Core Indicators for Monitoring the Ending the HIV Epidemic Initiative (Preliminary Data)

HIV Surveillance Data Tables

Core Indicators for Monitoring the Ending the HIV Epidemic Initiative (Preliminary Data)

This issue of HIV Surveillance Data Tables is published by the Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, Georgia.

Data are presented for diagnoses of HIV infection reported to CDC through March 2021 and preexposure prophylaxis (PrEP) data reported through December 2020.

HIV Surveillance Data Tables is not copyrighted and may be used and copied without permission. Citation of the source is, however, appreciated.

Suggested Citation

Centers for Disease Control and Prevention. Core indicators for monitoring the Ending the HIV Epidemic initiative (preliminary data): National HIV Surveillance System data reported through March 2021; and preexposure prophylaxis (PrEP) data reported through December 2020. HIV Surveillance Data Tables 2021;2(No. 3). http://www.cdc.gov/hiv/library/reports/surveillance-data-tables/vol-2-no-3/index.html. Published July 2021 Accessed [date].

Download the full report pdf icon[PDF – 2 MB].

Technical Notes

The Ending the HIV Epidemic in the U.S. (EHE) ini­tiative leverages critical scientific advances in HIV prevention, diagnosis, treatment, and outbreak response [1]. The goal of the initiative is to reduce new HIV infections by 75% by 2025 and then by at least 90% by 2030. The Centers for Disease Control and Prevention (CDC) routinely releases HIV Surveil­lance Data Tables on the core indicators for EHE to allow for more timely monitoring of progress. The full list of EHE core indicators and their definitions can be found in the Technical Notes of the Core Indi­cators for Monitoring the Ending the HIV Epidemic Initiative report at https://www.cdc.gov/hiv/library/reports/surveillance-data-tables/vol-1-no-1/index.html.

The tables included in this report provide prelimi­nary data on HIV diagnoses and linkage to HIV medi­cal care reported to CDC as of March 2021 for the years 2020 and 2021, and data on preexposure prophy­laxis (PrEP) coverage for the years 2019 and 2020 (preliminary). Data for the 3 indicators are provided at the national-, state-, and county-levels (EHE Phase I jurisdictions only). See Tabulation and Presentation of Data for details on how the indicators are calculated.

Tabulation and Presentation of Data

Diagnoses of HIV Infection

Diagnoses of HIV infection are the numbers of per­sons aged ≥ 13 years with HIV diagnosed during Janu­ary 2020 through March 2021 (Tables 1a–d). Data presented were reported (after the removal of person­ally identifiable information) to CDC.

An evaluation of surveillance data (2011–2015 diagnoses) found that, on average, approximately 75% of HIV diagnoses are reported to CDC during the year of diagnosis and approximately 95% of HIV diagnoses are reported to CDC by the end of the following year. Data reported to NHSS are considered preliminary until a 12-month reporting lag has been reached and should be interpreted with caution. In addition to being preliminary, data for years 2020 and 2021 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions [2].

More information on counting diagnoses of HIV infection can be found at HIV Surveillance Report, 2019.

Linkage to HIV Medical Care

Linkage to HIV medical care within 1 month of HIV diagnosis is measured for persons aged ≥13 years whose HIV infection was diagnosed during 2020, and who resided in any of the jurisdictions (including EHE Phase I jurisdictions) with complete reporting of laboratory data to CDC at the time of diagnosis (Tables 2a–c). The numerator is the number of persons aged ≥13 years whose HIV infection was diagnosed during 2020 and who had ≥1 CD4 or viral load (VL) test within 1 month of HIV diagnosis. The denominator is the number of persons aged ≥13 years whose HIV infection was diagnosed during 2020. Reporting of linkage to HIV medical care data requires a minimum 3-month reporting lag to account for delays in reporting of laboratory results to NHSS; therefore, data on linkage to HIV medical care in these surveillance tables are for persons with HIV diagnosed during 2020 and that were reported to NHSS through March 2021. Data are not provided for states and associated jurisdictions that do not have laws requiring reporting of all CD4 and viral loads, or that have incomplete reporting of laboratory data to CDC. Areas without laws: Idaho and New Jersey. Areas with incomplete reporting: Kansas, Kentucky, Pennsylvania, Vermont, and Puerto Rico.

Data reported to NHSS are considered preliminary until a 12-month reporting lag has been reached and should be interpreted with caution. In addition to being preliminary, data for years 2020 and 2021 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions [2].

More information on calculating linkage to care can be found at Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2019). pdf icon[PDF – 17 MB]

Preexposure Prophylaxis (PrEP) Coverage

PrEP coverage, reported as a percentage, is defined as the number of persons aged ≥ 16 years classified as having been prescribed PrEP during the specified year divided by the estimated number of persons aged ≥ 16 years who had indications for PrEP during the speci­fied year (Tables 3a–3c). PrEP coverage is an EHE indicator that is not a reportable disease or condition and is not reported to NHSS. Multiple data sources, described below, are used to calculate PrEP coverage.

Please use caution when interpreting PrEP data. Different data sources were used in the numerator and denominator to calculate PrEP coverage.

Persons prescribed PrEP

National pharmacy data from the IQVIA Real World Data—Longitudinal Prescriptions database (hereafter, IQVIA database) are used to classify persons aged ≥ 16 years who have been prescribed PrEP in the spe­cific year. The IQVIA database captures prescriptions from all payers and represents approximately 92% of all prescriptions from retail pharmacies and 60%–86% from mail-order outlets in the United States. The database does not include prescriptions from some closed health care systems that do not make their pre­scription data available to IQVIA. Therefore, these are minimum estimates of PrEP coverage. The annual number of persons classified as having been pre­scribed PrEP was based on a validated algorithm that discerns whether tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) was prescribed for PrEP after excluding prescriptions for HIV treatment, hepa­titis B treatment, or HIV postexposure prophylaxis [3–5]. Tenofovir alafenamide and emtricitabine (TAF/FTC) was approved as an alternative drug for PrEP by the U.S. Food and Drug Administration (FDA) in October 2019. Starting in 2019, TAF/FTC was included in the algorithm to classify the number of persons prescribed PrEP.

