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.
Highlights
Persons unaware of their human immunodeficiency virus (HIV) infection are estimated to account for approximately 40% of ongoing transmissions in the United States [1]
The percentage of undiagnosed HIV infections ranged from 5.7% to 18.5% across states (Figure 1); 50.5% of undiagnosed infections were in the South
Diagnosis delays were longer among persons who were older at diagnosis than among those who were younger (p
Summary
Persons unaware of their human immunodeficiency virus (HIV) infection are estimated to account for approximately 40% of ongoing transmissions in the United States [1]. As a result of increased testing, the percentage of persons living with HIV who are aware of their infection has steadily increased; at the end of 2014, an estimated 85% of persons living with HIV were aware of their infection, approaching the national goal of 90% by 2020 [2]. Persons aware of their HIV infection reduce their transmission risk behaviors and can enter HIV care and take antiretroviral treatment to achieve viral suppression (a viral load result of
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