Georgia Medical Monitoring Project Surveillance Summary, 2015-2017
Behavioral and Clinical Characteristics of Persons with Diagnosed HIV Infection, Georgia Medical Monitoring Project, 2015-2017
HIV/AIDS Epidemiology Section Epidemiology Program Division of Health Protection Georgia Department of Public Health

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

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The Georgia Medical Monitoring Project Surveillance Summary, 2015-2017 is published by the Georgia Department of Public Health (DPH), HIV/AIDS Epidemiology Section (HAES), 2 Peachtree Street NW, Atlanta, Georgia 30303. The Georgia Medical Monitoring Project Surveillance Summary, 2015-2017 is not copyrighted and may be used and reproduced without permission. Citation of the source is, however, appreciated. SUGGESTED CITATION: Georgia Department of Public Health, HIV/AIDS Epidemiology Section Medical Monitoring Project Surveillance Summary: Behavioral and Clinical Characteristics of Persons with Diagnosed HIV Infection, Georgia 2015-2017, https://dph.georgia.gov/georgia-medical-monitoring-project-mmp, Published 09/20/2019, [Accessed: date]
ACKNOWLEDGEMENTS: Publication of this report was made possible with the contributions of the Georgia Medical Monitoring Project (MMP) Team, the national MMP staff at the Centers for Disease Control and Prevention (CDC), assistance from HIV care facilities, and the cooperation of participants.
Georgia MMP Team: Natalie Lucas, MPH; Kiswana Branch, MPH; LaShanna Daniels, MPH; Melissa Gousse, MPH; Timothy Lockhart, MPH; Shaunta Rutherford, MPH, PhD; and Fay Stephens, MPH.
The report was prepared using code provided by CDC to replicate the national report, and the text is based on the national report: Centers for Disease Control and Prevention. Behavioral and Clinical Characteristics of Persons with Diagnosed HIV Infection--Medical Monitoring Project, United States, 2016 Cycle (June 2016May 2017). HIV Surveillance Special Report 21. https://www.cdc.gov/hiv/library/reports/ hiv-surveillance.html. Published February 2019. Accessed 07/08/2019.
This report was prepared by the following staff of the Georgia Department of Public Health: Fay Stephens, MPH; Pascale Wortley, MD, MPH; Cherie Drenzek, DVM, MS.

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Table of Contents
COMMENTARY ........................................................................................................................................................................ 5
HIGHLIGHTS OF ANALYSES .................................................................................................................................................. 5
TECHNICAL NOTES .................................................................................................................................................................. 9
REFERENCES .......................................................................................................................................................................... 10
TABLES................................................................................................................................................................................... 11
Table 1. Response rate by cycle year--Medical Monitoring Project, Georgia, 2015-2017 .......................................... 12
Table 2. Characteristics of participants and estimated percentages of persons living with diagnosed HIV infection by selected characteristics--Medical Monitoring Project, Georgia, 2015-2017............................................................... 13
Table 3. Stage of disease, CD4 counts, and viral suppression during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2017 ...................................................................................................................... 16
Table 4. Access to, and quality of, care--Medical Monitoring Project, Georgia, 2015-2017....................................... 17
Table 5. Sexually transmitted disease testing during the 12 months before the interview, by sexual activity-- Medical Monitoring Project, Georgia, 2015-2017 ........................................................................................................ 18
Table 6. Emergency department and hospital admission during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2017 ...................................................................................................................... 19
Table 7. Antiretroviral therapy (ART) use--Medical Monitoring Project, Georgia, 2015-2017 ................................... 20
Table 8. Antiretroviral therapy (ART) adherence among persons taking ART--Medical Monitoring Project, Georgia, 2015-2017 ..................................................................................................................................................................... 21
Table 9. Antiretroviral therapy (ART) prescription, ART dose adherence, durable viral suppression, and geometric mean CD4 count by subgroups--Medical Monitoring Project, Georgia, 2015-2017 ................................................... 23
Table 10. Depression and anxiety during the 2 weeks before the interview--Medical Monitoring Project, Georgia, 2015-2017 ..................................................................................................................................................................... 25
Table 11. Tobacco and electronic cigarette use--Medical Monitoring Project, Georgia, 2015-2017.......................... 26
Table 12. Alcohol use during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2017 ....................................................................................................................................................................................... 27
Table 13. Noninjection drug use during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2017 ..................................................................................................................................................................... 28
Table 14. Injection drug use during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2017 ..................................................................................................................................................................... 29
Table 15. Gynecological care and reproductive health among women--Medical Monitoring Project, Georgia, 20152017 .............................................................................................................................................................................. 30
Table 16. Sexual behavior during the 12 months before the interview among cisgender men and women--Medical Monitoring Project, Georgia, 2015-2017 ...................................................................................................................... 31

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Table 17. Sexual behavior during the 12 months before the interview among men who had sex with men (MSM), men who had sex only with women (MSW), and women who had sex with men (WSM)--Medical Monitoring Project, Georgia, 2015-2017 ......................................................................................................................................... 32
Table 18. Met and unmet needs for ancillary services during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2017 ...................................................................................................................... 33
Table 19. Intimate partner violence and sexual violence--Medical Monitoring Project, Georgia, 2015-2017 ........... 35
Table 20. Prevention services received during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2017....................................................................................................................................................... 36
Table 21. National indicators: homelessness, HIV stigma, and high-risk sex--Medical Monitoring Project, Georgia, 2015-2017 ..................................................................................................................................................................... 37
Appendix: Methods and Definitions ..................................................................................................................................... 38
METHODS.......................................................................................................................................................................... 38
DEFINITIONS...................................................................................................................................................................... 40
HIV/AIDS RESOURCES: .......................................................................................................................................................... 45

