New Release: CDC Monitoring Report and the NHAS Indicators
On July 27, 2017, the Centers for Disease Control and Prevention (CDC) released what we usually call “the Monitoring Report.” The full name of the report is “Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data [PDF, 2,374KB].” In addition, they published two new related fact sheets, Understanding the HIV Care Continuum [PDF, 200KB] and Selected National HIV Prevention and Care Outcomes in the United States [PDF, 255KB].
The report provides the most recent data that are available for key indicators that are used to monitor progress on HIV prevention, care, and treatment goals in programs of national significance including: the National HIV/AIDS Strategy (NHAS), Healthy People 2020, and the National Prevention Strategy.
The Monitoring Report signals that we are making progress on most of our national HIV prevention, care, and treatment goals and illustrates the impact that HIV continues to have on the lives of 1.1 million Americans who are living with the infection. It also shows us where we need to do better and re-assess our efforts, diagnose the problems, and use this information to make the changes to our policies, programs and services that are needed to turn the results around.
Many of these indicators are also used in other ways to document, monitor, and evaluate HIV prevention, care, and treatment efforts. In some of these cases, it is not the data itself, but the indicator definition that is used with other data to evaluate how well states, agencies, and grantees are doing in implementing programs and achieving the desired results. Probably the most important example of this way that the data are used is for reporting to the White House Office of Management and Budget on progress that fulfills the requirements of the Government Performance and Results Act (GPRA). The indicator data reported to satisfy the requirements of GPRA are examined and considered each year during the Federal budget formulation process. The data are also used in CDC’s Division of HIV/AIDS Prevention’s Strategic Plan and progress reports that CDC prepares for the nation [KB, 2,311KB] as a whole, the CDC State HV Prevention Progress Report [PDF, 9,264KB], and reports used to provide grantees with feedback on their performance on CDC-funded projects.
The data in Table 11 of the Monitoring Report provide the most recent data for the 17 indicators used to monitor progress on the National HIV/AIDS Strategy, including the three developmental indicators. Progress on the indicators was last reported and assessed in the NHAS progress reports that were released in July 2016 [PDF, 510KB] and December 2016 [PDF, 368KB].
If you look at the report, you will see that the most recent data are for 2014 or 2015. People sometimes wonder why more recent data are not available. It’s important to remember that the data represent the entire year, including the very last day of the year. Health care providers need some time to report information to health departments. The data need to be reviewed, verified, and critical missing data obtained before entry is completed and final quality assurance checks are done and corrections made. Then the data are submitted to CDC and additional checks are performed to ensure the completeness and quality of the data and remove duplicates across states before analyses can begin.
The methods used to collect surveillance data, the completeness of the data, the methods used to estimate missing data, laboratory technologies, and what we know about the natural history of HIV, the acute phase of infection, and transmission have all continued to evolve over time. This means that the methods used to calculate indicators must be reviewed and updated as needed so that they can be aligned with the current state of the science.
CDC’s latest Monitoring Report provides some data that are based on updated estimation and data collection methods that differ from the methods that were used in the past years. Data that are calculated using the updated methods are not comparable to those that are based on the earlier methods. In order to make comparisons over time, CDC has updated the results for these indicators (and the targets used to assess progress each year) starting with 2010 and has included them in the report. Additional details about these changes can be found in the technical notes of the Monitoring Report. These changes impact the following indicators:
- Percentage of people living with HIV who know their serostatus
- Death rate among persons with diagnosed HIV infection
- Number of adults prescribed pre-exposure prophylaxis (PrEP)
Understanding the data in the Monitoring Report is important for assessing and improving our efforts to fight HIV. In the coming weeks and months we will be reviewing the indicators in more detail on HIV.gov. In future blogs, we will review the most recent indicator results and discuss changes over time. We will compare the current result with annual target and will examine how race/ethnicity, age, gender, geographic region, and transmission risk group affect the results.
Obviously, blogs can do only so much, but I hope that these blogs will be a good way for you to get timely information that helps you understand a little more about the indicator, the results, and what they tell us about the progress that is being made and the challenges that remain.
The following information and resources are available from CDC: