Objectives. To describe provision of HIV telehealth services during the COVID-19 pandemic using data from the Centers for Disease Control and Prevention (CDC) Medical Monitoring Project Facility Survey for the Ending the HIV Epidemic in the United States initiative, which aims to achieve an at least 90% reduction in new HIV infections by 2030 and highlights telehealth as an important strategy. Methods. During 2021, we surveyed 1023 facilities providing HIV care to a nationally representative sample of US adults with diagnosed HIV, of which 45% responded. We calculated weighted percentages with 95% confidence intervals comparing the characteristics of facilities providing telehealth services. Results. Overall, 83.4% of facilities provided HIV care telehealth services by the facility's own providers (82.0%) or by outside providers through remote conferencing (27.0%). Gaps in coverage were identified in smaller facilities and in facilities in rural and primary care health professional shortage areas. Conclusions. Although most HIV care facilities provided telehealth services during the COVID-19 pandemic, gaps were identified, which must be addressed to meet Ending the HIV Epidemic in the United States goals and better prepare for future health emergencies. (Am J Public Health. Published online ahead of print January 16, 2025:e1-e5. https://doi.org/10.2105/AJPH.2024.307908).

Environmental cleaning is essential to patient and health worker safety, yet it is a substantially neglected area in terms of knowledge, practice, and capacity-building, especially in resource-limited settings. Public health advocacy, research and investment are urgently needed to develop and implement cost-effective interventions to improve environmental cleanliness and, thus, overall healthcare quality and safety. We outline here the CLEAN Group Consensus exercise yielding twelve urgent research questions, grouped into four thematic areas: standards, system strengthening, behaviour change, and innovation.

Ensuring good quality of life (QoL) among persons with diagnosed HIV (PWH) is a priority of the National HIV/AIDS Strategy (NHAS), which established 2025 goals for improving QoL. Goals are monitored through five indicators: self-rated health, unmet needs for mental health services, unemployment, hunger or food insecurity, and unstable housing or homelessness. Among the growing population of PWH aged ≥50 years, progress toward these goals has not been assessed. Data collected during the 2017-2022 cycles of the Medical Monitoring Project, an annual complex sample survey of U.S. adults with diagnosed HIV, assessed progress toward NHAS 2025 QoL goals among PWH aged ≥50 years, overall and by age group. The recent estimated annual percentage change from baseline (2017 or 2018) to 2022 was calculated for each indicator. Among PWH aged ≥50 years, the 2025 goal of 95% PWH with good or better self-rated health is 46.2% higher than the 2022 estimate. The 2025 goals of a 50% reduction in the other indicators range from 26.3% to 56.3% lower than the 2022 estimates. Decreasing hunger or food insecurity by 50% among PWH aged ≥65 was the only goal met by 2022. If recent trends continue, other NHAS QoL 2025 goals are unlikely to be met. Multisectoral strategies to improve access to housing, employment, food, and mental health will be needed to meet NHAS 2025 goals for QoL among older PWH.

BACKGROUND: Unmet needs for ancillary services are substantial among people with human immunodeficiency virus (PWH), and provider type could influence the prevalence of unmet needs for these services. METHODS: Data from a national probability sample of PWH were analyzed from the Centers for Disease Control and Prevention's Medical Monitoring Project. We analyzed 2019 data on people who had ≥1 encounter with a human immunodeficiency virus (HIV) care provider (N = 3413) and their care facilities. We assessed the proportion of needs that were unmet for individual ancillary services, overall and by HIV care provider type, including infectious disease (ID) physicians, non-ID physicians, nurse practitioners, and physician assistants. We calculated prevalence differences (PDs) with predicted marginal means to assess differences between groups. RESULTS: An estimated 98.2% of patients reported ≥1 need for an ancillary service, and of those 46% had ≥1 unmet need. Compared with patients of ID physicians, needs for many ancillary services were higher among patients of other provider types. However, even after adjustment, patients of non-ID physicians had lower unmet needs for dental care (adjusted PD, -5.6 [95% confidence interval {CI}, -9.9 to -1.3]), and patients of nurse practitioners had lower unmet needs for HIV case management services (adjusted PD, -5.4 [95% CI, -9.4 to -1.4]), compared with patients of ID physicians. CONCLUSIONS: Although needs were greater among patients of providers other than ID physicians, many of these needs may be met by existing support systems at HIV care facilities. However, additional resources may be needed to address unmet needs for dental care and HIV case management among patients of ID physicians.