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COMMENTARY
At year-end 2017, an estimated 58,808 persons in Georgia were living with diagnosed HIV infection [1]. In 2017, the number of new HIV diagnoses in Georgia was 2,698 [1]. Although the National HIV Surveillance System (NHSS) collects information about persons with diagnosed HIV infection [2], other surveillance systems provide more detailed information about care seeking, health care use, use of ancillary services, and other behaviors [3]. In 2005, in response to an Institute of Medicine report outlining the need for representative data on persons living with HIV [4], the Centers for Disease Control and Prevention (CDC) implemented the Medical Monitoring Project (MMP), which from 2009 to 2014 collected data from a 3-stage probability sample of persons receiving HIV medical care [5]. In 2015, in response to recommendations stemming from an Institute of Medicine review of national HIV data systems [6], MMP sampling and weighting methods were revised to include all persons with diagnosed HIV infection regardless of HIV care status.
MMP is a cross-sectional, nationally representative, complex sample survey that assesses the clinical and behavioral characteristics of adults with diagnosed HIV infection in the United States and Puerto Rico. The MMP samples in cycle years 2015-2017 were selected in 2 consecutive stages: (1) United States and dependent areas and (2) adults aged 18 years with diagnosed HIV infection reported to NHSS as of December 31, the year prior to the cycle year (ex: December 31, 2014 for the 2015 cycle). Georgia is one of a total of 23 project areas from 16 states and Puerto Rico which were funded to conduct data collection for MMP during the 2015, 2016, and 2017 cycles. This report is first to publish the Georgia MMP data collected by using the revised 2stage sampling method.
This report presents unweighted frequencies and weighted prevalence estimates with 95% confidence intervals for selected characteristics. The estimates describe the characteristics of adults with diagnosed

HIV infection who lived in Georgia as of the sampling date for the cycle year in which they participated in the Georgia MMP, hereafter referred to as persons with diagnosed HIV or persons. The period referenced is the 12 months before the participants' interviews and medical record abstractions unless otherwise noted.
Statistical software (SAS, version 9.4) was used for analysis of weighted data [7]. Data are not reported for estimates with a coefficient of variation 0.30. Values with an absolute confidence interval width 0.30, and values with an absolute confidence interval width between 0.05 and 0.30 and a relative confidence interval width >130% are marked with an asterisk and should be interpreted with caution. No statistical tests were performed. Additional information on MMP is available at https://www.cdc.gov/hiv/statistics/ systems/mmp/index.html.
HIGHLIGHTS OF ANALYSES
Response Rates
In total, 1528 persons considered to be residents of Georgia were sampled from NHSS for cycle years 20152017, and 582 participated (Table 1). Adjusted for eligibility, the response rates were 33% (2015), 43% (2016), and 45% (2017).
Sociodemographic Characteristics
An estimated 75% of persons were male and 24% were female(Table 2). Nearly half (46%) identified themselves as heterosexual or straight; 42% as lesbian or gay; 11% as bisexual; and 2% as another sexual orientation. An estimated 69% were black or African American, 21% were white, and 5% were Hispanic or Latino. Two-thirds (67%) were aged at least 40 years, and 52% had received an HIV diagnosis at least 10 years earlier. Over half (62%) had more than a high school education and 96% were born in a U.S. state or territory. The estimated prevalence of homelessness among all persons with diagnosed HIV was 8%. An estimated 98%

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had health insurance or coverage for antiretroviral therapy (ART) medications: 42% had coverage through the Ryan White HIV/AIDS Program, 30% had Medicaid, 38% had private health insurance, and 30% had Medicare. An estimated 40% had a disability, 47% were unemployed, and 39% had household incomes at or below the federal poverty threshold. An estimated 21% received Supplemental Security Income (SSI) and 27% received Social Security Disability Insurance (SSDI).
Clinical Characteristics
According to the CDC stage of disease classification for HIV infection [8], an estimated 53% of persons had ever had stage 3 (AIDS) disease (Table 3). An estimated 11% of persons had a geometric mean CD4 T-lymphocyte (CD4) count of 0199 cells/L. The estimated average geometric mean CD4 count among all persons was 563 cells/L, and the median geometric mean CD4 count was 535 cells/L (range: 3 2,124) (data not shown in table).
An estimated 69% of persons had an undetectable (<200 copies/mL) viral load at the most recent measurement, while 60% had undetectable viral loads at all measurements during the past 12 months (sustained viral suppression).
Use of Health Care Services
Overall, 97% had received outpatient HIV care during the past 12 months, and 99% had received outpatient HIV care during the past 24 months (Table 4). An estimated 80% were retained in care during the past 12 months, while 61% were retained in care during the past 24 months. An estimated 91% of persons had an ART prescription documented in the medical record during the 12 months before the interview. Of persons who met the clinical criteria for Pneumocystis pneumonia (PCP) prophylaxis, 38% had a prescription for PCP prophylaxis documented in the medical record.
Among sexually active persons, an estimated 53% were tested for gonorrhea, 52% for chlamydia, 67% for

syphilis, and 48% for all 3 sexually transmitted diseases (STDs) (Table 5).
An estimated 44% of persons were seen in an emergency department at least once, and 4% were seen at least 5 times (Table 6). An estimated 21% of persons were admitted to a hospital for an illness at least once.
Self-reported ART Medication Use and Adherence
An estimated 91% of persons were currently taking ART based on self-report (Table 7). Among the estimated 3% of persons without a history of ART use, 74%* had never taken ART because a health care provider advised a delay in treatment. Among the estimated 6% of persons with a history of ART use who were not currently taking ART, 46% were not taking ART due to money or insurance problems.
Among persons taking ART, 59% took all of their ART doses in the past 30 days (Table 8). Among persons taking ART, 66% had never been troubled by ART side effects during the past 30 days; 18% had rarely been troubled. The most common reasons given for not taking one's most recently missed ART dose were forgetting (36%) and a change in one's daily routine or being out of town (28%).
Clinical Characteristics by Subgroups
The estimated prevalence of ART prescription documented in a medical record was 85% among males and 82% among females (Table 9). An estimated 84% of blacks or African Americans were prescribed ART, compared with 82%* of Hispanics or Latinos and 86% of whites. The estimated prevalence of ART prescription was 76% among persons aged 18 to 29 years and 88% among those aged 50 years or older.
The estimated prevalence of sustained viral suppression was 61% among males and 56% among females. An estimated 57% of blacks or African Americans had sustained viral suppression, compared with 50%* of Hispanics or Latinos and 71% of whites. The estimated prevalence of sustained viral suppression was 35%

