Vital Signs: Human Immunodeficiency Virus Testing and Diagnosis Delays - United States

Abstract

Background: Persons 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.

Methods: Data 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.

Results: An 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.

Conclusions: Delayed 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 practice: Health 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.

FIGURE 1

Percentage of undiagnosed infections^,† among persons aged ≥13 years living with diagnosed or undiagnosed human immunodeficiency virus (HIV) infection — United States, 2015 * Overall percentage of undiagnosed infections = 14.5%. ^† Data classified manually. ^§ Estimates were derived by using HIV surveillance data for persons aged ≥13 years at diagnosis in the 50 states and the District of Columbia.

FIGURE 2

Percentage of persons tested for human immunodeficiency virus (HIV) in the past 12 months among men who have sex with men, persons who inject drugs, and heterosexual persons at increased risk for infection — National HIV Behavioral Surveillance (NHBS), United States, 2008–2016 * Data include all participants with complete valid survey data who tested negative during NHBS and cycle-specific inclusion criteria: men who have sex with men (born male, identified as male, and had oral or anal sex with another man); persons who inject drugs (injected drugs in the past 12 months); heterosexual persons at increased risk (male or female [not transgender], had sex with a member of the opposite sex in the past 12 months, never injected drugs, and met low income [not exceeding U.S. Department of Health and Human Services poverty guidelines] or low education [high school education or less] criteria). Groups are mutually exclusive.