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Clusters are a sign of rapid transmission
An HIV cluster or outbreak refers to rapid HIV transmission among people in a sexual or drug-using network. This can occur because communities have limited or no access to HIV prevention and care services. Stigma, discrimination, racism, poverty, and other social and structural factors all contribute to limiting access to these services. Health departments, community-based organizations (CBOs), and other partners use CDR to address these service gaps and improve health equity.
Prioritizing response to HIV clusters is important because clusters have very rapid transmission. For example:
- Transmission rates in molecular clusters average 8-11 times the national rate.
- Some clusters and outbreaks have had transmission rates more than 30 times the national rate.
- Rapidly growing clusters contribute disproportionately to future transmission.
People in detected clusters are only part of the network affected by rapid transmission
For CDR activities, “network” refers to the people in an HIV cluster and those with whom they have sex or share drugs, who may or may not have HIV. Some people with HIV can be in the network, even if they weren’t part of the initially detected cluster. People without HIV in the same sexual or drug-using networks are also considered part of the larger network.
Responding to clusters at individual, network, and systems levels
Because the network experiencing rapid transmission extends beyond the detected cluster, health departments should work to understand the network. Health departments can then address gaps in prevention and care at the individual, network, and systems levels. See Cluster Investigation and Response for examples of these activities.
Resources
- Oster AM, Lyss SB, McClung RP, et al. HIV Cluster and Outbreak Detection and Response: The Science and Experience. Am J Prev Med. Nov 2021;61(5 Suppl 1):S130 S142.
- Oster AM, France AM, Panneer N, et al. Identifying Clusters of Recent and Rapid HIV Transmission Through Analysis of Molecular Surveillance Data. J Acquir Immune Defic Syndr. Dec 15 2018;79(5):543-550.
- France AM, Panneer N, Ocfemia MCB, et al. Rapidly growing HIV transmission clusters in the United States, 2013–2016. presented at: Conference on Retroviruses and Opportunistic Infections; March 2018 Boston, MA.
- McClung RP, Atkins AD, Kilkenny M, et al. Response to a Large HIV Outbreak, Cabell County, West Virginia, 2018-2019. Am J Prev Med. Nov 2021;61(5 Suppl 1):S143-S150.
Source of original article: Centers for Disease Control and Prevention (CDC) / HIV (tools.cdc.gov).
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