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STATE-LEVEL ESTIMATES OF HIV INCIDENCE, PREVALENCE, AND UNDIAGNOSED INFECTIONS
Anna S. Johnson1, Ruiguang Song1, Irene Hall1
1CDC, Atlanta, GA, USA
The burden of HIV infection, the range of testing, and health outcomes for people living with HIV vary widely across the United States. Understanding the current status of HIV prevention and care outcomes in states informs efforts to achieve local HIV prevention and care goals and the goals of National HIV/AIDS Strategy.
Data from the National HIV Surveillance System on HIV diagnoses among persons aged ≥13 years and their first CD4 test result after diagnosis were used to produce state-level estimates of HIV incidence, prevalence, and percentage of undiagnosed infections during 2008–2014 for each of the 50 states and the District of Columbia. The indicators were derived from estimates of diagnosis delays based on a CD4 depletion model. Estimated annual percentage changes (EAPCs) in incidence, prevalence, and percentage undiagnosed were calculated and considered as significant if p-value is less than 0.05.
During 2008–2014, among 36 jurisdictions with numerically stable estimates (>100 HIV diagnoses per year) there were significant increases (EAPCs 1-4%) in HIV prevalence in 23 jurisdictions and significant decreases (EAPCs 3-8%) in percentages of undiagnosed HIV infection in 7 jurisdictions. Estimated annual numbers of HIV infections decreased (EAPCs 2-10%) in 9 jurisdictions. In 2014, HIV prevalence ranged from an estimated 2,359 persons in Nebraska to 145,916 in New York. The estimated annual number of HIV infections ranged from 68 in Nebraska to 5,082 in California. Estimated percentages of undiagnosed HIV infections ranged from10% in Pennsylvania to 19% in Texas. Five jurisdictions (California, Georgia, Florida, New York, and Texas) accounted for 52% of HIV infections and 51% of undiagnosed infections in 2014. In 2014, by region, states located in the South accounted for 45% of persons living with HIV, 51% of HIV infections, and 50% of undiagnosed HIV infections.
Estimates of and changes in HIV incidence, prevalence, and undiagnosed HIV infection varied by state and geographic region. Differences in HIV outcomes between states and regions are due to a complex array of social, demographic, economic, and political factors in addition to the capacity of public health, health care systems, and the community to address HIV. Public health officials in the South and states with high percentages of undiagnosed infection should consider tailoring HIV prevention and testing initiatives to their unique environments.