained in care (≥2 CD4 or VL tests, at least 3 months apart)
49% had the virus under control (viral suppression)
In addition to providing a snapshot of how the country is doing among all persons living with HIV, the prevalence-based continuum can also be used to compare U.S. data to other countries that monitor the continuum among all persons living with HIV; monitor testing efforts in the United States, which helps demonstrate the important role HIV diagnosis plays in achieving viral suppression; and monitor outcomes for broad populations such as African Americans or men who have sex with men (MSM). However, because of certain statistical limitations, the prevalence-based continuum does not provide information for sub-populations. The diagnosis-based continuum tracks progress among people who are living with diagnosed HIV infection and can be used to monitor outcomes among key sub-populations. For example, this continuum can be used to measure progress toward national goals aimed at reducing disparities for specific groups, such as Latino gay and bisexual men and young black MSM. It can also be used to monitor care outcomes at the state and local levels, which helps inform decision-making around programs and resource allocation as well as to identify additional action steps needed to meet national goals.
The diagnosis-based continuum data show that, in 2014, among people living with diagnosed HIV:
73% were receiving HIV medical care
57% were retained in care (2020 goal: 90% or more)
58% were virally suppressed (2020 goal: 80% or more)
In addition, the diagnosis-based continuum can also be used to monitor U.S. progress in comparison to national-level 2020 goals and to the UNAIDS 90-90-90 goals, both of which acknowledge testing and diagnosis as vital strategies in the nation’s efforts to reduce new HIV infections. CDC’s latest Monitoring Report shows that younger Americans are the least likely to have the virus suppressed, in large part because many don’t know they have HIV. With 9 out of 10 HIV infections being transmitted by people who are not aware of their infection or not in care, reducing the number of undiagnosed HIV infections and getting more people into care present the greatest opportunities to improve viral suppression in America. As part of ongoing efforts to get more people into care and achieving viral suppression, CDC funding supports more than 3 million tests across the country every year that identify, on average, more than 12,000 people with HIV whose infections were not previously diagnosed — accounting for one-third of annual HIV diagnoses. Testing is clearly the gateway to care for people living with HIV. For those who receive an HIV diagnosis, the test is the crucial first step toward care and treatment. For those who are not infected, testing opens the door to more advanced prevention options such as pre-exposure prophylaxis (PrEP). CDC remains firmly committed to ensuring that every person living with HIV in America has their infection diagnosed, is connected to medical care, and receives treatment over the long term. Although the work we do in HIV prevention has long been an uphill battle, we must continue to work together and strive for progress in the face of new challenges. Recent data indicate that national goals are within reach if we, as a community and as a nation, work collaboratively to ensure those at risk are getting the testing and those with diagnosed infection are getting the treatment they need. Thank you for continuing to work harder, together.
For more information, please see CDC’s updated slide set and fact sheets: Selected National HIV Prevention and Care Outcomes in the United States and Understanding the HIV Care Continuum. The Monitoring Report and continuum will be published annually in July.