Vital Signs: Human Immunodeficiency Virus Testing and Diagnosis Delays — United States

Abstract

BackgroundPersons unaware of their human immunodeficiency virus (HIV) infection account for approximately 40% of ongoing transmissions in the United States. Persons are unaware of their infection because of delayed HIV diagnoses that represent substantial missed opportunities to improve health outcomes and prevent HIV transmission.MethodsData from CDC’s National HIV Surveillance System were used to estimate, among persons with HIV infection diagnosed in 2015, the median interval (and range) from infection to diagnosis (diagnosis delay), based on the first CD4 test after HIV diagnosis and a CD4 depletion model indicating disease progression and, among persons living with HIV in 2015, the percentage with undiagnosed infection. Data from CDC’s National HIV Behavioral Surveillance were analyzed to determine the percentage of persons at increased risk for HIV infection who had tested in the past 12 months and who had missed opportunities for testing.ResultsAn estimated 15% of persons living with HIV in 2015 were unaware of their infection. Among the 39,720 persons with HIV infection diagnosed in 2015, the estimated median diagnosis delay was 3.0 years (interquartile range = 0.7–7.8 years); diagnosis delay varied by race/ethnicity (from 2.2 years among whites to 4.2 years among Asians) and transmission category (from 2.0 years among females who inject drugs to 4.9 years among heterosexual males). Among persons interviewed through National HIV Behavioral Surveillance, 71% of men who have sex with men, 58% of persons who inject drugs, and 41% of heterosexual persons at increased risk for HIV infection reported testing in the past 12 months. In each risk group, at least two thirds of persons who did not have an HIV test had seen a health care provider in the past year.ConclusionsDelayed HIV diagnoses continue to be substantial for some population groups and prevent early entry to care to improve health outcomes and reduce HIV transmission to others.Implications for Public Health PracticeHealth care providers and others providing HIV testing can reduce HIV-related adverse health outcomes and risk for HIV transmission by implementing routine and targeted HIV testing to decrease diagnosis delays.

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

“…To end the HIV epidemic in the United States, the HHS initiative directs a path forward for success ( 6 ). First, early detection of HIV infection must be improved ( 11 ). Second, once HIV infection is identified, rapid entry into care and prevention services is crucial to ensure achievement of viral suppression as quickly as possible.…”

“…Routine testing and targeted HIV testing are complementary approaches to addressing the 38% of transmissions that occurred from the estimated 15% of persons with undiagnosed HIV infection, by increasing awareness of HIV infection status and diagnosing infection sooner. Initial diagnosis is a necessary step to obtaining the benefits of HIV treatment and other psychosocial resources; however, the median interval between infection and diagnosis is 3 years ( 11 ). CDC recommends routine screening of all Americans aged 13–64 years at least once in their life and at least annual testing for those at high risk for acquiring HIV ( 13 ).…”

Disparities in Incidence of Human Immunodeficiency Virus Infection Among Black and White Women — United States, 2010–2016

“…Social and structural determinants create or sustain disparities in HIV infection, treatment, and care. For example, compared with their white counterparts, black women and men experience longer delays in diagnosis ( 8 ) and are less likely to be virally suppressed (i.e., <200 copies of viral RNA per mL of blood) ( 9 , 10 ). Targeted measures that address reducing transmission through viral suppression and preventing acquisition through biomedical and behavioral interventions (e.g., preexposure prophylaxis [PrEP] and condom use; and providing adequate treatment once HIV infection is diagnosed) will play important roles in reducing disparities.…”

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

“…91,92 In the United States, 22% of initial HIV diagnoses occur within 3 months of an AIDS diagnosis, indicating that persons are entering HIV care late. 93 Clinicians not offering HIV testing in emergency departments and acute medical care settings appears to be a major limitation in early diagnosis of HIV. 94 …”