BACKGROUND: Persons with HIV (PWH) at highest risk of anal cancer include gay, bisexual, and other men who have sex with men (GBMSM) and transgender women aged ≥ 35 years, and other PWH aged ≥ 45 years. Identifying and treating precancerous lesions can reduce anal cancer incidence in these groups. We assessed prevalence of anal cytology and access to high-resolution anoscopy (HRA) among PWH, overall and those at highest risk. METHODS: Data were obtained from the CDC's Medical Monitoring Project (MMP), a population-based survey of PWH aged ≥ 18 years, and a supplemental MMP facility survey. We report weighted percentages of PWH receiving anal cytology during the past 12 months, access to HRA, and characteristics of HIV care facilities by availability of HRA. RESULTS: Overall, 4.8% (95% CI 3.4 to 6.1) of PWH had anal cytology in the prior 12 months. Only 7.7% (95% CI 5.1 to 10.6) of GBMSM and transgender women aged ≥ 35 years, and 1.9% (95% CI 0.9 to 2.9) of all other PWH aged ≥ 45 years, had anal cytology. Prevalence was statistically significantly low among PWH with the following characteristics: non-Hispanic/Latino Black/African American, ≤ high school education, heterosexual orientation, and living in Southern MMP states. Among PWH, 32.8% (95% CI 28.0 to 37.7) had no HRA access on-site/through referral at their care facility; 22.2% (95% CI 19.5 to 24.9) had on-site access; 45.0% (95% CI 41.5 to 48.5) had HRA available through referral. Most facilities that received Ryan White HIV/AIDS Program funding, cared for > 1000 PWH, or provided on-site colposcopy also provided HRA on-site/through referral. CONCLUSIONS: Anal cytology and access to HRA was low among PWH, including those at highest risk of anal cancer. Our data may inform large-scale implementation of anal cancer prevention efforts.

People with human immunodeficiency virus (PWH) are disproportionately affected by depression, but the recent national estimates for US PWH encompassing both current symptoms and clinical diagnoses to assess missed diagnoses and lack of symptom remission are lacking. We used data from CDC's Medical Monitoring Project (MMP) to report nationally representative estimates of diagnosed and undiagnosed depression among US adult PWH. During June 2021 to May 2022, MMP collected interview data on symptoms consistent with major or other depression and depression diagnoses from medical records of 3928 PWH. We report weighted percentages and prevalence ratios (PRs) to quantify differences between groups on key social and health factors. Overall, 34% of PWH experienced any depression (diagnosis or Patient Health Questionnaire-8); of these, 26% had symptoms but no diagnosis (undiagnosed depression), 19% had both diagnosis and symptoms, and 55% had a diagnosis without symptoms. Among those with depression, persons with a disability (PR: 1.52) and food insecurity (PR: 1.67) were more likely to be undiagnosed. Unemployed persons (PR: 1.62), those experiencing a disability (PR: 2.78), food insecurity (PR: 1.46), or discrimination in human immunodeficiency virus (HIV) care (PR: 1.71) were more likely to have diagnosed depression with symptoms. Those with symptoms (undiagnosed or diagnosed) were less likely to be antiretroviral therapy (ART) dose adherent (PR: 0.88; PR: 0.73) or have sustained viral suppression (PR: 0.62; PR: 0.91) and were more likely to have unmet needs for mental health services (PR: 2.38, PR: 2.03). One-third of PWH experienced depression, of whom nearly half were undiagnosed or still experiencing clinically relevant symptoms. Expanding screening and effective treatment for depression could improve quality of life and HIV outcomes.

BACKGROUND: We compared HIV care outcomes by HIV provider type to inform efforts to strengthen the HIV provider workforce. SETTING: U.S. METHODS: We analyzed data from CDC's Medical Monitoring Project collected during 6/2019-5/2021 from 6,323 adults receiving HIV medical care. Provider types were infectious disease physicians only (ID physicians), non-ID physicians only (non-ID physicians), nurse practitioners only (NPs), physician assistants only (PAs), and ID physicians plus NPs and/or PAs (mixed providers). We measured patient characteristics, social determinants of health (SDOH), and clinical outcomes including retention in care; antiretroviral therapy prescription; antiretroviral therapy adherence; viral suppression; gonorrhea, chlamydia, and syphilis testing; satisfaction with HIV care; and HIV provider trust. RESULTS: Compared with patients of ID physicians, higher percentages of patients of other provider types had characteristics and SDOH associated with poor health outcomes and received HIV care at Ryan White HIV/AIDS Program-funded facilities. After accounting for these differences, most outcomes were not meaningfully different, however higher percentages of patients of non-ID physicians, NPs, and mixed providers were retained in care (6.5, 5.6, and 12.7 percentage points, respectively) and had STI testing in the past 12 months, if sexually active (6.9, 7.4, and 13.5 percentage points, respectively). CONCLUSION: Most HIV outcomes were equivalent across provider types. However, patients of non-ID physicians, NPs, and mixed providers were more likely to be retained in care and have recommended STI testing. Increasing delivery of comprehensive primary care by ID physicians and including primary care providers in ID practices could improve HIV primary care outcomes.

