Vital Signs:HIV Transmission Along the Continuum of Care — United States, 2016

Abstract

Background In 2016, an estimated 1.1 million persons had human immunodeficiency virus (HIV) infection in the United States; 38,700 were new infections. Knowledge of HIV infection status, behavior change, and antiretroviral therapy (ART) all prevent HIV transmission. Persons who achieve and maintain viral suppression (achieved by most persons within 6 months of starting ART) can live long, healthy lives and pose effectively no risk of HIV transmission to their sexual partners. Methods A model was used to estimate transmission rates in 2016 along the HIV continuum of care. Data for sexual and needle-sharing behaviors were obtained from National HIV Behavioral Surveillance. Estimated HIV prevalence, incidence, receipt of care, and viral suppression were obtained from National HIV Surveillance System data. Results Overall, the HIV transmission rate was 3.5 per 100 person-years in 2016. Along the HIV continuum of care, the transmission rates from persons who were 1) acutely infected and unaware of their infection, 2) non-acutely infected and unaware, 3) aware of HIV infection but not in care, 4) receiving HIV care but not virally suppressed, and 5) taking ART and virally suppressed were 16.1, 8.4, 6.6, 6.1, and 0 per 100 person-years, respectively. The percentages of all transmissions generated by each group were 4.0%, 33.6%, 42.6%, 19.8%, and 0%, respectively. Conclusion Approximately 80% of new HIV transmissions are from persons who do not know they have HIV infection or are not receiving regular care. Going forward, increasing the percentage of persons with HIV infection who have achieved viral suppression and do not transmit HIV will be critical for ending the HIV epidemic in the United States.

Sustained HIV viral suppression among men who have sex with men in the Miami-Dade County Ryan White Program: the effect of demographic, psychosocial, provider and neighborhood factors

“…Keywords: Human immunodeficiency virus, Viral suppression, Sustained viral suppression, Durable viral suppression, Men who have sex with men Background Suppression of the human immunodeficiency virus (HIV) (< 200 copies/mL) among people living with HIV (PLHIV) is associated with immune reconstruction [1] and a decreased risk of acquired immune deficiency syndrome (AIDS)-defining conditions [2] and death [3]. In addition, viral suppression prevents the transmission of HIV to others [4]. A recent analysis of National HIV Surveillance System and National HIV Behavioral Surveillance data showed a rate of 0 per 100 person-years of HIV transmission for individuals on antiretroviral therapy (ART) with suppressed viral loads, but a rate of 6.1 per 100 personyears for individuals in care who were not virally suppressed [4].…”

“…In addition, viral suppression prevents the transmission of HIV to others [4]. A recent analysis of National HIV Surveillance System and National HIV Behavioral Surveillance data showed a rate of 0 per 100 person-years of HIV transmission for individuals on antiretroviral therapy (ART) with suppressed viral loads, but a rate of 6.1 per 100 personyears for individuals in care who were not virally suppressed [4].…”

The Health Resources and Services Administration’s Ryan White HIV/AIDS Program in rural areas of the United States: Geographic distribution, provider characteristics, and clinical outcomes

“…Rural PLWH are more likely to delay HIV testing and receive an HIV diagnosis at later disease stages than their non-rural counterparts [10][11][12][13]. PLWH who are unaware of their infection account for 38% of all HIV transmissions; those aware of their infection but not in care account for another 42% of all HIV transmissions [19]. Therefore, while this analysis demonstrated that nearly all PLWH accessing care from rural RWHAP are retained in care and reached viral suppression, lack of access to HIV testing services or linkage to HIV care services for newly diagnosed PLWH in rural areas could contribute to continued HIV transmission within rural areas.…”

“…Retention in care and viral suppression are key steps along the HIV care continuum; PLWH who are retained in care are more likely to achieve viral suppression, and viral suppression is associated with improved health outcomes [16][17][18]. PLWH who are unaware of their HIV status or are aware of their status but are not actively engaged in HIV care are more likely to transmit HIV than PLWH who are aware of their HIV status and virally suppressed [19].…”

HIV Testing Among Adolescents With Acute Sexually Transmitted Infections

“…[16][17][18] Unfortunately, AYAs 13 to 24 years old have the highest transmission rate among all people living with HIV. 19 To make strides toward the Presidential Plan to End the HIV Epidemic, 20 we must identify missed opportunities for HIV testing and use these as gateways to treatment and prevention, especially in vulnerable AYAs. 21 Our primary research objective was to examine rates of HIV testing after an incident STI among AYAs in primary care settings and identify patient and health care factors related to receipt of HIV testing, which may serve as targets for future interventions to improve HIV testing.…”