The HIV Treat Pillar: An Update and Summary of Promising Approaches.

The Treat pillar of the Ending the HIV Epidemic in the U.S. plan calls for comprehensive strategies to enhance linkage to, and engagement in, HIV medical care to improve viral suppression among people with HIV and achieve the goal of 95% viral suppression by 2025.

A Data Visualization and Dissemination Resource to Support HIV Prevention and Care at the Local Level: Analysis and Uses of the AIDSVu Public Data Resource.

Background: AIDSVu is a public resource for visualizing HIV surveillance data and other population-based information relevant to HIV prevention, care, policy, and impact assessment.

Objective: The site, AIDSVu.org, aims to make data about the US HIV epidemic widely available, easily accessible, and locally relevant to inform public health decision making.

Data to Care: Lessons Learned From Delivering Technical Assistance to 20 Health Departments.

Background: Data to Care (D2C) is a public health strategy that uses HIV surveillance and other data to identify persons living with HIV who are "not in care" to link them to medical care or other services. To support health department implementation of D2C, the Centers for Disease Control and Prevention supported direct technical assistance (TA) to build health department D2C capacity.

Methods: Between 2013 and 2017, 2 contracting organizations worked with the Centers for Disease Control and Prevention to provide intensive D2C TA to 20 US health departments.

HIV-1 transmission during early infection in men who have sex with men: a phylodynamic analysis.

Background: Conventional epidemiological surveillance of infectious diseases is focused on characterization of incident infections and estimation of the number of prevalent infections. Advances in methods for the analysis of the population-level genetic variation of viruses can potentially provide information about donors, not just recipients, of infection. Genetic sequences from many viruses are increasingly abundant, especially HIV, which is routinely sequenced for surveillance of drug resistance mutations.

Quality of care for HIV infection provided by Ryan White Program-supported versus Non-Ryan White Program-supported facilities.

Background: The Ryan White HIV/AIDS Care Act (now the Treatment Modernization Act; Ryan White Program, or RWP) is a source of federal public funding for HIV care in the United States. The Health Services and Resources Administration requires that facilities or providers who receive RWP funds ensure that HIV health services are accessible and delivered according to established HIV-related treatment guidelines. We used data from population-based samples of persons in care for HIV infection in three states to compare the quality of HIV care in facilities supported by the RWP, with facilities not supported by the RWP.

Use of a population-based survey to determine incidence of AIDS-defining opportunistic illnesses among HIV-positive persons receiving medical care in the United States.

Background: Diagnosis of an opportunistic illness (OI) in a person with HIV infection is a sentinel event, indicating opportunities for improving diagnosis of HIV infection and secondary prevention efforts. In the past, rates of OIs in the United States have been calculated in observational cohorts, which may have limited representativeness.

Methods: We used data from a 1998 population-based survey of persons in care for HIV infection to demonstrate the utility of population-based survey data for the calculation of OI rates, with inference to populations in care for HIV infection in three geographic areas: King County Washington, selected health districts in Louisiana, and the state of Michigan.

Setting standards and an evaluation framework for human immunodeficiency virus/acquired immunodeficiency syndrome surveillance.

National acquired immunodeficiency syndrome surveillance commenced with the beginning of the human immunodeficiency virus (HIV) epidemic in the United States in 1981, and by 2003 all states had implemented HIV surveillance. This information, used for prevention interventions, and the allocation of resources, must be accurate to determine trends in HIV transmission and the number of persons living with HIV. Standards for data accuracy were developed through a national consensus approach and integrated into a framework for local and national program evaluation.

Improving the representativeness of behavioral and clinical surveillance for persons with HIV in the United States: the rationale for developing a population-based approach.

The need for a new surveillance approach to understand the clinical outcomes and behaviors of people in care for HIV evolved from the new challenges for monitoring clinical outcomes in the HAART era, the impact of the epidemic on an increasing number of areas in the US, and the need for representative data to describe the epidemic and related resource utilization and needs. The Institute of Medicine recommended that the Centers for Disease Control and Prevention and the Heath Resources and Services Administration coordinate efforts to survey a random sample of HIV-infected persons in care, in order to more accurately measure the need for prevention and care services. The Medical Monitoring Project (MMP) was created to meet these needs.

Pregnancy and other factors associated with higher CD4+ T-cell counts at HIV diagnosis in Southeast Michigan, 1992-2002.

Background: Early diagnosis of HIV infection provides the opportunity for treatment to prevent progression to AIDS and for intervention to prevent further transmission. The impact of routine screening of pregnant women and other factors on the stage of HIV disease at diagnosis were evaluated.

Methods: Data were collected in 1992-2002 from the medical records of persons presenting for HIV-related care at 2 major medical centers in Detroit, Michigan.

A two-stage sampling method for clinical surveillance of individuals in care for HIV infection in the United States.

Objectives: The goals of this study were two-fold: (1) to describe methods for drawing a population-based sample of individuals in care for HIV infection and (2) to compare data from the sample with data from existing surveillance systems that describe care for HIV.

Methods: The authors implemented a two-stage sampling method, using local HIV/AIDS surveillance data as a sampling frame of HIV care providers in three states. At selected providers, medical records of a random sample of patients were abstracted.

HIV/AIDS surveillance and prevention: improving the characterization of HIV transmission.

By focusing on the most probable mode of exposure, HIV/AIDS surveillance systems have historically been largely effective at describing how HIV is acquired in the United States. However, this analysis demonstrates that the use of the current Centers for Disease Control and Prevention (CDC) risk hierarchy may be inadequate to describe recent trends in HIV acquisition by women, who continue to make up a greater number and proportion of new cases of HIV infection and AIDS both in Michigan and nationally. The authors suggest two changes to the current risk hierarchy to increase the accuracy of describing HIV acquisition: (1).

Does access to health care impact survival time after diagnosis of AIDS?

Lack of access to health care is often blamed for poor health outcomes, but this effect is not supported by existing HIV/AIDS literature. The authors examined the association between access to care and survival time after progression to AIDS, using survival analysis methods. This study combined data from two CDC sponsored studies of HIV-infected persons, a cross-sectional interview study and a longitudinal medical record review study.