About the EHE Indicators: Linkage to Care

There are six EHE indicators: HIV incidence, knowledge of HIV status, diagnoses, linkage to HIV medical care, HIV viral suppression, and PrEP coverage.

Each indicator was chosen with specific public health goals in mind and in line with the four key strategies of the initiative: diagnose, prevent, treat and respond. Incidence measures our overarching goal of reducing new infections by 90% by 2030. Diagnoses, and Knowledge of Status are all key to identifying which individuals need to be linked to care, and represent important steps on the HIV Care Continuum. Data have shown that upon diagnosis, immediate linkage to care and treatment results in improved HIV outcomes, so it is important to track how these indicators change over time. Viral Suppression and PrEP use will have the greatest impact on reducing new transmissions if they are scaled up.

Explore HIV indicator data on the AHEAD dashboard.

What Is Linkage to HIV Care?

Linkage to care measures the percentage of people who received an HIV diagnosis in a calendar year and received HIV medical care within 1 month of diagnosis.

The EHE linkage to care goal is to increase the percentage of people who receive HIV medical care within 1 month of HIV diagnosis to 95% from a 2017 baseline of 77.8%.

Linkage to HIV medical care is measured by documentation of one or more CD4 or HIV viral load tests within 1 month after HIV diagnosis.

Prompt linkage to care after HIV diagnosis is a crucial early step in successful HIV treatment. It enables a person with HIV to see a medical provider who can perform tests and prescribe the antiretroviral therapy (HIV medicine) needed to suppress the virus to undetectable levels. An undetectable viral load—a very low level of HIV in the blood—prevents disease progression, reduces the risk of complications, and prevents transmission of the virus to others. Prompt linkage to care and initiation of HIV treatment improves health outcomes and reduces transmission.

Uses of Linkage to Care Data

Linkage to care data can:

1. Help assess the effectiveness of strategies being used to connect people with diagnosed HIV to care and treatment and where improvements may be needed.
2. Reveal populations or geographical areas where there may be barriers that delay or prevent prompt access to HIV care that need to be addressed.
3. Identify disparities among groups experiencing delays in care and inform focused outreach and intervention and/or where strategies need to be better tailored.

How Is the Linkage to Care Indicator Calculated?

To calculate linkage to care, CDC divides the number of people aged 13 years and older with a new HIV diagnosis who had a CD4 or viral load test within one month of diagnosis by the total number of people with a new HIV diagnosis in that same year.

Of note, this indicator is only available for jurisdictions that have complete data reported to CDC's National HIV Surveillance System (NHSS). Areas with complete data have at least 95% of HIV laboratory results reported to their surveillance programs and have transmitted their data to NHSS. NHSS includes data for persons aged ≥13 years. Linkage to care data by area are based on residence at time of HIV diagnosis.

For the baseline year 2017, linkage to HIV medical care data were available for the following 41 states and the District of Columbia: Alabama, Alaska, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

There were 41 areas with complete lab reporting for 2018; however, the composition of the states changed. In 2018, linkage data were available for Nevada but not Connecticut.

For 2019, the number of areas with complete laboratory data increased to 45. Linkage to HIV medical care data were available for the following 44 states and the District of Columbia: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

For 2020, the number of areas with complete laboratory data increased to 46. Linkage to HIV medical care data were available for the following 45 states and the District of Columbia: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

For 2021, the number of areas with complete laboratory data increased to 48. Linkage to HIV medical care data were available for the following 47 states and the District of Columbia: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

For 2022, the number of areas with complete laboratory data increased to 49. Linkage to HIV medical care data were available for the following 48 states and the District of Columbia: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

For 2023, national analyses included data from all 50 states and the District of Columbia. While data for Idaho were included in national and regional analyses, they are not presented in jurisdiction-level tables due to the state's lack of mandatory reporting of all CD4 and viral load test results. Conversely, data for Puerto Rico were not included in national and regional analyses but are available in jurisdiction-level tables.

About Linkage to HIV Care Data

Linkage to care data are not provided for jurisdictions that do not have laws requiring reporting of all CD4 and viral loads. Areas without laws: Idaho. Areas with a lapse in reporting in 2023: Tennessee. Data for the years 2024 and 2025 are preliminary.

Totals for linkage to care include other transmission categories, such as persons whose infection was attributed to hemophilia, blood transfusion, or perinatal exposure, or whose transmission category was not reported or not identified. These data are not displayed in tables because the numbers are too small to be meaningful.

Data presented by quarter: Linkage to care for a quarter is calculated for the cumulative number of persons who received an HIV diagnosis through the specified quarter of the calendar year. A 3-month reporting delay is required for calculating linkage to care due to known delays in reporting of laboratory data (e.g., linkage to care through September 2024 is calculated by using data reported to CDC's NHSS through December 2024). Data presented by quarter are preliminary.

Data reported to NHSS are considered preliminary until a 12-month reporting delay has been reached.

Data for the years 2024 and 2025 are considered preliminary and based on data reported to CDC's NHSS as of June 2025. Linkage to HIV medical care data are preliminary through March 2025.

Data Sources

1. National HIV Prevention and Care Objectives: 2025 Update

   See Full Citation

Centers for Disease Control and Prevention. Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data—United States and 6 Territories and Freely Associated States, 2023. https://www.cdc.gov/hiv-data/nhss/national-hiv-prevention-and-care-objectives-2025.html. Published April 29, 2025. Accessed June 4, 2025.

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2. HIV Surveillance Data Tables (early release), 2020; 1(1)

   See Full Citation

Centers for Disease Control and Prevention. Core indicators for Monitoring the Ending the HIV Epidemic Initiative (Data reported through December 2019). HIV Surveillance Data Tables (early release), 2020; 1(1). https://stacks.cdc.gov/view/cdc/149334. Published March 2020. Accessed March 2, 2026.

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