Association Between County-Level Social Vulnerability and Centers for Disease Control and Prevention-Funded HIV Testing Program Outcomes in the United States, 2020-2022.

BACKGROUND

Community-level social vulnerabilities may affect HIV outcomes. This analysis assessed the association between county-level social vulnerability and Centers for Disease Control and Prevention (CDC)-funded HIV testing program outcomes.

SETTING

HIV testing data from 60 state and local health departments and 119 community-based organizations were submitted to CDC during 2020-2022.

METHODS

HIV testing data were combined with the county-level Minority Health Social Vulnerability Index, which measures economic, medical, and social vulnerability. We calculated absolute and relative disparity measures for HIV testing program outcomes (ie, HIV positivity, linkage to HIV medical care, interview for partner services, referral to preexposure prophylaxis providers) between high and low social vulnerability counties. We compared differences in HIV testing program outcomes by demographic factors and test site type.

RESULTS

The majority (85.8%) of the 4.9 million tests were conducted in high social vulnerability counties. HIV positivity (1.1%) and linkage to medical care after a new diagnosis (77.5%) were higher in high social vulnerability counties. However, interview for partner services after a new diagnosis (72.1%) and referrals to preexposure prophylaxis providers among eligible HIV-negative persons (48.1%) were lower in high social vulnerability counties. Additionally, the relative disparity in HIV testing program outcomes varied by demographic factors and test site type.

CONCLUSIONS

CDC-funded HIV testing programs reach the most vulnerable communities. However, testing outcomes vary by community vulnerability, demographic factors, and test site type. Continued monitoring of the relationship between county-level social vulnerability and HIV testing program outcomes would guide HIV testing efforts and allocate resources effectively to achieve the national goal of ending the HIV epidemic.