This cross-sectional study evaluates use and availability of follow-up anoscopy among persons at highest risk for anal cancer. | eng

INTRODUCTION: The sexual and reproductive health of cisgender women with HIV is essential for overall health and well-being. Nationally representative estimates of sexual and reproductive health outcomes among women with HIV were assessed in this study. METHODS: Data from the Centers for Disease Control and Prevention's Medical Monitoring Project-including data on sexual and reproductive health-were collected during June 2018-May 2021 through interviews and medical record abstraction among women with HIV and analyzed in 2023. Among women with HIV aged 18-44 years (n=855), weighted percentages were reported, and absolute differences were assessed between groups, highlighting differences ≥|5%| with CIs that did not cross the null. RESULTS: Overall, 86.4% of women with HIV reported receiving a cervical Pap smear in the past 3 years; 38.5% of sexually active women with HIV had documented gonorrhea, chlamydia, and syphilis testing in the past year; 88.9% of women with HIV who had vaginal sex used ≥1 form of contraception in the past year; and 53.4% had ≥1 pregnancy since their HIV diagnosis-of whom 81.5% had ≥1 unintended pregnancy, 24.6% had ≥1 miscarriage or stillbirth, and 9.8% had ≥1 induced abortion. Some sexual and reproductive health outcomes were worse among women with certain social determinants of health, including women with HIV living in households <100% of the federal poverty level compared with women with HIV in households ≥139% of the federal poverty level. CONCLUSIONS: Many women with HIV did not receive important sexual and reproductive health services, and many experienced unintended pregnancies, miscarriages/stillbirths, or induced abortions. Disparities in some sexual and reproductive health outcomes were observed by certain social determinants of health. Improving sexual and reproductive health outcomes and reducing disparities among women with HIV could be addressed through a multipronged approach that includes expansion of safety net programs that provide sexual and reproductive health service coverage.

BACKGROUND: Data are needed to assess the capacity of HIV care facilities to implement recommended Ending the HIV Epidemic activities. SETTING: US HIV care facilities. METHODS: We analyzed 2021 survey data from 514 facilities that were recruited from a census of facilities providing care to a national probability sample of US adults with HIV. We present weighted estimates of facility characteristics, services, and policies and estimates of the proportion of all US HIV patients attending these facilities. RESULTS: Among HIV care facilities, 37% were private practices, 72% were in areas with population >1 million, and 21% had more than 1000 HIV patients. Most provided preexposure prophylaxis (83%) and postexposure prophylaxis (84%). More than 67% of facilities provided HIV-specific stigma or discrimination training for all staff (covering 70% of patients) and 66% provided training on cultural competency (covering 74% of patients). A majority of patients attended facilities that provided on-site access to HIV/sexually transmitted infection (STI) transmission risk reduction counseling (89%); fewer had on-site access to treatment for substance use disorders (35%). We found low provision of on-site assistance with food banks or meal delivery (14%) and housing (33%). Approximately 71% of facilities reported using data to systematically monitor patient retention in care. On-site access to adherence tools was available at 58% of facilities; 29% reported notifying patients of missed prescription pickups. CONCLUSION: Results indicate some strengths that support Ending the HIV Epidemic-recommended strategies among HIV care facilities, such as high availability of preexposure prophylaxis/postexposure prophylaxis, as well as areas for improvement, such as provision of staff antistigma trainings and adherence supports.

Failure to maintain viral suppression may be attributed to suboptimal care engagement. Using data collected during 2015-2018, we describe nationally representative estimates of engagement in care among US adults with diagnosed HIV, overall and by viral suppression. Of those who felt they did not receive enough care, we described detailed information on barriers to care by viral suppression. We reported weighted percentages and evaluated differences between groups using Rao-Scott chi-square tests (p < .05). Persons who were not virally suppressed were less likely to be retained in care (57.3 vs. 90.8%). Common barriers to care included life circumstances that impeded receipt of care (50.0%), financial barriers (34.5%), and not feeling sick enough to take medicine (32.0%). Barriers to care varied by viral suppression status, and people who were not virally suppressed were more likely to report more than one barrier to care. These findings demonstrate that barriers can be multifaceted; addressing barriers to care by expanding comprehensive care models in HIV care settings could improve clinical outcomes among people with HIV.