The number of persons classified as having been prescribed PrEP is reported by sex, age group, and race/ethnicity. Transmission category data are not available in the IQVIA database, and race/ethnicity data are available for < 40% of persons with PrEP prescriptions. Please use caution when interpreting PrEP data by race/ethnicity. Race/ethnicity catego­ries available in the IQVIA database include white, black/African American, Hispanic/Latino, and other. The number of persons prescribed PrEP for each racial/ethnic group presented in this report was extrapolated by applying the racial/ethnic distribu­tion of known records to those for which data on race/ethnicity were unknown.

Geographic Designations

In the IQVIA database, a person’s location is reported as a 3-digit ZIP code prefix (hereafter, ZIP3) assigned by the U.S. Postal Service. To estimate the number of persons prescribed PrEP at the state or county level, a probability-based approach is used to crosswalk between ZIP3s and states/counties by using data from (a) the U.S. Census Bureau’s American Community Survey (ACS) 5-year estimates by ZIP Code Tabulation Areas (ZCTAs) [6], and (b) the U.S Department of Housing and Urban Development’s ZIP Code Crosswalk Files [7]. Because of reliability concerns, subnational estimates of <40 are not included.

Persons with PrEP indications

ACS and U.S. Census Bureau files were used to estimate the number of men who have sex with men (MSM) in a jurisdiction [8, 9]. Next, behavioral data from the National Health and Nutrition Examination Survey (NHANES) were used to estimate the proportion of HIV-negative MSM with indications for PrEP [10].

The number of HIV-negative MSM with indications for PrEP was multiplied by the ratio of percentage of diagnoses during the specified year attributed to other major transmission risk groups compared to the percentage among MSM in a given state or county. The estimated numbers of persons with indications for PrEP in the 3 major transmission risk groups (MSM, heterosexuals, persons who inject drugs) in each jurisdiction were then summed to yield a state- or county-specific estimate. State estimates were then summed for a national total of persons with indications for PrEP [8]. Jurisdictional estimates were rounded to the nearest 10.

The tables included in this report provide updated data on PrEP coverage for the year 2019 and data for the year 2020 by using the IQVIA data reported through December 2020. IQVIA conducts data quality assurance activities. As a result, the number of persons classified as having been prescribed PrEP in a given year might change from time to time. The impact of the changes may vary by demographic category nationally and by jurisdiction. The data sources used to estimate the number of persons with indications for PrEP have different schedules of availability. Consequently, the availability of a denominator lags the availability of a numerator by approximately 1 year. PrEP coverage data with a lagged denominator are considered preliminary.

For this release of HIV Surveillance Data Tables, 2018 denominators were used for 2019 and 2020 PrEP coverage data; consequently, 2019 and 2020 PrEP coverage data are considered preliminary. In addition to being preliminary, data for the year 2020 should be interpreted with awareness of the impact of the COVID-19 pandemic on filling PrEP prescriptions in state/local jurisdictions.

More information on calculating PrEP coverage can be found at Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2018. pdf icon[PDF – 3.8 MB]

References

  1. HHS. What is Ending the HIV Epidemic: A Plan for America? https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview. Updated June 2, 2021. Accessed June 30, 2021.
  2. CDC [Schuchat A, CDC COVID-19 Response Team]. Public health response to the initiation and spread of pandemic COVID-19 in the United States, February 24–April 21, 2020. MMWR 2020;69(18):551–556. doi:http://dx.doi.org/10.15585/mmwr.mm6918e2
  3. Wu H, Mendoza MC, Huang YA, Hayes T, Smith DK, Hoover KW. Uptake of HIV preexposure prophylaxis among commercially insured persons—United States, 2010–2014. Clin Infect Dis 2017; 64(2):144–149. doi:10.1093/cid/ciw701
  4. CDC [Huang YA, Zhu W, Smith DK, Harris N, Hoover KW]. HIV preexposure prophylaxis, by race and ethnicity—United States, 2014–2016. MMWR 2018;67(41):1147–1150. doi:10.15585/mmwr.mm6741a3
  5. Furukawa NW, Smith DK, Gonzalez CJ, et al. Evaluation of algorithms used for PrEP surveillance using a reference population from New York City, July 2016– June 2018. Public Health Rep 2020;135(2):202–210. doi:10.1177/0033354920904085
  6. U.S. Census Bureau. American Community Survey 5-year data (2009-2018). https://www.census.gov/data/developers/data-sets/acs-5year.2016.html. Published December 19, 2019. Accessed June 30, 2021.
  7. U.S. Department of Housing and Urban Development (HUD). HUD USPS ZIP code crosswalk files. https://www.huduser.gov/portal/datasets/usps_crosswalk.html. Published 2019. June 30, 2021.
  8. Grey JA, Bernstein KT, Sullivan PS, Purcell DW, Chesson HW, Gift TL, Rosenberg ES. Estimating the population sizes of men who have sex with men in US states and counties using data from the American Community Survey. JMIR public health and surveillance. 2016;2(1):e14.
  9. Purcell DW, Johnson CH, Lansky A, Prejean J, Stein R, Denning P, et al. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. Open AIDS J 2012;6:98-107.
  10. CDC [Smith DK, Van Handel M, Wolitski RJ, et al]. Vital Signs: Estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV acquisition—United States, 2015. MMWR 2015;64(46):1291–1295. doi:10.15585/mmwr.mm6446a4

Suggested Citation

Centers for Disease Control and Prevention. Core indicators for monitoring the Ending the HIV Epidemic initiative (preliminary data): National HIV Surveillance System data reported through March 2021; and preexposure prophylaxis (PrEP) data reported through December 2020. HIV Surveillance Data Tables 2021;2(No. 3). http://www.cdc.gov/hiv/library/reports/surveillance-data-tables/vol-2-no-3/index.html. Published July 2021 Accessed [date].