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among persons aged 18 to 29 years and 69% among those aged 50 years or older.
Depression and Substance Use
The estimated prevalence of major or other depression in the past 2 weeks based on the Patient Health Questionnaire (PHQ-8) algorithm [9] was 20%, including 10% with major depression (Table 10). Based on the total PHQ-8 symptom score (see the appendix), an estimated 17% of persons had moderate or severe depression. The estimated prevalence of mild, moderate, or severe anxiety in the past 2 weeks based on the Generalized Anxiety Disorder Scale (GAD-7) [10] was 23%, including 8% with severe anxiety.
The estimated prevalence of current smoking was 37%: 29% of persons smoked daily, and 4% less than monthly (Table 11). The estimated prevalence of alcohol use was 65%: 6% of persons drank alcohol daily, 20% weekly, 13% monthly, and 27% less than monthly (Table 12). An estimated 14% of persons engaged in binge drinking during the past 30 days.
An estimated 30% of persons used noninjection drugs for nonmedical purposes (Table 13). In total, an estimated 27% used marijuana, 5% used poppers (amyl nitrite), 5% used cocaine, 3% used methamphetamines, and 3% used prescription opioids. An estimated 2% of persons used injection drugs for nonmedical purposes (Table 14).
Gynecologic and Reproductive Health
Among females, 76% reported receiving a Papanicolaou (Pap) test (Table 15). An estimated 27% of females reported being pregnant at least once since testing positive for HIV infection.
Sexual Behavior
An estimated 38% of men had receptive anal sex with men, 38% had insertive anal sex with men, and 21% had vaginal sex (Table 16). An estimated 32% of men did not

have vaginal or anal sex. Among women, 55% had vaginal sex, and 45% did not have vaginal or anal sex.
Among men who had sex with men, an estimated 9% engaged in high-risk sex, compared with 10% of women
who had sex with men (Table 17). In terms of prevention strategies among sexually active persons, an estimated 56% of men who had sex with men engaged in sex while sustainably virally suppressed, 71% had condom-protected sex, and 69% had sex with an HIVpositive partner. Among sexually active men who had sex only with women, 61% engaged in sex while sustainably virally suppressed, 74% had condomprotected sex, and 26% had sex with an HIV-positive partner. Among sexually active women who had sex with men, 52% engaged in sex while sustainably virally suppressed, 65% had condom-protected sex, and 30% had sex with an HIV-positive partner.
Met and Unmet Need for Ancillary Services
An estimated 50% of persons received dental care; 43% received HIV case management services; 42% received medicine through the AIDS Drug Assistance Program (ADAP); and 39% received services through the Supplemental Nutrition Assistance Program (SNAP) or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (Table 18). An estimated 31% of persons had unmet needs for dental care; 16% for SNAP or WIC; 14% for shelter or housing services; 12% for meal or food services; 11% for mental health services; 11% for HIV case management services; 11% for transportation assistance; 8% for HIV peer group support; and 5% for patient navigation services.
Intimate Partner Violence and Sexual Violence
An estimated 24% of persons had ever been physically hurt by a romantic or sexual partner, including 3% who experienced this in the past 12 months (Table 19). An estimated 14% of persons had ever been threatened with harm or physically forced to have unwanted sex.
Prevention Activities

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An estimated 52% of persons received counseling from a physician, nurse, or other health care worker about HIV and STD risk reduction; 29% had a one-on-one conversation with an outreach worker, a counselor, or a prevention program worker about prevention; and 12%
participated in a small-group session (excluding discussions with friends) to discuss the prevention of HIV and other STDs (Table 20). An estimated 47% of persons received free condoms from various organizations.
Division of HIV/AIDS Prevention National Indicators
The estimated prevalence of homelessness among persons who received outpatient HIV care in the past 12 months was 8% (Table 21). The median HIV stigma score (see the appendix) among all persons was 38. An estimated 8% of persons engaged in high-risk sex.