Hepatitis A virus can cause severe and prolonged illness in persons with HIV (PWH). In July 2020, the Advisory Committee on Immunization Practices (ACIP) expanded its recommendation for hepatitis A vaccination to include all PWH aged ≥1 year. We used a decision analytic model to estimate the value of vaccinating a cohort of adult PWH aged ≥20 years with diagnosed HIV in the United States using a limited societal perspective. The model compared 3 scenarios over an analytic horizon of 1 year: no vaccination, current vaccine coverage, and full vaccination. We incorporated the direct medical costs and nonmedical costs (i.e., public health costs and productivity loss). We estimated the total number of infections averted, cost to vaccinate, and incremental cost per case averted. Full implementation of the ACIP recommendation resulted in 775 to 812 fewer adult cases of hepatitis A in 1 year compared with the observed vaccination coverage. The incremental cost-effectiveness ratio for the full vaccination scenario was $48,000 for the 2-dose single-antigen hepatitis A vaccine and $130,000 for the 3-dose combination hepatitis A and hepatitis B vaccine per case averted, compared with the observed vaccination scenario. Depending on type of vaccine, full hepatitis A vaccination of PWH could lead to ≥80% reduction in the number of cases and $48,000 to $130,000 in additional cost per case averted. Data on hepatitis A health outcomes and costs specific to PWH are needed to better understand the longer-term costs and benefits of the 2020 ACIP recommendation.

We describe characteristics, clinical features and outcomes of multisystem inflammatory syndrome in children among American Indian and Alaska Native (AI/AN) persons compared with non-Hispanic white persons. AI/AN patients with multisystem inflammatory syndrome in children were younger, more often obese, and from areas of higher social vulnerability. A greater proportion of AI/AN patients had severe respiratory involvement and shock.

OBJECTIVE: To describe the landscape of needs for housing assistance among people with HIV (PWH) and availability of Housing Opportunities for People with AIDS (HOPWA) funding with respect to housing service needs, nationally and for 17 US jurisdictions. DESIGN: The CDC Medical Monitoring Project (MMP) is an annual, cross-sectional survey designed to report nationally and locally representative estimates of characteristics and outcomes among adults with diagnosed HIV in the United States. METHODS: We analyzed 2015-2020 data from MMP and 2019 funding data from HOPWA. Weighted percentages and 95% confidence intervals (CIs) for national and jurisdiction-level estimates were reported. RESULTS: Nationally, 1 in 4 (27.7%) PWH had shelter or housing service needs. Among those who needed housing services, 2 in 5 (40.4%) did not receive them (range: 21.3% in New York to 62.3% in Georgia). Reasons for unmet needs were multifactorial and varied by jurisdiction. Available 2019 HOPWA funding per person in need would cover up to 1.24 months of rent per person nationally (range: 0.53 months in Virginia to 9.54 months in Puerto Rico), and may not have matched housing assistance needs among PWH in certain jurisdictions. CONCLUSION: Addressing housing service needs necessitates a multipronged approach at the provider, jurisdiction, and national level. Locally, jurisdictions should work with their partners to understand and address housing service needs among PWH. Nationally, distribution of HOPWA funding for housing services should be aligned according to local needs; the funding formula could be modified to improve access to housing services among PWH.

OBJECTIVE: To evaluate HIV care continuum trends over time among women with HIV (WWH). DESIGN: The Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV in the United States. METHODS: We used 2015-2019 MMP data collected from 5139 adults with diagnosed HIV infection who identified as cisgender women. We calculated weighted percentages with 95% confidence intervals (CIs) for all characteristics and estimated annual percentage change (EAPC) and the associated 95% CI to assess trends. EAPCs were considered meaningful from a public health perspective if at least 1% with P values less than 0.05. RESULTS: Among cisgender women with diagnosed HIV infection during 2015-2019, 58.8% were Black or African American (95% CI 54.4-63.3), 19% were Hispanic/Latina (95% CI 14.7-23.2), and 16% were Non-Hispanic White (95% CI 14.1-17.9) persons. There was a meaningful increase in the percentage who ever had stage 3 HIV disease from 55.8% (95% CI 51.0-60.5) in 2015 to 61.5% (95% CI 58.1-64.8) in 2019 (EAPC 1.7%; CI 1.5-1.9; P < 0.001). There were no meaningful changes over time among women, overall, in retention in care, antiretroviral therapy (ART) prescription, ART adherence, missed appointments, or recent or sustained viral suppression. CONCLUSION: The HIV care continuum outcomes among WWH did not meaningfully improve from 2015 to 2019, raising a concern that Ending the HIV Epidemic in the US (EHE) initiative goals will not be met. To improve health and reduce transmission of HIV among WWH, multifaceted interventions to retain women in care, increase ART adherence, and address social determinants of health are urgently needed.