Confidential information, referrals, and educational material on HIV infection and AIDS

CDC-INFO
1-800-232-4636 (in English, en Español)
1-888-232-6348 (TTY)
http://wwwn.cdc.gov/dcs/ContactUs/Form

Acknowledgments

HIV Surveillance Data Tables was prepared by the following staff and contractors of the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC: Anna Satcher Johnson, Zanetta Gant, Ya-lin Huang, Dawn Smith, Jianmin Li, Xiaohong Hu, Baohua Wu, Kyung Lee, Weiming Zhu, Lei Yu, Saja Khader, Tameka Hayes, Norma Harris.

Michael Friend and the Web and Consumer Services Team of the Prevention Communications Branch are acknowledged for editing and desktop publishing this report.

Publication of HIV Surveillance Data Tables was made possible by the contributions of the state and territorial health departments and the HIV surveillance programs that provided surveillance data to CDC.

Table 1a. Diagnoses of HIV infection among persons aged ≥13 years, by selected characteristics, January 2020 through March 2021—United States (preliminary)
2020 2021
(January-March)
No. No.
Gender
Male 22,514 3,723
Female 5,041 817
Transgender male-to-femalea 541 69
Transgender female-to-malea 35 6
Additional gender identityb 10 3
Age at diagnosis (yr)
13–24 5,617 885
25–34 10,386 1,680
35–44 5,494 953
45–54 3,683 591
≥55 2,961 509
Race/ethnicity
American Indian/Alaska Native 184 25
Asian 581 111
Black/African American 12,219 2,046
Hispanic/Latinoc 7,199 1,088
Native Hawaiian/other Pacific Islander 58 13
White 7,350 1,287
Multiracial 550 48
Transmission categoryd
Male-to-male sexual contact 19,131 3,194
Injection drug use
Male 1,105 161
Female 774 127
Male-to-male sexual contact and injection drug use 972 151
Heterosexual contacte
Male 1,827 282
Female 4,278 693
Otherf
Male 30 7
Female 25 4
Region of residenceg
Northeast 4,020 525
Midwest 3,748 552
South 14,814 2,806
West 5,559 735
Total 28,141 4,618

Abbreviation: CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. In addition to being preliminary, data for years 2020 and 2021 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care related services, and case surveillance activities in state/local jurisdictions.
a “Transgender male-to-female” includes individuals who were assigned “male” sex at birth but have ever identified as “female” gender. “Transgender female-to-male” includes individuals who were assigned “female” sex at birth but have ever identified as “male” gender.
b Additional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
c Hispanic/Latino persons can be of any race.
d Data have been statistically adjusted to account for missing transmission category, therefore values may not sum to column subtotals and total. Data presented based on sex at birth and include transgender persons.
e Heterosexual contact with a person known to have, or with a risk factor for, HIV infection.
f Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.
g Data are based on residence at time of diagnosis of HIV infection.

Diagnoses of HIV Infection among Persons Aged ≥13 Years, by Selected Characteristics, January 2020 Through March 2021—United States And 6 Dependent Areas (Preliminary)
2020 2021 (Janurary–March)
No. No.
Gender
Male 22,750 3,770
Female 5,082 827
Transgender male-to-femalea 543 69
Transgender female-to-malea 35 6
Additional gender identityb 10 3
Age at diagnosis (yr)
13–24 5,664 893
25–34 10,464 1,699
35–44 5,554 964
45–54 3,731 604
≥55 3,007 515
Race/ethnicity 
American Indian/Alaska Native 184 25
Asian 581 111
Black/African American 12,221 2,047
Hispanic/Latinoc 7,474 1,143
Native Hawaiian/other Pacific Islander 58 13
White 7,352 1,288
Multiracial 550 48
Transmission categoryd
Male-to-male sexual contact 19,306 3,232
Injection drug use
Male 1,125 164
Female 776 127
Male-to-male sexual contact and injection drug use 978 151
Heterosexual contacte
Male 1,865 288
Female 4,316 703
Otherf
Male 30 7
Female 25 4
Region of residenceg
Northeast 4,020 525
Midwest 3,748 552
South 14,814 2,806
West 5,559 735
U.S. dependent areas 279 57
Total 28,420 4,675

Abbreviation: CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data are for cases reported to CDC through March 2021, are considered preliminary until a 12-month reporting lag has been reached, and should be interpreted with caution. In addition to being preliminary, data for years 2020 and 2021 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care related services, and case surveillance activities in state/local jurisdictions.
a “Transgender male-to-female” includes individuals who were assigned “male” sex at birth but have ever identified as “female” gender. “Transgender female-to-male” includes individuals who were assigned “female” sex at birth but have ever identified as “male” gender.
b Additional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
c Hispanic/Latino persons can be of any race.
d Data have been statistically adjusted to account for missing transmission category, therefore values may not sum to column subtotals and total. Data presented based on sex at birth and include transgender persons.
e Heterosexual contact with a person known to have, or with a risk factor for, HIV infection.
f Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.
g Data are based on residence at time of diagnosis of HIV infection.

