About the Six EHE Indicators

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.

Learn more about the 6 EHE indicators by viewing data either by demographic or geographic location.

What is Linkage to HIV Care?

Linkage to HIV medical care was measured by documentation of ≥1 CD4 or VL tests ≤1 month after HIV diagnosis. Of note, this indicator is only available for areas that have complete data. Areas with complete data have at least 95% of laboratory results reported to their surveillance programs and have transmitted their data to CDC’s National HIV Surveillance System (NHSS). NHSS includes data for persons aged ≥13 years. Linkage to care data by area are based on residence at time of diagnosis of HIV infection.

For the baseline year 2017, linkage to HIV medical care was available for 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 are 41 areas with complete lab reporting for 2018; however, the composition of the states changed. In 2018, linkage was available for Nevada but not available for Connecticut.

For 2019, the number of areas with complete laboratory data increased to 45. Linkage to HIV medical care data is available for 44 states and the District of Columbia including: 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 is available for 44 states and the District of Columbia including: 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, 2022, and 2023, the number of areas with complete laboratory data increased to 48. Linkage to HIV medical care data is available for 47 states and the District of Columbia including: 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.

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, or that have incomplete reporting of laboratory data to CDC. For years 2021, 2022, and 2023, the only area without laws was Idaho and areas with incomplete reporting were New Jersey, Pennsylvania (excluding Philadelphia), and Puerto Rico.

Totals for linkage to care include other risk factors, such as persons whose infection was attributed to hemophilia, blood transfusion, or perinatal exposure or whose risk factor 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 June 2023 is calculated using data reported to CDC’s National HIV Surveillance System through September 2023). Data presented by quarter are preliminary.

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

Data for year 2022 and 2023 are considered preliminary and based on data reported to CDC’s National HIV Surveillance System as of September 2023. Diagnoses data are preliminary through September 2023. Linkage to HIV Medical Care and PrEP Coverage are preliminary through June 2023.

Data Sources

1. HIV Surveillance Data Tables, 2023; 4(4) —

   See Full Citation

Centers for Disease Control and Prevention. Core indicators for monitoring the Ending the HIV Epidemic initiative (preliminary data): National HIV Surveillance System data reported through September 2023; and preexposure prophylaxis (PrEP) data reported through June 2023. HIV Surveillance Data Tables, 2023; 4(4). https://www.cdc.gov/hiv/library/reports/surveillance-data-tables/. Published December 2023. Accessed December 15, 2023.

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2. HIV Surveillance Supplemental Report 2023, 28(4) —

   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 dependent areas, 2021. HIV Surveillance Supplemental Report, 2023; 28(4). http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published May 2023. Accessed July 12, 2023.

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