Increasing HIV testing, preexposure prophylaxis (PrEP), and antiretroviral therapy (ART) are pillars of the federal Ending the HIV Epidemic in the U.S. (EHE) initiative, with a goal of decreasing new HIV infections by 90% by 2030.* In response to the COVID-19 pandemic, a national emergency was declared in the United States on March 13, 2020, resulting in the closure of nonessential businesses and most nonemergency health care venues; stay-at-home orders also limited movement within communities (1). As unemployment increased during the pandemic (2), many persons lost employer-sponsored health insurance (3). HIV testing and PrEP prescriptions declined early in the COVID-19 pandemic (4-6); however, the full impact of the pandemic on use of HIV prevention and care services and HIV outcomes is not known. To assess changes in these measures during 2019-2021, quarterly data from two large U.S. commercial laboratories, the IQVIA Real World Data - Longitudinal Prescription Database (IQVIA),(†) and the National HIV Surveillance System (NHSS)(§) were analyzed. During quarter 1 (Q1)(¶) 2020, a total of 2,471,614 HIV tests were performed, 190,955 persons were prescribed PrEP, and 8,438 persons received a diagnosis of HIV infection. Decreases were observed during quarter 2 (Q2), with 1,682,578 HIV tests performed (32% decrease), 179,280 persons prescribed PrEP (6% decrease), and 6,228 persons receiving an HIV diagnosis (26% decrease). Partial rebounds were observed during quarter 3 (Q3), with 2,325,554 HIV tests performed, 184,320 persons prescribed PrEP, and 7,905 persons receiving an HIV diagnosis. The proportion of persons linked to HIV care, the number who were prescribed ART, and proportion with a suppressed viral load test (<200 copies of HIV RNA per mL) among those tested were stable during the study period. During public health emergencies, delivery of HIV services outside of traditional clinical settings or that use nonclinical delivery models are needed to facilitate access to HIV testing, ART, and PrEP, as well as to support adherence to ART and PrEP medications.

Monkeypox virus, an orthopoxvirus sharing clinical features with smallpox virus, is endemic in several countries in Central and West Africa. The last reported outbreak in the United States, in 2003, was linked to contact with infected prairie dogs that had been housed or transported with African rodents imported from Ghana (1). Since May 2022, the World Health Organization (WHO) has reported a multinational outbreak of monkeypox centered in Europe and North America, with approximately 25,000 cases reported worldwide; the current outbreak is disproportionately affecting gay, bisexual, and other men who have sex with men (MSM) (2). Monkeypox was declared a public health emergency in the United States on August 4, 2022.(†) Available summary surveillance data from the European Union, England, and the United States indicate that among MSM patients with monkeypox for whom HIV status is known, 28%-51% have HIV infection (3-10). Treatment of monkeypox with tecovirimat as a first-line agent is available through CDC for compassionate use through an investigational drug protocol. No identified drug interactions would preclude coadministration of tecovirimat with antiretroviral therapy (ART) for HIV infection. Pre- and postexposure prophylaxis can be considered with JYNNEOS vaccine, if indicated. Although data are limited for monkeypox in patients with HIV, prompt diagnosis, treatment, and prevention might reduce the risk for adverse outcomes and limit monkeypox spread. Prevention and treatment considerations will be updated as more information becomes available.

BACKGROUND: The HIV Medicine Association of the Infectious Disease Society of America publishes Primary Care Guidance for Persons with Human Immunodeficiency Virus. We assessed receipt of recommended baseline tests among newly diagnosed patients initiating HIV care. METHODS: The Medical Monitoring Project is a Centers for Disease Control and Prevention survey designed to produce nationally representative estimates of behavioral and clinical characteristics of adults with diagnosed HIV in the United States. We analyzed data for 725 participants in the 2015-2019 data collection cycles who received an HIV diagnosis within the past 2 years and had ≥1 HIV provider visit. We estimated the prevalence of having recommended tests after the first HIV provider visit and between 3 months before and 3/6 months after the first HIV provider visit and estimated prevalence differences of having 4 combinations of tests by sociodemographic and clinical characteristics. RESULTS: Within 6 months of care initiation, HIV monitoring tests were performed for 91.3% (95% CI, 88.7%-93.8%) of patients; coinfection blood tests, 27.5% (95% CI, 22.5%-32.4%); site-based STI tests, 59.7% (95% CI, 55.4%-63.9%); and blood chemistry and hematology tests, 50.8% (95% CI, 45.8%-55.8%). Patients who were younger, gay, or bisexual were more likely to receive site-based STI tests, and patients receiving care at Ryan White HIV/AIDS Program (RWHAP)-funded facilities were more likely than patients at non-RWHAP-funded facilities to receive all test combinations. CONCLUSIONS: Receipt of recommended baseline tests among patients initiating HIV care was suboptimal but was more likely among patients at RWHAP-funded facilities. Embedding clinical decision support in HIV provider workflow could increase recommended baseline testing.

