Increasing Capacity to Detect Clusters of Rapid HIV Transmission in Varied Populations-United States.

Alexandra M Oster,Anne Marie France,Meg Watson,Joel O Wertheim,Ellsworth Campbell,Nivedha Panneer,Sheryl B Lyss,William M Switzer,R Paul Mcclung,Angela L Hernandez,Laurie Linley,M Cheryl Bañez Ocfemia,Neeraja Saduvala

doi:10.3390/v13040577

Abstract

Molecular cluster detection analyzes HIV sequences to identify rapid HIV transmission and inform public health responses. We describe changes in the capability to detect molecular clusters and in geographic variation in transmission dynamics. We examined the reporting completeness of HIV-1 polymerase sequences in quarterly National HIV Surveillance System datasets from December 2015 to December 2019. Priority clusters were identified quarterly. To understand populations recently affected by rapid transmission, we described the transmission risk and race/ethnicity of people in clusters first detected in 2018–2019. During December 2015 to December 2019, national sequence completeness increased from 26% to 45%. Of the 1212 people in the 136 clusters first detected in 2018–2019, 69% were men who have sex with men (MSM) and 11% were people who inject drugs (PWID). State-by-state analysis showed substantial variation in transmission risk and racial/ethnic groups in clusters of rapid transmission. HIV sequence reporting has increased nationwide. Molecular cluster analysis identifies rapid transmission in varied populations and identifies emerging patterns of rapid transmission in specific population groups, such as PWID, who, in 2015–2016, comprised only 1% of people in such molecular clusters. These data can guide efforts to focus, tailor, and scale up prevention and care services for these populations.

Highlights

Responding to HIV clusters and outbreaks is one of the four pillars of the U.S Ending the HIV Epidemic (EHE) initiative, which aims to reduce new HIV infections by 90% by2030
Analysis of HIV sequences reported to the National HIV Surveillance System (NHSS) to identify molecular clusters began with data submitted through December 2015
To understand changes in a key component of molecular cluster detection capability, for each quarterly NHSS data set from December 2015 to December 2019, we calculated HIV-1 polymerase sequence reporting completeness

Summary

Introduction

Responding to HIV clusters and outbreaks is one of the four pillars of the U.S Ending the HIV Epidemic (EHE) initiative, which aims to reduce new HIV infections by 90% by2030. Responding to HIV clusters and outbreaks is one of the four pillars of the U.S Ending the HIV Epidemic (EHE) initiative, which aims to reduce new HIV infections by 90% by. Seven states with substantial rural burden (i.e., EHE jurisdictions) [1]. Analyzing HIV nucleotide sequences is one method to identify clusters of rapid transmission for public health responses [2,3,4]. Analysis of HIV sequences reported to the National HIV Surveillance System (NHSS) to identify molecular clusters began with data submitted through December 2015. 22 state/territorial and five local health departments were funded by the Centers for Disease Prevention and Control (CDC). In 2018, requirements to collect HIV sequences expanded to all CDC-funded health departments (i.e., 50 state, two territorial, and seven local health departments) [5]

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