Philpott David Ce, Curran Kathryn G, Russell Olivia O, McClung Robert P, Hallmark Camden J, Pieczykolan Lauren Love, Schlanger Karen, Panneer Nivedha, Oster Alexandra M, France Anne Marie
Epidemic Intelligence Service, Centers for Disease Control and Prevention.
Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention.
J Acquir Immune Defic Syndr. 2025 Mar 6. doi: 10.1097/QAI.0000000000003658.
Clusters of rapid HIV transmission indicate larger underlying networks that are not effectively reached by HIV prevention, testing, and care services. Starting in 2018, the Centers for Disease Control and Prevention (CDC) funded 59 U.S. health departments (HDs) to detect and respond to HIV clusters; HDs began reporting clusters to CDC in January 2020.
For clusters reported to CDC, we described cluster characteristics at detection, including detection method; size; HIV transmission category, defined as that of >50% of cluster members; and HD investigation and response activities.
During 2020-2022, 45 HDs reported 322 HIV clusters, with most detected by molecular analysis of HIV sequences (75%). Most were detected in the South (46%) and three-quarters were predominant sexual transmission. Median cluster size at detection for molecular clusters was 10 persons (interquartile range 7-18). Among 205 clusters with follow-up data, investigation and response activities were conducted for 95%, including direct outreach to persons in clusters for partner services (64%), medical chart reviews (42%), and focused testing events (13%). Limited data on named partners tested showed that 11% received new HIV diagnoses.
HD HIV cluster detection activities detected many clusters. Response activities were tailored for different clusters and intervened in networks with rapid transmission and high undiagnosed infection, as indicated by high positivity among partners. Cluster detection and response is an important tool to identify and address gaps in HIV prevention, testing, and care that facilitate rapid transmission.
艾滋病毒快速传播集群表明存在更大的潜在网络，而艾滋病毒预防、检测和护理服务未能有效覆盖这些网络。从2018年开始，美国疾病控制与预防中心（CDC）资助了59个美国卫生部门（HDs）来检测和应对艾滋病毒集群；各卫生部门于2020年1月开始向CDC报告集群情况。
对于向CDC报告的集群，我们描述了检测时的集群特征，包括检测方法；规模；艾滋病毒传播类别，定义为集群成员中超过50%的传播类别；以及卫生部门的调查和应对活动。
在2020 - 2022年期间，45个卫生部门报告了322个艾滋病毒集群，其中大多数通过艾滋病毒序列的分子分析检测到（75%）。大多数集群在南部被检测到（46%），四分之三以性传播为主。分子集群检测时的集群规模中位数为10人（四分位间距7 - 18）。在有后续数据的205个集群中，95%开展了调查和应对活动，包括直接向集群中的人员提供伴侣服务外展（64%）、病历审查（42%）和重点检测活动（13%）。关于接受检测的指名伴侣的有限数据显示，11%被新诊断出感染艾滋病毒。
卫生部门的艾滋病毒集群检测活动发现了许多集群。针对不同集群开展了应对活动，并对传播迅速且未诊断感染率高的网络进行了干预，伴侣中的高阳性率表明了这一点。集群检测和应对是识别和解决促进快速传播的艾滋病毒预防、检测和护理差距的重要工具。