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TECHNICAL NOTES
POPULATION OF INFERENCE
For the 2015, 2016, and 2017 Medical Monitoring Project (MMP) data collection cycles (data collected June 1, 2015-May 31, 2016; June 1, 2016May 31, 2017; and June 1, 2017-May 31, 2018, respectively), the population of inference was adults with diagnosed HIV (aged 18 years) living in Georgia as of December 31st of the year prior to the start of the data collection cycle.
DATA COLLECTION
Persons with diagnosed HIV were sampled for MMP using data from the National HIV Surveillance System (NHSS). Sampled persons were recruited to participate in person, by telephone, or by mail. To be eligible for MMP, the person had to be, as of December 31 of the year prior to the data collection cycle: living with diagnosed HIV infection, aged 18 years, and residing in Georgia.
A trained interviewer conducted either a computerassisted telephone interview or an in-person interview. Persons who agreed to participate were interviewed over the telephone or in a private location (e.g., at home or in a
clinic). The interview (approximately 45 minutes) included questions about demographics, health care use, met and unmet needs for ancillary services, sexual behavior, depression and anxiety, gynecologic and reproductive history (females only), drug and alcohol use, and use of prevention services. Participants were given a token of appreciation of $50 (2015 cycle) or $75 (2016 and 2017 cycles) in cash or the equivalent for participation.
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REFERENCES
1. Georgia Department of Public Health, HIV/AIDS Epidemiology Section HIV Surveillance Summary, Georgia 2017, https://dph.georgia.gov/data-fact-sheetsummaries, Published February 2019, Accessed: 07/08/2019.
2. Nakashima AK, Fleming PL. HIV/AIDS surveillance in the United States, 19812001. J Acquir Immune Defic Syndr 2003;32(suppl 1):S68S85.
3. McNaghten AD, Wolfe MI, Onorato I, et al. Improving the representativeness of behavioral and clinical surveillance for persons with HIV in the United States: the rationale for developing a population-based approach. PLoS One 2007;2(6):e550.
4. Institute of Medicine. Measuring What Matters: Allocation, Planning and Quality Assessment for the Ryan White CARE Act. Washington, DC: National Academies Press; 2004. https://www.nap.edu/read/ 10855. Published November 7, 2003. Accessed January 11, 2019.
5. CDC. Behavioral and Clinical Characteristics of Persons Receiving Medical Care for HIV Infection-- Medical Monitoring Project, United States, 2010. HIV Surveillance Special Report 9. https://www.cdc.gov/ hiv/library/reports/hivsurveillance.html. Published October 2014. Accessed January 11, 2019.
6. Institute of Medicine. Monitoring HIV Care in the United States: Indicators and Data Systems. Washington, DC: National Academies Press; 2012. doi:10.17226/13225.
7. SAS Institute Inc. SAS version 9.4. Cary, NC: SAS Institute; 2011.
8. CDC [Selik RM, Mokotoff ED, Branson B, Owen SM, Whitmore S, Hall HI]. Revised surveillance case definition for HIV infection--United States, 2014. MMWR 2014;63(RR-03):110. https://www.cdc.gov/mmwr/ indrr_2014.html. Accessed January 11, 2019.
9. Kroenke K, Strine TW, Spitzer RL, et al. The PHQ8 as a measure of current depression in the

general population. J Affect Disord 2009;114(1 3):163173. 10. Spitzer RL, Kroenke K, Williams JB, Lwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166(10):10921097.

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TABLES

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Table 1. Response rate by cycle year--Medical Monitoring Project, Georgia, 2015-2017

Cycle Year

No. Sampled No. Participating Response Rate (%)a

2015

519

164

33.3

2016

511

207

43.2

2017

498

211

45.2

Note. Percentages might not sum to 100 because of rounding.

a Response rates are adjusted for eligibility.

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Table 2. Characteristics of participants and estimated percentages of persons living with diagnosed HIV infection by selected characteristics--Medical Monitoring Project, Georgia, 2015-2017

No.a

%b

95% CIc

Gender

Male

417

75.0

Female

156

23.8

Transgenderd

8

-

Sexual orientation

Lesbian or gay

222

41.7

Heterosexual or straight

280

45.5

Bisexual

58

10.7

Other sexual orientation

12

2.1

Race/ethnicity

American Indian/Alaska Native

2

-

Asian

1

-

Black/African American

419

69.4

Hispanic/Latinoe

26

4.9

Native Hawaiian/Other Pacific Islander

1

-

White

106

21.2

Multiple races

27

4.0

Age at time of interview (yr)

1824

12

2.4

2529

47

8.3

3034

56

10.6

3539

58

11.8

4044

59

9.8

4549

74

12.6

5054

114

18.0

5559

95

15.1

6064

31

5.1

65

36

6.3

Education

Less than high school

89

13.4

High school diploma or GED

145

24.8

More than high school

340

61.8

Country or territory of birth

United States or U.S. territory

549

95.5

Foreign born

24

4.5

Time since HIV diagnosis (yr)

<5

100

18.2

59

161

29.6

10

317

52.2

Homeless at any time, past 12 monthsf

Yes

43

7.5

No

531

92.5

Incarcerated > 24 hours, past 12 months

Yes

34

5.4

No

540

94.6

Health insurance or coverage for antiretroviral medications, past 12 monthsg

71.478.7 20.227.4
-
37.346.0 41.249.9
7.913.4 0.93.3
65.373.5 2.96.8 17.424.9 2.45.5
1.03.7 5.910.7 7.813.3 8.814.8 7.312.4 9.815.4 14.821.3 12.118.1
3.26.9 4.28.4
10.616.2 21.028.5 57.766.0
93.797.3 2.76.3
14.721.6 25.633.7 47.856.6
5.29.7 90.394.8
3.67.2 92.896.4

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Yes

563

97.7

No

9

-

Type of health insurance or coverage for antiretroviral medications, past 12 months

