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 PrEP Coverage?

PrEP coverage, reported as a percentage, was calculated as the number who have been prescribed PrEP divided by the estimated number of persons who had indications for PrEP. PrEP prescription data values <40 in any jurisdiction are not reported because of reliability concerns. For more detailed information on the denominator of this indicator, please visit the CDC Data Tables. Caution should be used when interpreting the PrEP coverage percentages. Different data sources were used for the numerator and denominator; therefore, it is unknown whether all persons prescribed PrEP (numerator) are also contained in the estimate of the number of persons with indications for PrEP (denominator).

The number of persons prescribed PrEP was estimated using data from IQVIA pharmacy database reported through June 2023 based on an algorithm that included FDA approved drugs for PrEP. The validated algorithm included persons who had:

• At least one generic or brand tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) prescription for >28 days and for whom TDF/FTC was not prescribed for HIV treatment, hepatitis B treatment, or HIV postexposure prophylaxis.
• Tenofovir alafenamide and emtricitabine (TAF/FTC) was approved as an alternative drug for PrEP by the FDA in October 2019. Long-acting injectable cabotegravir (CAB-LA) was approved by the FDA as an additional prevention option for PrEP in December 2021. After the respective approvals, TAF/FTC and CAB-LA were included in the algorithm to classify the number of persons prescribed PrEP.

Although IQVIA recorded 94% of all prescriptions from retail pharmacies and 74% from mail-order outlets in the United States, prescriptions from closed health care systems that do not make their prescription data available to IQVIA (e.g., managed care organizations or military health plans) were not included. Therefore, the calculated values represent minimum estimates of PrEP coverage. PrEP coverage is not available by transmission category due to the lack of availability in the IQVIA database.

Race/ethnicity data were only available for <40% of persons prescribed PrEP each year. Number prescribed PrEP and PrEP coverage by race/ethnicity were adjusted applying the distribution of records with known race/ethnicity to records with missing race/ethnicity. Hispanic/Latino persons can be of any race. Race/ethnicity categories available in the IQVIA data include:

• Black/African American,
• Hispanic/Latino,
• Other, and
• White.

The number of persons prescribed PrEP for each racial/ethnic group presented was extrapolated by applying the racial/ethnic distribution of known records to those for which data on race/ethnicity were unknown.

To estimate the number of persons prescribed PrEP at the state or county level, a probability-based approach is used to crosswalk between a 3-digit zip code assigned by the U.S. Postal Service and states or counties.

The number of persons with PrEP indications was estimated using 2018 data from National HIV Surveillance System, data from the National Health and Nutrition Examination Survey, and from U.S. Census Bureau’s American Community Survey. Data are rounded to the nearest 10. Data for which values are unknown were not reported thus values may not sum to column total. The data sources used to estimate the number of persons with indications for PrEP have different schedules of data availability. Consequently, the availability of a denominator may lag the availability of a numerator. 2017 denominators were used for 2017 PrEP coverage data; 2018 denominators were used for 2018, 2019, 2020, 2021, 2022, and 2023 PrEP coverage data; consequently, 2019-2023 PrEP coverage data are considered preliminary.

U.S. Census Bureau ACS datasets, which include household data on cohabitating same-sex partners, were used to estimate the number of men who have sex with men (MSM) in a jurisdiction. Next, behavioral data from NHANES were used to estimate the proportion of HIV-negative MSM with indications for PrEP. Finally, the number of HIV-negative MSM with indications for PrEP was multiplied by the ratio of percentage of HIV diagnoses (from NHSS) during the specified year attributed to other major transmission risk groups compared to the percentage among MSM in a given state or county. The estimated number of persons with indications for PrEP in the 3 groups at highest risk of transmission (MSM, heterosexuals, persons who inject drugs) in each jurisdiction was then summed to yield a state- or county-specific estimate. State estimates were then summed for a national total of persons with indications for PrEP.

For all states and jurisdictions except Puerto Rico, 2017 data from all sources were used in calculating both the numerator and denominator of the 2017 PrEP coverage estimate. However, prior to 2018, ACS did not include data needed to estimate the number of persons with indications for PrEP in Puerto Rico and the San Juan Municipio; consequently, the number of persons with indications for PrEP in Puerto Rico in 2017, was not available. In 2018, the ACS conducted a separate Puerto Rico survey and these data are now available and are being used to determine the number of persons with indications for PrEP in 2018 for Puerto Rico. The number of persons with PrEP indications in Puerto Rico and the San Juan Municipio are not available for 2017. 2018 data are used for 2017.

In addition to being preliminary, data for the years 2020 and 2021 should be interpreted with awareness of the impact of the COVID-19 pandemic on filling PrEP prescriptions in state/local jurisdictions. For further details, please refer to the report below.

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.

About PrEP Coverage Data

For more information on the methods for estimating the number of persons prescribed PrEP, please refer to the following published reports:

CDC [Smith DK, Van Handel M, Wolitski RJ, et al]. Vital Signs: Estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV acquisition—United States, 2015. MMWR 2015;64(46):1291–1295. doi:10.15585/ mmwr.mm6446a4.

Centers for Disease Control and Prevention. HIV Surveillance Data Tables (early release): Core indicators for monitoring the Ending the HIV Epidemic initiative, data reported through December 2019. https://www.cdc.gov/hiv/pdf/library/reports/ehe-core-indicators/cdc-hiv-ehe-core-indicators-2019.pdf. Published March 2020. Accessed May 26, 2020.

Furukawa NW, Smith DK, Gonzalez CJ, et al. Evaluation of Algorithms Used for PrEP Surveillance Using a Reference Population From New York City, July 2016–June 2018. Public Health Reports 2020; 135(2): 202-210.

Grey JA, Bernstein KT, Sullivan PS, Purcell DW, Chesson HW, Gift TL, et al. Estimating the population sizes of men who have sex with men in US states and counties using data from the American Community Survey. JMIR Public Health Surveill 2016;2(1):e14

Harris NS, Johnson AS, Huang YA, et al. Vital Signs: Status of Human Immunodeficiency Virus Testing, Viral Suppression, and HIV Preexposure Prophylaxis — United States, 2013–2018. MMWR Morb Mortal Wkly Rep 2019;68:1117–1123.DOI: http://dx.doi.org/10.15585/mmwr.mm6848e1

Huang YA, Zhu W, Smith DK, Harris N, Hoover KW. HIV Preexposure Prophylaxis, by Race and Ethnicity — United States, 2014–2016. MMWR Morb Mortal Wkly Rep 2018;67:1147–1150. DOI: http://dx.doi.org/10.15585/mmwr.mm6741a3

Smith DK, Van Handel M, Grey J. Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015. Ann Epidemiol 2018;28(12):850– 857.e9. doi:10.1016/j.annepidem.2018.05.003.

Huang YA, Zhu W, Wiener J, Kourtis AP, Hall HI, Hoover KW. Impact of COVID-19 on HIV preexposure prophylaxis prescriptions in the United States—a time series analysis. Clin Infect Dis 2022:ciac038. doi:10.1093/cid/ciac038

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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