Association Between County-Level Social Vulnerability and CDC-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 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 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 (i.e., HIV positivity, linkage to medical care, interview for partner services, referral to PrEP 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 PrEP 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.

Conclusion: 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.