Volume 4, Number 3 | HIV Surveillance Data Tables | Reports | Resource Library | HIV

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 by 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, available 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.

The tables included in this report provide preliminary data on HIV diagnoses and linkage to HIV medical care for the years 2022 and 2023 based on cases reported to CDC as of June 2023. Data on preexposure prophylaxis (PrEP) coverage are provided for the years 2019, 2020, 2021, 2022, and 2023 (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 2022 through June 2023 (Tables 1a–d). Data presented were reported (after the removal of personally identifiable information) to CDC.

An evaluation of surveillance data (2016–2020 diagnoses) found that, on average, approximately 80% of HIV diagnoses are reported to CDC during the year of diagnosis and approximately 98% of HIV diagnoses are reported to CDC by the end of the following year. Data for years 2022 and 2023 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 in the HIV Surveillance Report, 2021, available at https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-34/index.html.

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 2022 through March 2023 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 2022 through March 2023 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 2022 through March 2023. 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 2022 through March 2023 and reported to NHSS through June 2023. Data for the year 2022 are considered preliminary until a 12-month reporting delay has been reached and should be interpreted with caution.

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. Areas without laws: Idaho. Areas with incomplete reporting: New Jersey, Pennsylvania (excluding Philadelphia), and Puerto Rico.

More information on calculating linkage to care can be found in Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2021, available at https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-28-no-4/index.html.

Preexposure Prophylaxis (PrEP) Coverage

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 note that changes in the total percentage across each report are because data are received at multiple points through the year; readers should note the period for which the data are calculated and use caution when comparing partial year data to full year data.

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 94% of all prescriptions from retail pharmacies and 74% 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. Long-acting injectable cabotegravir (CAB-LA) was approved by the FDA as an additional prevention option for PrEP in December 2021. After the respective approvals, TAF/FTC and CAB-LA were 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 gay, bisexual, and other 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 2019–2023 by using the IQVIA data reported through March 2023. 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. PrEP coverage data with a lagged denominator are considered preliminary.

For this release of HIV Surveillance Data Tables, 2018 denominators were used for 2019 through 2023 PrEP coverage data; consequently, 2019 through 2023 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 in Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2021, available at https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html.