Frequently Asked Questions

The purpose of AHEAD is to help stakeholders evaluate the nation's progress toward reaching the goals of the EHE initiative and to use the data to inform local EHE and HIV related community planning efforts.

AHEAD displays both data and goals for 57 priority areas*:

• 50 priority counties/areas
• 7 priority states

In addition to the 57 priority areas, AHEAD provides data on the remaining 43 states. The Dashboard tracks national and jurisdictional progress for the six EHE indicators leading to the overarching goal of the initiative: reducing new HIV transmissions 75% by 2025 and 90% by 2030.

On AHEAD, stakeholders can:

• View progress towards goals for the 57 priority areas;
• Review cumulative quarterly data;
• Filter by specific EHE HIV indicator data;
• Filter by demographic variables at the national, state, and local levels;
• Compare data across peer, county-level priority areas through an automated comparison feature;
• Contextualize the data: HIV diagnoses data are presented alongside HIV linkage to care data to foster a deeper understanding of the relationship between indicators; and
• Download data in multiple formats: all AHEAD data, partial data, and as a graphic.

These indicators were chosen because progress on these indicators will have the greatest impact on ending the HIV epidemic in the U.S. by 2030: incidence, diagnoses, knowledge of status, linkage to HIV medical care, viral suppression, and PrEP coverage.

These six indicators were chosen with specific public health goals in mind in addition to aligning with the four key strategies of the initiative: diagnose, prevent, treat, and respond. Incidence measures the overarching goal of reducing new transmissions by 90% by 2030. Diagnoses and knowledge of status are both key to identifying which individuals need to be linked to HIV medical care and represent important steps on the HIV care continuum. Data have shown that, upon diagnosis, immediate linkage to HIV medical care and treatment results in improved HIV outcomes, so it is important to track how these indicators change over time. If scaled, viral suppression and PrEP use are the two EHE indicators that will have the greatest impact on reducing new transmissions.

For incidence, the stated EHE 2030 goal is a 90% reduction from baseline year (2017) and the stated 2025 goal is a 75% reduction; these also apply to the diagnosis indicator. The stated 2030 and 2025 goals for other EHE indicators are as follows:

• Knowledge of status: 95%
• Linkage to care: 95%
• Viral suppression: 95%
• PrEP coverage: 50%

The Ending the HIV Epidemic initiative focuses its efforts in 48 counties, Washington, DC, and San Juan, Puerto Rico, where >50% of HIV diagnoses occurred in 2016 and 2017, and an additional seven states with a substantial number of HIV diagnoses in rural areas, bringing the total number of Phase I jurisdictions to 57.

The 50 priority counties/areas are:

• Maricopa County, AZ
• Alameda County, CA
• Los Angeles County, CA
• Orange County, CA
• Riverside County, CA
• Sacramento County, CA
• San Bernardino County, CA
• San Diego County, CA
• San Francisco County, CA
• Distric of Columbia
• Broward County, FL
• Duval County, FL
• Hillsborough County, FL
• Miami-Dade County, FL
• Palm Beach County, FL
• Pinellas County, FL
• Cobb County, GA
• De Kalb County, GA
• Fulton County, GA
• Gwinnett County, GA
• Cook County, IL
• Marion County, IN
• East Baton Rouge Parish, LA
• Orleans Parish, LA
• Baltimore City, MD
• Montgomery County, MD
• Prince George's County, MD
• Suffolk County, MA
• Wayne County, MI
• Clark County, NV
• Essex County, NJ
• Hudson County, NJ
• Bronx County, NY
• Kings County, NY
• New York County, NY
• Queens County, NY
• Mecklenburg County, NC
• Cuyahoga County, OH
• Franklin County, OH
• Hamilton County, OH
• Philadelphia County, PA
• San Juan Municipio, Puerto Rico
• Shelby County, TN
• Bexar County, TX
• Dallas County, TX
• Harris County, TX
• Tarrant County, TX
• Travis County, TX
• King County, WA

The 7 priority states are:

• Alabama
• Arkansas
• Kentucky
• Mississippi
• Missouri
• Oklahoma
• South Carolina

The data source for 5 of the 6 EHE indicators is CDC's National HIV Surveillance System (NHSS), the primary source for monitoring HIV trends in the United States. CDC funds and assists state and local health departments to collect case information.

The sixth indicator, pre-exposure prophylaxis (PrEP) coverage uses 4 data sources: IQVIA Real World Data—Longitudinal Prescriptions Database (IQVIA), American Community Survey (ACS), National Health and Nutrition Examination Survey (NHANES), and NHSS.

IQVIA is a pharmacy database that is used as the data source for the numerator, which is the number of persons classified as having been prescribed PrEP. Three data sources, ACS, NHANES, and NHSS are used to estimate the denominator, the number of persons with indicators for PrEP. Additionally, in one instance, Puerto Rico, ACS is used in combination with NHANES and NHSS to estimate PrEP coverage denominator for Puerto Rico.

Data for the year 2020, which coincided with the onset of the COVID-19 pandemic, should be interpreted with caution. The pandemic had a significant impact on access to HIV testing, care, and related services, and case surveillance activities in state and local jurisdictions. As the COVID-19 pandemic lasted beyond 2020, readers should also consider the potential influence of these pandemic effects on U.S. public health systems when interpreting HIV data for 2021–2022.

The reduction in HIV diagnoses in 2020 is likely due to disruptions in clinical care services, patient hesitancy in accessing clinical services, and shortages in HIV testing reagents/materials during the COVID-19 pandemic. Inclusion of 2020 data in trend assessments is discouraged.

Estimates of new HIV infections (HIV incidence) and knowledge of HIV status are not available for the year 2020 due to the impact of the COVID-19 pandemic on HIV testing. More time and data are needed to accurately assess COVID-19’s impact on HIV transmission in the United States.

AHEAD can be cited in the following format, using APA style.

U.S. Health and Human Services. (2019, August 18). America's HIV Epidemic Analysis Dashboard (AHEAD). Retrieved from https://ahead.hiv.gov/