Diagnoses of HIV Infection among Persons Aged ≥13 Years, by Area of Residence, January 2020 Through March 2021—United States And 6 Dependent Areas (Preliminary)
2020 2021
(January–March)
Area of residence No. No.
Alabama 578 24
Alaska 29 2
Arizona 687 76
Arkansas 247 54
California 3,270 388
Colorado 309 62
Connecticut 153 18
Delaware 97 21
District of Columbia 205 31
Florida 3,569 962
Georgia 1,699 251
Hawaii 43 2
Idaho 29 0
Illinois 777 96
Indiana 431 63
Iowa 99 21
Kansas 139 25
Kentucky 293 64
Louisiana 742 205
Maine 17 4
Maryland 722 113
Massachusetts 373 22
Michigan 532 105
Minnesota 221 59
Mississippi 380 52
Missouri 361 95
Montana 14 2
Nebraska 67 3
Nevada 372 60
New Hampshire 29 2
New Jersey 733 77
New Mexico 69 10
New York 1,894 255
North Carolina 1,088 276
North Dakota 23 1
Ohio 855 37
Oklahoma 208 30
Oregon 178 40
Pennsylvania 765 146
Rhode Island 49 1
South Carolina 727 160
South Dakota 34 6
Tennessee 638 136
Texas 2,877 238
Utah 129 22
Vermont 7 0
Virginia 623 178
Washington 416 70
West Virginia 121 11
Wisconsin 209 41
Wyoming 14 1
Subtotal 28,141 4,618
U.S. dependent areas
American Samoa 0 0
Guam 0 1
Northern Mariana Islands 0 0
Puerto Rico 277 56
Republic of Palau 0 0
U.S. Virgin Islands 2 0
Subtotal 279 57
Total 28,420 4,675

Abbreviation: CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data are based on residence at time of diagnosis of HIV infection. Data are for cases reported to CDC through March 2021 are considered preliminary until a 12-month reporting lag has been reached, and should be interpreted with caution. In addition to being preliminary, data for years 2020 and 2021 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care related services, and case surveillance activities in state/local jurisdictions.

Diagnoses of HIV Infection among Persons Aged ≥13 Years, by Area of Residence, January 2020 Through March 2021—Ending the HIV Epidemic Phase I Jurisdictions (Preliminary)
2020 2021
(January–March)
Area of residence No. No.
Arizona
Maricopa County 491 61
California
Alameda County 149 24
Los Angeles County 1,145 132
Orange County 261 48
Riverside County 228 33
Sacramento County 24 1
San Bernardino County 214 16
San Diego County 249 5
San Francisco County 152 26
District of Columbia 205 31
Florida
Broward County 489 124
Duval County 236 70
Hillsborough County 259 68
Miami-Dade County 834 235
Orange County 398 98
Palm Beach County 227 46
Pinellas County 158 45
Georgia
Cobb County 126 12
DeKalb County 226 37
Fulton County 481 67
Gwinnett County 111 15
Illinois
Cook County 592 72
Indiana
Marion County 168 30
Louisiana
East Baton Rouge Parish 127 25
Orleans Parish 109 45
Maryland
Baltimore City 171 21
Montgomery County 87 21
Prince George’s County 212 31
Massachusetts
Suffolk County 119 9
Michigan
Wayne County 228 50
Nevada
Clark County 323 53
New Jersey
Essex County 183 26
Hudson County 118 9
New York
Bronx County 334 37
Kings County 426 58
New York County 289 34
Queens County 306 27
North Carolina
Mecklenburg County 210 66
Ohio
Cuyahoga County 184 8
Franklin County 199 14
Hamilton County 128 1
Pennsylvania
Philadelphia County 321 54
Puerto Rico
San Juan Municipio 68 17
Tennessee
Shelby County 223 45
Texas
Bexar County 283 22
Dallas County 608 68
Harris County 647 20
Tarrant County 231 10
Travis County 157 26
Washington
King County 202 34

Abbreviation: CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data are based on residence at time of diagnosis of HIV infection. Data are for cases reported to CDC through March 2021 are considered preliminary until a 12-month reporting lag has been reached, and should be interpreted with caution. In addition to being preliminary, data for years 2020 and 2021 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care related services, and case surveillance activities in state/local jurisdictions.

Linkage to HIV Medical Care Within 1 Month After HIV Diagnosis During 2020, among Persons Aged ≥13 Years, by Selected Characteristics—44 States and the District of Columbia (Preliminary)
Total diagnoses ≥1 CD4 or VL tests No CD4 or VL test
No. No. % No. %
Gender
Male 20,960 17,262 82.4 3,698 17.6
Female 4,666 3,823 81.9 843 18.1
Transgender male-to-femalea 508 413 81.3 95 18.7
Transgender female-to-malea 32 30 93.8 2 6.3
Additional gender identityb 9 8 88.9 1 11.1
Age at diagnosis (yr)
13–24 5,257 4,215 80.2 1,042 19.8
25–34 9,676 7,916 81.8 1,760 18.2
35–44 5,108 4,198 82.2 910 17.8
45–54 3,391 2,895 85.4 496 14.6
≥55 2,743 2,312 84.3 431 15.7
Race/ethnicity
American Indian/Alaska Native 179 145 81.0 34 19.0
Asian 557 491 88.2 66 11.8
Black/African American 11,434 9,135 79.9 2,299 20.1
Hispanic/Latinoc 6,717 5,658 84.2 1,059 15.8
Native Hawaiian/other Pacific Islander 57 49 86.0 8 14.0
White 6,726 5,633 83.7 1,093 16.3
Multiracial 505 425 84.2 80 15.8
Transmission categoryd
Male-to-male sexual contact 17,946 14,839 82.7 3,106 17.3
Injection drug use 963 760 78.9 204 21.1
Male 710 561 79.0 149 21.0
Female 898 726 80.9 171 19.1
Male-to-male sexual contact and injection drug use 1,643 1,336 81.3 307 18.7
Heterosexual contacte 3,964 3,270 82.5 694 17.5
Male 28 22 79.3 6 20.7
Female 24 22 91.7 2 8.3
Totalf 26,175 21,536 82.3 4,639 17.7