Ryan White

Yes

245

41.6

No

320

58.4

Medicaid

Yes

182

29.8

No

390

70.2

Private health insurance

Yes

210

38.3

No

355

61.7

Medicare

Yes

179

30.2

No

389

69.8

Other public insurance

Yes

21

3.6

No

543

96.4

Tricare/CHAMPUS or Veterans Administration

Yes

22

4.2

No

540

95.8

Insurance type unknownh

Yes

5

-

No

560

98.9

Any disabilityi

Yes

236

39.9

No

338

60.1

Received Supplemental Security Income (SSI), past 12 months

Yes

131

21.0

No

438

79.0

Received Social Security Disability Insurance (SSDI), past 12 months

Yes

157

26.7

No

411

73.3

Went without food due to lack of money, past 12 months

Yes

104

18.8

No

470

81.2

Employment statusj

Employed

232

41.7

Unemployed

275

47.0

Student

13

2.4

Retired

54

8.8

Combined yearly household income (US$)k

019,999

271

48.8

20,00039,999

134

24.2

40,00074,999

81

14.9

75,000

58

12.1

Poverty guidelinesl

Above poverty threshold

325

61.1

At or below poverty threshold

219

38.9

Total

582

100

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

96.199.3 -
37.345.9 54.162.7
25.933.8 66.274.1
34.042.6 57.466.0
26.334.2 65.873.7
2.05.2 94.898.0
2.36.0 94.097.7
98.099.9
35.744.2 55.864.3
17.624.5 75.582.4
22.830.5 69.577.2
15.422.2 77.884.6
37.446.0 42.751.4
1.13.8 6.411.2
44.353.2 20.428.1 11.718.0
9.015.2
56.865.5 34.543.2
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Abbreviations: CI, confidence interval; GED, general educational development; CHAMPUS, Civilian Health and Medical Program of the Uniformed Services; US$, U.S. dollar; HHS, Department of Health and Human Services [footnotes only]. Note. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding. Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. Values with an absolute confidence interval width 0.30 and values with an absolute confidence interval width of between 0.05 and 0.30 and a relative confidence interval width >130% are marked with an asterisk and should be interpreted with caution. a Numbers are unweighted. b Percentages are weighted percentages. c CIs incorporate weighted percentages. d Persons were classified as transgender if sex at birth and gender reported by the persons were different, or if the person chose transgender in response to the question about self-identified gender. e Hispanics or Latinos might be of any race. Persons are classified in only 1 race/ethnicity category. f Living on the street, in a shelter, in a single-roomoccupancy hotel, or in a car. g Persons could select more than 1 response for health insurance or coverage for antiretroviral medications. h Unknown insurance type means that the person had insurance or coverage for antiretroviral medications, but the type of insurance or coverage could not be determined. i Includes physical, mental, and emotional disabilities. j Employed includes employed for wages, self-employed, or homemaker. k Income from all sources, before taxes, in the last calendar year. l Poverty guidelines as defined by HHS; the 2014 guidelines were used for persons interviewed in 2015 and the 2015 guidelines were used for persons interviewed in 2016. More information regarding the HHS poverty guidelines can be found at http://aspe.hhs.gov/frequently-askedquestions-related-poverty-guidelines-and-poverty.

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Table 3. Stage of disease, CD4 counts, and viral suppression during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2017

No.a

%b

95% CIc

HIV infection stage 3 (AIDS)d

Yes

338

53.4

49.057.8

No

240

46.6

42.251.0

Geometric mean CD4 count (cells/L)

0199

58

11.4

8.514.4

200349

78

16.4

12.919.9

350499

81

16.2

12.819.6

500

263

56.0

51.360.7

Lowest CD4 count (cells/L), past 12 months

049

27

5.5

3.47.7

50199

51

10.1

7.312.8

200349

94

19.3

15.623.0

350499

91

17.7

14.221.3

500

224

47.3

42.652.1

Viral suppression

Most recent viral load documented undetectable or <200 copies/mL

403

68.6

64.572.7

Most recent viral load documented detectable, 200 copies/mL, or missing/unknown

179

31.4

27.335.5

Durable viral suppression

All viral load measurements documented undetectable or <200 copies/mL

356

60.3

56.064.5

Any viral load 200 copies/mL or missing/unknown

226

39.7

35.544.0

Total

582

100

Abbreviations: CD4, CD4 T-lymphocyte count (cells/L); CI, confidence interval; CDC, the Centers for Disease Control and Prevention [footnotes only]. Source of stage of disease information: CDC. Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years--United States, 2008. MMWR 2008;57(RR-10):112. Note. CD4 counts and viral load measurements are from medical record abstraction. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding. Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. a Numbers are unweighted. b Percentages are weighted percentages. c CIs incorporate weighted percentages. d HIV infection, stage 3 (AIDS): Documentation of an AIDS-defining condition or either a CD4 count of <200 cells/L or a CD4 percentage of total lymphocytes of <14. Documentation of an AIDS-defining condition supersedes a CD4 count or percentage that would not, by itself, be the basis for a stage 3 (AIDS) classification.

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Table 4. Access to, and quality of, care--Medical Monitoring Project, Georgia, 2015-2017

No.a

%b

95% CIc

Ever received outpatient HIV cared

Yes

578

99.2

98.5100.0

No

4

-

-

Received outpatient HIV care, past 12 monthsd

Yes

568

97.3

95.699.0

No

11

-

-

Received outpatient HIV care, past 24 monthsd

Yes

573

98.9

97.999.9

No

6

-

-

Retained in care, past 12 monthse

Yes

453

79.8

76.283.4

No

110

20.2

16.623.8

Retained in care, past 24 monthse

Yes

340

60.6

56.364.9

No

222

39.4

35.143.7

Prescribed ART, past 12 monthsf

Yes

496

90.7

87.993.5

No

47

9.3

6.512.1

Prescribed PCP prophylaxis, past 12 monthsg

Yes

29

38.3

26.849.9

No

46

61.7

50.173.2

Prescribed MAC prophylaxis, past 12 monthsh

Yes

5

-

-

No

21

81.0

65.496.6

Received influenza vaccination, past 12 months

Yes

457

78.7

75.082.4

No

114

21.3

17.625.0

Total

582

100

Abbreviation: CI, confidence interval; ART, antiretroviral therapy; PCP, Pneumocystis pneumonia; MAC, Mycobacterium avium

complex; CD4, CD4 T-lymphocyte count (cells/L) [footnotes only].

Note. CD4 counts, viral load measurements, prophylaxes, and vaccinations are from medical record abstraction. Measurement

period is the 12 months before the interview unless otherwise noted.

Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding.

Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses.

a Numbers are unweighted.

b Percentages are weighted percentages.

c CIs incorporate weighted percentages.

d Outpatient HIV care was defined as any documentation of the following: encounter with an HIV care provider, viral load test result,

CD4 test result, HIV resistance test or tropism assay, ART prescription, PCP prophylaxis, or MAC prophylaxis.

e Two elements of outpatient HIV care at least 90 days apart in each 12 month period.

f ART prescription documented in medical record; persons with no medical record abstraction were considered to have no

documentation of ART prescription.

g Among persons with CD4 cell count <200 cells/L.

h Among persons with CD4 cell count <50 cells/L.