Unstably housed sexually active people with HIV (PWH) experience both a high incidence of sexually transmitted infections (STIs) and barriers to annual STI screening recommended by CDC guidelines. We used Medical Monitoring Project data to describe STI testing among unstably housed PWH by attendance at Ryan White HIV/AIDS Program-funded facilities.

OBJECTIVE: To investigate unmet needs for HIV ancillary care services by health care coverage type and Ryan White HIV/AIDS Program (RWHAP) assistance among adults with HIV. DESIGN: We analyzed data using the 2017-2019 cycles of the CDC Medical Monitoring Project, an annual, cross-sectional study designed to produce nationally representative estimates of characteristics among adults with diagnosed HIV. METHODS: Unmet need was defined as needing, but not receiving, ≥1 HIV ancillary care service. We estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) using predicted marginal means to examine associations between health care coverage type and unmet needs for HIV ancillary care services, adjusting for age. Associations were stratified by receipt of RWHAP assistance. RESULTS: Unmet needs for HIV ancillary care services were highest among uninsured persons (58.7%) and lowest among those with private insurance living ≥400% of the federal poverty level (FPL; 21.7%). Uninsured persons who received RWHAP assistance were less likely than those who did not receive RWHAP assistance to have unmet needs for HIV clinical support services (aPR: 0.21; 95% CI: 0.16-0.28) and other medical services (aPR: 0.75; 95% CI: 0.59-0.96), but not subsistence services (aPR: 0.97; 95% CI: 0.74-1.27). Unmet needs for other medical services and subsistence services did not differ by RWHAP assistance among those with Medicaid, Medicare, or other health care coverage. CONCLUSIONS: RWHAP helped reduce some needs for uninsured persons. However, with growing socioeconomic inequities following the COVID-19 pandemic, expanding access to needed services for all people with HIV could improve key outcomes.

OBJECTIVE: To evaluate whether reported prevalence of unemployment, subsistence needs, and symptoms of depression and anxiety among adults with diagnosed HIV during the COVID-19 pandemic were higher than expected. DESIGN: The Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV in the United States. METHODS: We analyzed 2015-2019 MMP data using linear regression models to calculate expected prevalence, along with corresponding prediction intervals (PI), for unemployment, subsistence needs, depression, and anxiety for June-November 2020. We then assessed whether observed estimates fell within the expected prediction interval for each characteristic, overall and among specific groups. RESULTS: Overall, the observed estimate for unemployment was higher than expected (17% vs 12%) and exceeded the upper limit of the PI. Those living in households with incomes > = 400% of FPL were the only group where the observed prevalence of depression and anxiety during the COVID-19 period was higher than the PIs; in this group, the prevalence of depression was 9% compared with a predicted value of 5% (75% higher) and the prevalence of anxiety was 11% compared with a predicted value 5% (137% higher). We did not see elevated levels of subsistence needs, although needs were higher among Black and Hispanic compared with White persons. CONCLUSIONS: Efforts to deliver enhanced employment assistance to persons with HIV and provide screening and access to mental health services among higher income persons may be needed to mitigate the negative effects of the US COVID-19 pandemic.

Ancillary care services are essential for supporting care engagement and viral suppression among persons with HIV. Estimating unmet needs for ancillary care services may help address care barriers and improve clinical outcomes, but recent, nationally representative estimates are lacking. Using CDC Medical Monitoring Project data from 2015-2018, we report representative estimates of unmet needs for ancillary care services and associations with HIV clinical outcomes among U.S. adults with HIV. Data were collected through interview and medical record abstraction. We described weighted percentages for all characteristics and associations with HIV clinical outcomes using prevalence ratios with predicted marginal means, adjusting for potential confounding. Substantial unmet needs were reported; unmet needs were higher among persons with social determinants of poor health, persons who engaged in drug use or binge drinking, and those who experienced depression or anxiety. Having unmet needs for care was associated with adverseHIV clinical outcomes, with a dose response effect between number of unmet needs and outcomes. Expanding ancillary care access based on a comprehensive care model, strengthening partnerships between providers to connect patients to essential services, and tailoring services based on need may help reduce disparities in unmet needs and improve outcomes.