Abbreviations: CD4, CD4+ T-lymphocyte count (cells/µL) or percentage; VL, viral load (copies/mL); CDC, the Centers for Disease Control and Prevention [footnotes only]; NHSS, National HIV Surveillance System [footnotes only].
Note. Data are based on residence at diagnosis of HIV infection. Data are for cases reported to CDC through March 2021, are considered preliminary until a 12-month reporting lag has been reached, and should be interpreted with caution. In addition to being preliminary, data for years 2020 and 2021 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care related services, and case surveillance activities in state/local jurisdictions. Linkage to HIV medical care was measured by documentation of ≥ 1 CD4 or VL tests ≤ 1 month after HIV diagnosis. Reporting of linkage to HIV medical care data requires a minimum 3-month reporting lag to account for delays in reporting of laboratory results to NHSS; therefore, data on linkage to HIV medical care in these surveillance tables are for persons with HIV diagnosed during 2020 and reported to NHSS through March 2021. Data are not provided for states and associated jurisdictions that do not have laws requiring reporting of all CD4 and viral loads or that have incomplete reporting of laboratory data to CDC. Areas without laws: Idaho and New Jersey. Areas with incomplete reporting: Kansas, Kentucky, Pennsylvania, Puerto Rico, and Vermont.
a “Transgender male-to-female” includes individuals who were assigned “male” sex at birth but have ever identified as “female” gender. “Transgender female-to-male” includes individuals who were assigned “female” sex at birth but have ever identified as “male” gender.
b Additional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
c Hispanic/Latino persons can be of any race.
d Data have been statistically adjusted to account for missing transmission category; therefore, values may not sum to column total. Data presented based on sex at birth and may include transgender persons.
e Heterosexual contact with a person known to have, or with a risk factor for, HIV infection.
f Includes persons whose infection was attributed to hemophilia, blood transfusion, or perinatal exposure or whose risk factor was not reported or not identified. Data not displayed because the numbers were too small to be meaningful.

Linkage to HIV Medical Care Within 1 Month of HIV Diagnosis During 2020, among Persons Aged ≥13 Years, by Area of Residence—44 States and the District of Columbia (Preliminary)
Total diagnoses ≥1 CD4 or VL tests ≥1 CD4 or VL tests
Area of residence No. No. % No. %
Alabama 578 465 80.4 113 19.6
Alaska 29 28 96.6 1 3.4
Arizona 687 583 84.9 104 15.1
Arkansas 247 210 85.0 37 15.0
California 3,270 2,767 84.6 503 15.4
Colorado 309 271 87.7 38 12.3
Connecticut 153 132 86.3 21 13.7
Delaware 97 78 80.4 19 19.6
District of Columbia 205 180 87.8 25 12.2
Florida 3,569 3,001 84.1 568 15.9
Georgia 1,699 1,446 85.1 253 14.9
Hawaii 43 38 88.4 5 11.6
Illinois 777 656 84.4 121 15.6
Indiana 431 313 72.6 118 27.4
Iowa 99 88 88.9 11 11.1
Louisiana 742 565 76.1 177 23.9
Maine 17 16 94.1 1 5.9
Maryland 722 638 88.4 84 11.6
Massachusetts 373 324 86.9 49 13.1
Michigan 532 446 83.8 86 16.2
Minnesota 221 194 87.8 27 12.2
Mississippi 380 278 73.2 102 26.8
Missouri 361 284 78.7 77 21.3
Montana 14 12 85.7 2 14.3
Nebraska 67 61 91.0 6 9.0
Nevada 372 318 85.5 54 14.5
New Hampshire 29 23 79.3 6 20.7
New Mexico 69 57 82.6 12 17.4
New York 1,894 1,634 86.3 260 13.7
North Carolina 1,088 897 82.4 191 17.6
North Dakota 23 18 78.3 5 21.7
Ohio 855 748 87.5 107 12.5
Oklahoma 208 160 76.9 48 23.1
Oregon 178 151 84.8 27 15.2
Rhode Island 49 45 91.8 4 8.2
South Carolina 727 640 88.0 87 12.0
South Dakota 34 30 88.2 4 11.8
Tennessee 638 471 73.8 167 26.2
Texas 2,877 1,989 69.1 888 30.9
Utah 129 112 86.8 17 13.2
Virginia 623 509 81.7 114 18.3
Washington 416 371 89.2 45 10.8
West Virginia 121 91 75.2 30 24.8
Wisconsin 209 185 88.5 24 11.5
Wyoming 14 13 92.9 1 7.1
Total 26,175 21,536 82.3 4,639 17.7

Abbreviations: CD4, CD4+ T-lymphocyte count (cells/µL) or percentage; VL, viral load (copies/mL); CDC, the Centers for Disease Control and Prevention [footnotes only]; NHSS, National HIV Surveillance System [footnotes only].
Note. Data are based on residence at diagnosis of HIV infection. Data are for cases reported to CDC through March 2021, are considered preliminary until a 12-month reporting lag has been reached, and should be interpreted with caution. In addition to being preliminary, data for years 2020 and 2021 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care related services, and case surveillance activities in state/local jurisdictions. Linkage to HIV medical care was measured by documentation of ≥ 1 CD4 or VL tests ≤ 1 month after HIV diagnosis. Reporting of linkage to HIV medical care data requires a minimum 3-month reporting lag to account for delays in reporting of laboratory results to NHSS; therefore, data on linkage to HIV medical care in these surveillance tables are for persons with HIV diagnosed during 2020 and reported to NHSS through March 2021. Data are not provided for states and associated jurisdictions that do not have laws requiring reporting of all CD4 and viral loads or that have incomplete reporting of laboratory data to CDC. Areas without laws: Idaho and New Jersey. Areas with incomplete reporting: Kansas, Kentucky, Pennsylvania, Puerto Rico, and Vermont.