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

Page 17

Table 5. Sexually transmitted disease testing during the 12 months before the interview, by sexual activity-- Medical Monitoring Project, Georgia, 2015-2017

Total population

Sexually activea persons only

No.b

%c

95% CId

No.b

%c

95% CId

Gonorrheae

Yes, received test

247

46.3

41.850.7

173

52.5

46.858.2

No test documented

294

53.7

49.358.2

160

47.5

41.853.2

Chlamydiaf

Yes, received test

246

46.1

41.650.6

172

52.2

46.657.9

No test documented

295

53.9

49.458.4

161

47.8

42.153.4

Syphilisg

Yes, received test

344

64.2

59.968.5

224

67.4

62.172.7

No test documented

197

35.8

31.540.1

109

32.6

27.337.9

Gonorrhea, chlamydia, and syphilis

Yes, received all 3 tests

217

41.1

36.645.5

157

47.7

42.153.4

All 3 tests not documented

324

58.9

54.563.4

176

52.3

46.657.9

Total

582

100

363

100

Abbreviation: CI, confidence interval; EIA, enzyme immunoassay [footnotes only]; NAAT, nucleic acid amplification test [footnotes only]. Note. Information on laboratory testing for sexually transmitted diseases was based on medical record abstraction. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding. Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. a Sexual activity was reported in the interview component of the Medical Monitoring Project and was defined as anal or vaginal intercourse. b Numbers are unweighted. c Percentages are weighted percentages. d CIs incorporate weighted percentages e Testing for Neisseria gonorrhoeae was defined as documentation of a result from culture, gram stain, enzyme immunoassay (EIA), nucleic acid amplification test (NAAT), or nucleic acid probe. f Chlamydia trachomatis testing was defined as a result from culture, direct fluorescent antibody (DFA), EIA or enzyme-linked immunoassay (ELISA), NAAT, or nucleic acid probe. g Syphilis testing was defined as a result from nontreponemal syphilis tests (rapid plasma reagin [RPR], Venereal Disease Research Laboratory [VDRL]), treponemal syphilis tests (Treponema pallidum hemagglutination assay [TPHA], T.pallidum particle agglutination [TP-PA], microhemagglutination assay for antibody to T.pallidum [MHA-TP], fluorescent treponemal antibody absosrbed [FTA-ABS] tests), or dark-field microscopy.

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

Page 18

Table 6. Emergency department and hospital admission during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2017

No.a

%b

95% CIc

Number of visits to emergency department

0

325

56.3

51.960.7

1

123

22.5

18.826.3

24

102

17.5

14.220.9

5

20

3.6

2.05.3

Number of hospital admissions

0

451

78.8

75.282.4

1

83

15.0

11.818.1

24

27

5.0

3.06.9

5

9

-

-

Total

582

100

Abbreviation: CI, confidence interval. Note. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding. Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. a Numbers are unweighted. b Percentages are weighted percentages. c CIs incorporate weighted percentages.

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

Page 19

Table 7. Antiretroviral therapy (ART) use--Medical Monitoring Project, Georgia, 2015-2017

No.a

%b

95% CIc

Ever taken ART

Yes

559

97.1

95.598.8

No

13

2.9

1.24.5

Currently taking ART

Yes

526

91.0

88.393.7

No

46

9.0

6.311.7

Reasons for not currently taking ART, among those persons with a history of ART used

Health care provider never discussed restarting ART with participant

Yes

5

-

-

No

28

78.9*

61.196.6

Money or insurance problems

Yes

13

45.8*

26.964.8

No

20

54.2*

35.273.1

Person doesn't believe he/she needs ART

Yes

8

-

-

No

25

70.3*

51.888.8

Person thinks ART would make him/her feel sick or harm him/ her

Yes

8

-

-

No

25

74.8*

58.990.8

Person decided not to take ART for some other reason

Yes

13

36.1*

18.553.7

No

20

63.9*

46.381.5

Total

582

100

Abbreviations: CI, confidence interval.

Note. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding.

Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. Values with an absolute

confidence interval width 0.30 and values with an absolute confidence interval width of between 0.05 and 0.30 and a relative confidence

interval width >130% are marked with an asterisk and should be interpreted with caution.

a Numbers are unweighted.

b Percentages are weighted percentages.

c CIs incorporate weighted percentages.

d Persons could select more than 1 response for reasons not taking ART.

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

Page 20

Table 8. Antiretroviral therapy (ART) adherence among persons taking ART--Medical Monitoring Project, Georgia, 2015-2017

No.a

%b

95% CIc

ART adherence in the past 30 days

How many days did you miss at least 1 dose of any of your HIV medicines?

0

309

58.8

12

132

25.0

35

59

11.6

610

12

2.1

11+

13

2.5

How well did you do at taking your HIV medicines in the way you were supposed to?

Very poor

7

-

Poor

9

-

Fair

23

4.2

Good

72

13.8

Very good

154

28.9

Excellent

261

50.2

How often did you take your HIV medicines in the way you were supposed to?

Never

5

-

Rarely

6

-

Sometimes

11

-

Usually

25

4.4

Almost always

136

26.3

Always

343

65.2

How often were you troubled by ART side effects?