National guidelines recommend annual STI testing for sexually active people living with HIV, including transgender women. Using data from the US Medical Monitoring Project during 2015-2019, in the previous 12 months, 63.3% of sexually active HIV-positive transgender women were tested for syphilis, 56.6% for chlamydia, and 54.4% for gonorrhea.

The year 2020 marked 30 years since passage of the Ryan White CARE Act in the United States. Named for Ryan White—a child with HIV who endured discrimination and emerged as a spokesperson for HIV education and understanding before dying of AIDS in 1990 at age 18—the CARE Act established the Ryan White HIV/AIDS Program (RWHAP) within the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services. The RWHAP provides a comprehensive system of HIV primary medical care, medication, and essential support services to about half of people with diagnosed HIV (PWH) in the United States. The RWHAP has demonstrated rising levels of viral suppression among PWH who had at least one outpatient visit at a RWHAP-funded facility; in 2018, 87.1% of PWH receiving care at RWHAP-funded facilities were virally suppressed (HRSA, 2019). Today, the RWHAP is a key part of Ending the HIV Epidemic: A Plan for America—an initiative that aims to reduce new HIV infections in the United States by 90% by 2030.

BACKGROUND: Health inequities among people with HIV may be compounded by disparities in the prevalence of comorbidities associated with increased risk of severe illness from COVID-19. SETTING: Complex sample survey designed to produce nationally representative estimates of behavioral and clinical characteristics of adults with diagnosed HIV in the United States. METHODS: We estimated prevalence of having ≥1 diagnosed comorbidity associated with severe illness from COVID-19 and prevalence differences (PD) by race/ethnicity, income level, and type of health insurance. We considered PDs ≥5 percentage points to be meaningful from a public health perspective. RESULTS: An estimated 37.9% (95% CI, 36.6 to 39.2) of adults receiving HIV care had ≥1 diagnosed comorbidity associated with severe illness from COVID-19. Compared with non-Hispanic Whites, non-Hispanic Blacks or African Americans were more likely (adjusted prevalence difference [APD], 7.8 percentage points [95% CI, 5.7 to 10.0]) and non-Hispanic Asians were less likely (APD, -13.7 percentage points [95% CI, -22.3 to -5.0]) to have ≥1 diagnosed comorbidity after adjusting for age differences. There were no meaningful differences between non-Hispanic Whites and adults in other racial/ethnic groups. Those with low income, were more likely to have ≥1 diagnosed comorbidity (PD, 7.3 percentage points [95% CI, 5.1 to 9.4]). CONCLUSIONS: Among adults receiving HIV care, non-Hispanic Blacks and those with low income were more likely to have ≥1 diagnosed comorbidity associated with severe COVID-19. Building health equity among people with HIV during the COVID-19 pandemic may require reducing the impact of comorbidities in heavily affected communities.

Research suggests that language barriers in health care settings may adversely affect clinical outcomes and patient satisfaction. We describe the characteristics of adults with limited English proficiency (LEP) and diagnosed HIV in the United States. The Medical Monitoring Project is a complex sample survey of adults with diagnosed HIV in the United States that uses two-stage, probability-proportional-to-size sampling. We analyzed weighted interview and medical record data collected from June 2015-May 2018. The prevalence of LEP among adults with HIV was 10%. Higher percentages of adults with LEP, compared with adults with English proficiency (EP), were female, Hispanic/Latino, less educated and poor, only had Ryan White HIV/AIDS Program (RWHAP) health care coverage, attended RWHAP-funded facilities, were satisfied with their HIV medical care, were prescribed antiretroviral therapy (ART), were virally suppressed and received testing for sexually transmitted diseases. We found no statistical difference in ART adherence among adults with LEP and EP. Despite the association between LEP and the risk for health disparities, more persons with LEP were virally suppressed compared with persons with EP. One possible explanation is attendance at RWHAP-funded facilities by adults with LEP; however, future studies are needed to explore other possible explanations.