Table 2c. Linkage to HIV Medical Care Within 1 Month of HIV Diagnosis During 2020, among Persons Aged ≥13 Years, By Area of Residence—Ending The HIV Epidemic Phase I Jurisdictions (Preliminary)
Total diagnoses ≥1 CD4 or VL tests No CD4 or VL test
Area of residence No. No. % No. %
Arizona
Maricopa County 491 419 85.3 72 14.7
California
Alameda County 149 127 85.2 22 14.8
Los Angeles County 1,145 963 84.1 182 15.9
Orange County 261 235 90.0 26 10.0
Riverside County 228 188 82.5 40 17.5
Sacramento County 24 20 83.3 4 16.7
San Bernardino County 214 157 73.4 57 26.6
San Diego County 249 218 87.6 31 12.4
San Francisco County 152 144 94.7 8 5.3
District of Columbia 205 180 87.8 25 12.2
Florida
Broward County 489 426 87.1 63 12.9
Duval County 236 190 80.5 46 19.5
Hillsborough County 259 220 84.9 39 15.1
Miami-Dade County 834 700 83.9 134 16.1
Orange County 398 336 84.4 62 15.6
Palm Beach County 227 183 80.6 44 19.4
Pinellas County 158 132 83.5 26 16.5
Georgia
Cobb County 126 111 88.1 15 11.9
DeKalb County 226 196 86.7 30 13.3
Fulton County 481 419 87.1 62 12.9
Gwinnett County 111 88 79.3 23 20.7
Illinois
Cook County 592 498 84.1 94 15.9
Indiana
Marion County 168 124 73.8 44 26.2
Louisiana
East Baton Rouge Parish 127 103 81.1 24 18.9
Orleans Parish 109 86 78.9 23 21.1
Maryland
Baltimore City 171 149 87.1 22 12.9
Montgomery County 87 77 88.5 10 11.5
Prince George’s County 212 192 90.6 20 9.4
Massachusetts
Suffolk County 119 106 89.1 13 10.9
Michigan
Wayne County 228 188 82.5 40 17.5
Nevada
Clark County 323 276 85.4 47 14.6
New York
Bronx County 334 286 85.6 48 14.4
Kings County 426 359 84.3 67 15.7
New York County 289 248 85.8 41 14.2
Queens County 306 272 88.9 34 11.1
North Carolina
Mecklenburg County 210 175 83.3 35 16.7
Ohio
Cuyahoga County 184 168 91.3 16 8.7
Franklin County 199 178 89.4 21 10.6
Hamilton County 128 114 89.1 14 10.9
Pennsylvania
Philadelphia County 321 280 87.2 41 12.8
Tennessee
Shelby County 223 149 66.8 74 33.2
Texas
Bexar County 283 171 60.4 112 39.6
Dallas County 608 420 69.1 188 30.9
Harris County 647 460 71.1 187 28.9
Tarrant County 231 148 64.1 83 35.9
Travis County 157 105 66.9 52 33.1
Washington
King County 202 182 90.1 20 9.9

Abbreviations: CD4, CD4+ T-lymphocyte count (cells/µL) or percentage; VL, viral load (copies/mL); CDC, the Centers for Disease Control and Prevention [footnotes only]; NHSS, National HIV Surveillance System [footnotes only].
Note. Data are based on residence at diagnosis of HIV infection. Data are for cases reported to CDC through March 2021, are considered preliminary until a 12-month reporting lag has been reached, and should be interpreted with caution. In addition to being preliminary, data for years 2020 and 2021 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care related services, and case surveillance activities in state/local jurisdictions. Linkage to HIV medical care was measured by documentation of ≥ 1 CD4 or VL tests ≤ 1 month after HIV diagnosis. Reporting of linkage to HIV medical care data requires a minimum 3-month reporting lag to account for delays in reporting of laboratory results to NHSS; therefore, data on linkage to HIV medical care in these surveillance tables are for persons with HIV diagnosed during 2020 and reported to NHSS through March 2021. Data are not provided for states and associated jurisdictions that do not have laws requiring reporting of all CD4 and viral loads or that have incomplete reporting of laboratory data to CDC. Areas without laws: Idaho and New Jersey. Areas with incomplete reporting: Kansas, Kentucky, Pennsylvania, Puerto Rico, and Vermont.

Number of Persons Prescribed Prep, Number of Persons with Prep Indications, And Prep Coverage During January 2019 Through December 2020 among Persons Aged ≥16 Years, by Selected Characteristics—United States
2019 2020
Persons prescribed PrEPa Persons with PrEP indicationsb PrEP coveragec Persons prescribed PrEPa Persons with PrEP indicationsb PrEP coveragec
No. No. % No. No. &
Sex at birth
Male 248,106 989,200 25.1 257,141 989,200 26.0
Female 20,856 227,010 9.2 21,872 227,010 9.6
Age (yr)
16–24 37,244 246,290 15.1 34,452 246,290 14.0
25–34 109,593 434,680 25.2 111,444 434,680 25.6
35–44 62,374 238,470 26.2 66,804 238,470 28.0
45–54 36,273 173,420 20.9 37,845 173,420 21.8
≥55 23,538 123,350 19.1 28,489 123,350 23.1
Race/ethnicityd
Black/African American 36,578 468,540 7.8 39,499 468,540 8.4
Hispanic/Latinoe 42,270 312,820 13.5 45,648 312,820 14.6
Other 11,423 131,180 8.7 11,357 131,180 8.7
White 178,834 300,650 59.5 182,626 300,650 60.7
Total 269,106 1,216,210 22.1 279,130 1,216,210 23.0