Never

352

66.3

Rarely

89

17.7

About half the time

37

7.2

Most of the time

20

3.8

Always

23

5.0

Reasons for last missed ART dosed

Had a problem getting a prescription, a refill, insurance coverage, or paying for HIV medicines

Yes

133

26.1

No

387

73.9

In the hospital or too sick to take HIV medicines

Yes

32

5.6

No

488

94.4

Fell asleep early or overslept

Yes

129

24.6

No

390

75.4

Change in your daily routine or were out of town

Yes

144

28.3

No

376

71.7

Had side effects from your HIV medicines

Yes

43

8.8

No

476

91.2

Felt depressed or overwhelmed

Yes

59

11.5

No

461

88.5

54.363.3 21.029.0
8.614.5 0.93.4 1.13.8
2.46.1 10.617.0 24.833.0 45.754.8
2.66.2 22.330.4 60.969.5
61.970.6 14.221.2
4.89.6 2.15.6 2.97.1
22.130.1 69.977.9
3.67.5 92.596.4
20.628.5 71.579.4
24.232.5 67.575.8
6.211.4 88.693.8
8.614.4 85.691.4

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

Page 21

Was drinking or using drugs

Yes

25

4.8

No

495

95.2

Forgot to take HIV medicines

Yes

183

36.2

No

337

63.8

Did not feel like taking HIV medicines

Yes

41

7.3

No

480

92.7

Total

526

100

Abbreviation: CI, confidence interval.

Note. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding.

Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses.

a Numbers are unweighted.

b Percentages are weighted percentages.

c CIs incorporate weighted percentages.

d Persons could report more than 1 reason for last missed dose.

2.96.8 93.297.1
31.840.7 59.368.2
5.09.6 90.495.0

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

Page 22

Table 9. Antiretroviral therapy (ART) prescription, ART dose adherence, durable viral suppression, and geometric mean CD4 count by subgroups--Medical

Monitoring Project, Georgia, 2015-2017

Prescription of ART

ART dose adherencea

Sustained viral suppressionb Geometric mean CD4 count

No.c Row %d 95% CIe

No.c Row %d 95% CIe No.c Row %d 95% CIe No.c Row2%00d 95% CIe

Gender

Male

359 85.4 81.789.1 225

59.4 54.264.6 260 61.4 56.466.4 304 90.2 87.293.3

Female

129 81.5 74.588.4

82

59.3 50.368.3 90 56.0 47.464.6 112 84.2 76.991.4

Transgenderf

7 93.7 81.1100.0

2

-

- 6 80.5* 54.0100.0

5 71.8* 38.5100.0

Sexual orientation

Lesbian or gay

187 83.7 78.489.0 119

60.2 53.167.3 130 58.1 51.265.0 152 90.5 86.394.8

Heterosexual or straight

236 83.1 78.288.0 156

59.7 53.266.2 177 62.0 55.968.2 209 87.2 82.691.8

Bisexual

52 89.8 81.498.2

29

55.1 41.169.1 37 62.6 49.276.0

43 89.3 80.398.3

Other sexual orientation

12 100.0 100.0100.0

4

-

- 8 67.5* 40.894.1

9 74.6* 49.799.6

Race/ethnicity

American Indian/Alaska Native

1

-

-

2

-

- 2

-

-

1

-

-

Asian

1

-

-

0

-

- 0

-

-

1

-

-

Black/African American

355 83.6 79.687.5 207

55.2 49.860.5 247 56.9 51.862.0 300 86.6 82.890.4

Hispanic/Latinog

21 82.2* 67.297.3

14 50.7* 29.671.8 13 50.2* 29.570.8

19 94.5 84.0100.0

Native Hawaiian/Other Pacific

1

-

-

1

-

- 1

-

-

1

-

-

Islander

White

90 85.6 78.392.9

66

68.4 58.778.1 74 71.0 61.880.2

76 93.5 88.498.7

Multiple races

27 100.0 100.0100.0

19 75.9* 59.492.5 19 71.3* 53.389.2

24 90.9 80.7100.0

Age at time of interview (yr)

1829

44 75.7 64.287.2

21

43.9 29.358.5 20 34.5 21.847.2

36 87.0 77.196.9

3039

97 84.7 77.492.0

51

47.7 37.557.9 65 55.3 45.565.0

83 86.3 79.193.6

4049

111 81.4 74.088.8

67

61.5 52.270.8 82 59.9 50.868.9

92 88.2 81.894.6

50

244 88.2 84.192.4 170

66.0 59.972.2 189 69.1 63.374.9 211 90.1 86.394.0

Total

496 84.6 81.387.8 309

58.8 54.363.3 356 60.3 56.064.5 422 88.6 85.691.5

Abbreviations: CD4, CD4 T-lymphocyte count (cells/L); CI, confidence interval. Note. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of

rounding. Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. Values with a denominator sample size <30, values with an absolute

confidence interval width 0.30, and values with an absolute confidence interval width of between 0.05 and 0.30 and a relative confidence interval width >130% are marked with an asterisk and

should be interpreted with caution.

a In past 30 days, 100% adherence to ART doses.

b All viral load measurements in the 12 months preceding the interview documented undetectable or <200 copies/mL.

c Numbers are unweighted.

d Percentages are weighted percentages.

e CIs incorporate weighted percentages.

f Persons were classified as transgender if sex at birth and gender reported by the person were different, or if the person chose transgender in response to the question about self-identified gender.

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

Page 23

g Hispanics or Latinos might be of any race. Persons are classified in only 1 race/ethnicity category.

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

Page 24

Table 10. Depression and anxiety during the 2 weeks before the interview--Medical Monitoring Project, Georgia, 20152017

No.a

%b

95% CIc

Depression based on DSM-IV criteriad

No depression

460

80.0

76.583.5

Other depression

57

9.9

7.312.5

Major depression

55

10.1

7.412.8

Moderate or severe depression (PHQ-8 score 10)

Yes

94

17.1

13.820.5

No

478

82.9

79.586.2

Anxietye

No anxiety

440

76.7

73.080.3

Mild anxiety

32

5.7

3.67.7

Moderate anxiety

55

9.6

7.112.1

Severe anxiety

46

8.1

5.710.5

Total

582

100

Abbreviation: CI, confidence interval; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th edition; PHQ-8, Patient Health Questionnaire. Note. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding. Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. a Numbers are unweighted. b Percentages are weighted percentages. c CIs incorporate weighted percentages. d Responses to the items on the PHQ-8 were used to define "major depression" and "other depression," according to criteria from the DSM-IV. "Major depression" was defined as having at least 5 symptoms of depression; "other depression" was defined as having 24 symptoms of depression. e Responses to the Generalized Anxiety Disorder Scale (GAD-7) were used to define "mild anxiety", "moderate anxiety" and "severe anxiety," according to criteria from the DSM-IV. "Severe anxiety" was defined as having a score of 15; "moderate anxiety" was defined as having a score of <15 and 10; and "mild anxiety" was defined as having a score of <10 and 5.