During 2018, estimated incidence of human immunodeficiency virus (HIV) infection among Hispanic and Latino (Hispanic/Latino) persons in the United States was four times that of non-Hispanic White persons (1). Hispanic/Latino men who have sex with men (MSM) accounted for 24% (138,023) of U.S. MSM living with diagnosed HIV infection at the end of 2018 (1). Antiretroviral therapy (ART) adherence is crucial for viral suppression, which improves health outcomes and prevents HIV transmission (2). Barriers to ART adherence among Hispanic/Latino MSM have been explored in limited contexts (3); however, nationally representative analyses are lacking. The Medical Monitoring Project reports nationally representative estimates of behavioral and clinical experiences of U.S. adults with diagnosed HIV infection. This analysis used Medical Monitoring Project data collected during 2015-2019 to examine ART adherence and reasons for missing ART doses among HIV-positive Hispanic/Latino MSM (1,673). On a three-item ART adherence scale with 100 being perfect adherence, 77.3% had a score of ≥85. Younger age, poverty, recent drug use, depression, and unmet needs for ancillary services were predictors of lower ART adherence. The most common reason for missing an ART dose was forgetting; 63.9% of persons who missed ≥1 dose reported more than one reason. Interventions that support ART adherence and access to ancillary services among Hispanic/Latino MSM might help improve clinical outcomes and reduce transmission.

Although non-Hispanic American Indian and Alaska Native (AI/AN) persons account for 0.7% of the U.S. population,* a recent analysis reported that 1.3% of coronavirus disease 2019 (COVID-19) cases reported to CDC with known race and ethnicity were among AI/AN persons (1). To assess the impact of COVID-19 among the AI/AN population, reports of laboratory-confirmed COVID-19 cases during January 22(†)-July 3, 2020 were analyzed. The analysis was limited to 23 states(§) with >70% complete race/ethnicity information and five or more laboratory-confirmed COVID-19 cases among both AI/AN persons (alone or in combination with other races and ethnicities) and non-Hispanic white (white) persons. Among 424,899 COVID-19 cases reported by these states, 340,059 (80%) had complete race/ethnicity information; among these 340,059 cases, 9,072 (2.7%) occurred among AI/AN persons, and 138,960 (40.9%) among white persons. Among 340,059 cases with complete patient race/ethnicity data, the cumulative incidence among AI/AN persons in these 23 states was 594 per 100,000 AI/AN population (95% confidence interval [CI] = 203-1,740), compared with 169 per 100,000 white population (95% CI = 137-209) (rate ratio [RR] = 3.5; 95% CI = 1.2-10.1). AI/AN persons with COVID-19 were younger (median age = 40 years; interquartile range [IQR] = 26-56 years) than were white persons (median age = 51 years; IQR = 32-67 years). More complete case report data and timely, culturally responsive, and evidence-based public health efforts that leverage the strengths of AI/AN communities are needed to decrease COVID-19 transmission and improve patient outcomes.

OBJECTIVES: Hepatitis C virus (HCV) and HIV transmission in the United States may increase as a result of increasing rates of opioid use disorder (OUD) and associated injection drug use (IDU). Epidemiologic trends among American Indian/Alaska Native (AI/AN) persons are not well known. METHODS: We analyzed 2010-2014 Indian Health Service data on health care encounters to assess regional and temporal trends in IDU indicators among adults aged >/=18 years. IDU indicators included acute or chronic HCV infection (only among adults aged 18-35 years), arm cellulitis and abscess, OUD, and opioid-related overdose. We calculated rates per 10 000 AI/AN adults for each IDU indicator overall and stratified by sex, age group, and region and evaluated rate ratios and trends by using Poisson regression analysis. RESULTS: Rates of HCV infection among adults aged 18-35 increased 9.4% per year, and rates of OUD among all adults increased 13.3% per year from 2010 to 2014. The rate of HCV infection among young women was approximately 1.3 times that among young men. Rates of opioid-related overdose among adults aged <50 years were approximately 1.4 times the rates among adults aged >/=50 years. Among young adults with HCV infection, 25.6% had concurrent OUD. Among all adults with arm cellulitis and abscess, 5.6% had concurrent OUD. CONCLUSIONS: Rates of HCV infection and OUD increased significantly in the AI/AN population. Strengthened public health efforts could ensure that AI/AN communities can address increasing needs for culturally appropriate interventions, including comprehensive syringe services programs, medication-assisted treatment, and opioid-related overdose prevention and can meet the growing need for treatment of HCV infection.

People with HIV (PWH) who contract hepatitis A may have higher level and prolonged hepatitis A viremia with an increased potential to transmit hepatitis A.1,2 Many PWH have risk factors for which hepatitis A vaccination is recommended, including male-to-male sexual contact, injection and noninjection drug use, homelessness, and chronic liver disease.3,4 However, in February 2020, the U.S. Advisory Committee on Immunization Practices (ACIP) recommended that all PWH age $ 1 year be routinely vaccinated for hepatitis A (https://www.cdc.gov/vaccines/schedules/index.html). The number of additional adults receiving HIV care who have an indication for vaccination based on the 2020 ACIP update is unknown and could inform public health practice and resource allocation.