Abbreviations: PrEP, preexposure prophylaxis; n/a, not available; FDA, Food and Drug Administration [footnotes only].
Note: Data for year 2020 are preliminary and should be interpreted with caution due to the impact of the COVID-19 pandemic on filling PrEP prescriptions in state/local jurisdictions.
a Estimated using data from IQVIA pharmacy database reported through December 2020 based on an algorithm that included FDA approved drugs for PrEP. Data for which values are unknown were not reported thus values may not sum to column total.
b Estimated using 2018 data from National HIV Surveilance System, National Health and Nutrition Examination Survey, and U.S. Census Bureau’s American Community Survey. Data are rounded to the nearest 10. Data for which values are unknown were not reported thus values may not sum to column total. The data sources used to estimate the number of persons with indications for PrEP have different schedules of data availability. Consequently, the availability of a denominator may lag the availability of a numerator. In this table, 2018 denominators were used for 2019 and 2020 PrEP coverage data.
c PrEP coverage, reported as a percentage, was calculated as the number who have been prescribed PrEP divided by the estimated number of persons who had indications for PrEP.
d Race/ethnicity data were only available for <40% of persons prescribed PrEP each year. Number prescribed PrEP and PrEP coverage for race/ethnicity reported in the table were adjusted by applying the distribution of records with known race/ethnicity to records with missing race/ethnicity.
e Hispanic/Latino persons can be of any race.

Number of Persons Prescribed Prep, Number of Persons with Prep Indications, And Prep Coverage January 2019 Through December 2020 among Persons Aged ≥16 Years, by Area of Residence—United States And Puerto Rico
2019 2020
Persons prescribed PrEPa Persons with PrEP indicationsb PrEP coveragec Persons prescribed PrEPa Persons with PrEP indicationsb PrEP coveragec
No. No. % No. No. %
Alabama 1,826 11,020 16.6 1,840 11,020 16.7
Alaska 228 1,780 12.8 216 1,780 12.1
Arizona 4,468 25,780 17.3 4,707 25,780 18.3
Arkansas 731 5,130 14.2 783 5,130 15.3
California 40,844 165,030 24.7 39,572 165,030 24.0
Colorado 4,223 25,120 16.8 4,198 25,120 16.7
Connecticut 2,625 9,560 27.5 2,289 9,560 23.9
Delaware 460 4,400 10.5 424 4,400 9.6
District of Columbia 5,701 12,950 44.0 5,454 12,950 42.1
Florida 21,479 125,330 17.1 33,458 125,330 26.7
Georgia 8,427 39,030 21.6 9,078 39,030 23.3
Hawaii 806 4,360 18.5 841 4,360 19.3
Idaho 450 4,790 9.4 562 4,790 11.7
Illinois 16,368 55,860 29.3 15,001 55,860 26.9
Indiana 2,915 22,170 13.1 2,919 22,170 13.2
Iowa 1,385 4,760 29.1 1,350 4,760 28.4
Kansas 892 5,060 17.6 863 5,060 17.1
Kentucky 1,568 12,990 12.1 1,482 12,990 11.4
Louisiana 3,881 15,920 24.4 3,349 15,920 21.0
Maine 624 3,950 15.8 584 3,950 14.8
Maryland 4,867 27,300 17.8 4,429 27,300 16.2
Massachusetts 9,113 24,900 36.6 8,535 24,900 34.3
Michigan 4,312 29,570 14.6 4,259 29,570 14.4
Minnesota 4,106 21,720 18.9 3,842 21,720 17.7
Mississippi 927 4,530 20.5 1,049 4,530 23.2
Missouri 3,387 18,370 18.4 3,260 18,370 17.7
Montana 261 2,290 11.4 272 2,290 11.9
Nebraska 601 2,180 27.6 650 2,180 29.8
Nevada 2,124 11,390 18.6 2,221 11,390 19.5
New Hampshire 597 3,020 19.8 568 3,020 18.8
New Jersey 5,572 25,280 22.0 5,413 25,280 21.4
New Mexico 1,061 6,800 15.6 1,151 6,800 16.9
New York 34,321 72,640 47.2 30,658 72,640 42.2
North Carolina 5,288 32,490 16.3 5,737 32,490 17.7
North Dakota 194 1,520 12.8 200 1,520 13.2
Ohio 5,986 40,320 14.8 6,227 40,320 15.4
Oklahoma 1,133 11,030 10.3 1,454 11,030 13.2
Oregon 3,289 19,750 16.7 3,308 19,750 16.7
Pennsylvania 9,950 36,490 27.3 9,914 36,490 27.2
Puerto Rico 327 9,700 3.4 358 9,700 3.7
Rhode Island 1,053 3,880 27.1 1,030 3,880 26.5
South Carolina 1,701 10,390 16.4 1,989 10,390 19.1
South Dakota 144 910 15.8 115 910 12.6
Tennessee 3,814 22,460 17.0 4,852 22,460 21.6
Texas 22,754 123,790 18.4 26,467 123,790 21.4
Utah 1,983 6,840 29.0 2,175 6,840 31.8
Vermont 335 1,060 31.6 287 1,060 27.1
Virginia 4,329 31,430 13.8 4,627 31,430 14.7
Washington 9,441 40,050 23.6 8,735 40,050 21.8
West Virginia 563 5,250 10.7 491 5,250 9.4
Wisconsin 2,415 12,980 18.6 2,271 12,980 17.5
Wyoming 93 890 10.4 86 890 9.7

Abbreviations: PrEP, preexposure prophylaxis; n/a, not available; FDA, Food and Drug Administration [footnotes only].
Note: Data for year 2020 are preliminary and should be interpreted with caution due to the impact of the COVID-19 pandemic on filling PrEP prescriptions in state/local jurisdictions
a Estimated using data from IQVIA pharmacy database reported through December 2020 based on an algorithm that included FDA approved drugs for PrEP. Data for which values are unknown were not reported thus values may not sum to column total.
b Estimated using 2018 data from National HIV Surveilance System, National Health and Nutrition Examination Survey, and U.S. Census Bureau’s American Community Survey. Data are rounded to the nearest 10. Data for which values are unknown were not reported thus values may not sum to column total. The data sources used to estimate the number of persons with indications for PrEP have different schedules of data availability. Consequently, the availability of a denominator may lag the availability of a numerator. In this table, 2018 denominators were used for 2019 and 2020 PrEP coverage data.
c PrEP coverage, reported as a percentage, was calculated as the number who have been prescribed PrEP divided by the estimated number of persons who had indications for PrEP.

Number of Persons Prescribed Prep, Number of Persons with Prep Indications, And Prep Coverage January 2019 Through December 2020 among Persons Aged ≥16 Years, by Area of Residence—Ending The HIV Epidemic Phase I Jurisdictions
  2019 2020
  Persons prescribed PrEPa Persons with PrEP indicationsb PrEP coveragec Persons prescribed PrEPa Persons with PrEP indicationsb PrEP coveragec
  No. No. % No. No. %
Arizona
Maricopa County 3,456 22,720 15.2 3,639 22,720 16.0
California
Alameda County 2,152 8,930 24.1 1,912 8,930 21.4
Los Angeles County 13,464 67,450 20.0 13,901 67,450 20.6
Orange County 1,990 10,510 18.9 2,040 10,510 19.4
Riverside County 1,719 11,080 15.5 1,793 11,080 16.2
Sacramento County 931 5,920 15.7 898 5,920 15.2
San Bernardino County 751 11,890 6.3 775 11,890 6.5
San Diego County 3,626 14,500 25.0 3,520 14,500 24.3
San Francisco County 8,639 10,840 79.7 7,511 10,840 69.3
District of Columbia 5,701 12,950 44.0 5,454 12,950 42.1
Florida
Broward County 3,682 20,470 18.0 6,512 20,470 31.8
Duval County 496 8,970 5.5 703 8,970 7.8
Hillsborough County 1,370 12,910 10.6 1,423 12,910 11.0
Miami-Dade County 6,476 21,760 29.8 10,075 21,760 46.3
Orange County 2,752 15,310 18.0 3,719 15,310 24.3
Palm Beach County 874 9,170 9.5 2,966 9,170 32.3
Pinellas County 1,085 9,530 11.4 1,130 9,530 11.9
Georgia
Cobb County 548 3,070 17.9 600 3,070 19.5
DeKalb County 1,522 6,290 24.2 1,605 6,290 25.5
Fulton County 3,203 13,120 24.4 3,344 13,120 25.5
Gwinnett County 674 3,240 20.8 742 3,240 22.9
Illinois
Cook County 13,383 39,060 34.3 12,162 39,060 31.1
Indiana
Marion County 1,107 9,150 12.1 1,105 9,150 12.1
Louisiana
East Baton Rouge Parish 489 1,810 27.0 493 1,810 27.2
Orleans Parish 1,475 4,590 32.1 1,230 4,590 26.8
Maryland
Baltimore City 880 6,330 13.9 799 6,330 12.6
Montgomery County 897 5,770 15.5 851 5,770 14.7
Prince George’s County 789 4,040 19.5 731 4,040 18.1
Massachusetts
Suffolk County 2,705 6,520 41.5 2,560 6,520 39.3
Michigan
Wayne County 1,194 9,270 12.9 1,131 9,270 12.2
Nevada
Clark County 1,816 11,670 15.6 1,872 11,670 16.0
New Jersey
Essex County 672 4,090 16.4 650 4,090 15.9
Hudson County 1,019 4,650 21.9 963 4,650 20.7
New York
Bronx County 2,199 5,570 39.5 1,832 5,570 32.9
Kings County 7,319 15,650 46.8 6,611 15,650 42.2
New York County 13,583 15,540 87.4 12,253 15,540 78.8
Queens County 3,796 9,230 41.1 3,454 9,230 37.4
North Carolina
Mecklenburg County 1,318 8,450 15.6 1,481 8,450 17.5
Ohio
Cuyahoga County 932 7,520 12.4 869 7,520 11.6
Franklin County 1,986 11,620 17.1 2,126 11,620 18.3
Hamilton County 546 7,720 7.1 580 7,720 7.5
Pennsylvania
Philadelphia County 3,578 9,840 36.4 3,221 9,840 32.7
Puerto Rico
San Juan Municipio d 2,190 n/a d 2,190 n/a
Tennessee
Shelby County 630 6,450 9.8 772 6,450 12.0
Texas
Bexar County 1,468 11,920 12.3 1,689 11,920 14.2
Dallas County 3,997 28,670 13.9 4,944 28,670 17.2
Harris County 4,838 40,670 11.9 5,768 40,670 14.2
Tarrant County 1,443 11,340 12.7 1,579 11,340 13.9
Travis County 4,501 11,590 38.8 4,916 11,590 42.4
Washington
King County 6,576 17,890 36.8 6,067 17,890 33.9

Abbreviations: PrEP, preexposure prophylaxis; n/a, not available; FDA, Food and Drug Administration [footnotes only].
Note: Data for year 2020 are preliminary and should be interpreted with caution due to the impact of the COVID-19 pandemic on filling PrEP prescriptions in state/local jurisdictions
a Estimated using data from IQVIA pharmacy database reported through December 2020 based on an algorithm that included FDA approved drugs for PrEP. Data for which values are unknown were not reported thus values may not sum to column total.
b Estimated using 2018 data from National HIV Surveilance System, National Health and Nutrition Examination Survey, and U.S. Census Bureau’s American Community Survey. Data are rounded to the nearest 10. Data for which values are unknown were not reported thus values may not sum to column total. The data sources used to estimate the number of persons with indications for PrEP have different schedules of data availability. Consequently, the availability of a denominator may lag the availability of a numerator. In this table, 2018 denominators were used for 2019 and 2020 PrEP coverage data.
c PrEP coverage, reported as a percentage, was calculated as the number who have been prescribed PrEP divided by the estimated number of persons who had indications for PrEP.
d Data value <40 was not reported due to unreliability.