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

Page 25

Table 11. Tobacco and electronic cigarette use--Medical Monitoring Project, Georgia, 2015-2017

No.a

%b

95% CIc

Smoked 100 cigarettes (lifetime)

Yes

290

51.9

47.556.2

No

282

48.1

43.852.5

Cigarette smoking status

Never smoked

282

48.1

43.852.5

Former smoker

86

15.2

12.018.3

Current smoker

204

36.7

32.541.0

Frequency of current cigarette smoking

Never

368

63.3

59.067.5

Daily

166

29.4

25.433.4

Weekly

13

-

-

Monthly

6

-

-

Less than monthly

19

3.5

1.95.0

Smoked 50 cigars, cigarillos, or little filtered cigars (lifetime)

Yes

102

17.4

14.220.7

No

471

82.6

79.385.8

Cigars, cigarillos, or little filtered cigars smoking status

Never smoked

471

82.6

79.385.8

Former smoker

48

7.7

5.59.9

Current smoker

54

9.8

7.212.4

Frequency of current cigars, cigarillos, or little filtered cigars smoking

Never

519

90.2

87.692.8

Daily

11

-

-

Some days

18

3.2

1.64.8

Rarely

25

4.6

2.76.4

Electronic cigarette smoking status

Never used electronic cigarettes

408

71.0

67.075.0

Used electronic cigarettes, but not in the past 30 days

124

21.8

18.325.4

Used electronic cigarettes in the past 30 days

40

7.2

4.89.5

Total

582

100

Abbreviation: CI, confidence interval. Note. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding. Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. a Numbers are unweighted. b Percentages are weighted percentages.

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

Page 26

c CIs incorporate weighted percentages.

Table 12. Alcohol use during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2017

No.a

%b

95% CIc

Any alcohol used

Yes

362

65.2

61.069.3

No

210

34.8

30.739.0

Frequency of alcohol use

Daily

35

6.0

4.08.1

Weekly

114

19.8

16.423.3

Monthly

71

12.7

9.715.7

Less than monthly

142

26.6

22.730.5

Never Binge drinking past 30 dayse

210

34.8

30.739.0

Yes

82

14.2

11.217.2

No

489

85.8

82.888.8

Total

582

100

Abbreviation: CI, confidence interval. Note. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding. Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. a Numbers are unweighted. b Percentages are weighted percentages. c CIs incorporate weighted percentages. d Persons who drank at least 1 alcoholic beverage during the 12 months before the interview. Alcoholic beverage was defined as a 12-ounce beer, 5-ounce glass of wine, or 1.5-ounce shot of liquor. e Persons who drank 5 alcoholic beverages in a single sitting (4 for women) during the 30 days before the interview.

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

Page 27

Table 13. Noninjection drug use during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2017

No.a

%b

95% CIc

Use of any noninjection drugsd

Yes

165

29.9

25.933.9

No

407

70.1

66.174.1

Noninjection drugsd used

Marijuana

Yes

151

27.3

23.431.2

No

421

72.7

68.876.6

Crack

Yes

12

1.8

0.82.9

No

560

98.2

97.199.2

Cocaine that is smoked or snorted

Yes

26

4.7

2.86.5

No

546

95.3

93.597.2

Methamphetamine (e.g., crystal meth, tina, crank, ice)

Yes

15

2.8

1.44.2

No

557

97.2

95.898.6

Amphetamine (e.g., speed, bennies, uppers)

Yes

5

-

-

No

567

98.9

97.999.9

Club drugs (e.g., Ecstasy or X, ketamine or Special K, GHB or Liquid Ecstasy)

Yes

12

2.3

1.03.7

No

560

97.7

96.399.0

Amyl nitrite (poppers)

Yes

24

5.0

2.97.0

No

548

95.0

93.097.1

Prescription opioids (e.g., oxycodone, hydrocodone, Vicodin, Percocet)e

Yes

16

3.0

1.54.6

No

556

97.0

95.498.5

Prescription tranquilizers (e.g., Valium, Ativan, Xanax, downers, nerve pills)e

Yes

12

2.2

0.93.5

No

560

97.8

96.599.1

Total

582

100

Disclaimer: The use of trade names is for identification only and does not imply endorsement by the Department of Health and Human

Services or the Centers for Disease Control and Prevention.

Abbreviations: CI, confidence interval; GHB, gamma hydroxybutyrate.

Note. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding.

Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses.

a Numbers are unweighted.

b Percentages are weighted percentages.

c CIs incorporate weighted percentages.

d Includes all drugs that were not injected (i.e., administered by any route other than injection), including legal drugs that were not used

for medical purposes.

e That was not prescribed or was prescribed but taken more than directed.

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

Page 28

Table 14. Injection drug use during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2017

No.a

%b

95% CIc

Use of any injection drugs

Yes

8

1.6*

0.5-2.8

No

564

98.4

97.299.5

Injection drugs used

Cocaine

Yes

3

-

-

No

569

99.5

98.9100.0

Heroin

Yes

1

-

-

No

571

99.8

99.4100.0

Heroin and cocaine (speedball)

No

572

100.0

100.0100.0

Methamphetamine (e.g., crystal meth, tina, crank, ice)

Yes

7

-

-

No

565

98.5

97.499.6

Amphetamine (e.g., speed, bennies, uppers)

Yes

2

-

-

No

570

99.6

99.0100.0

Prescription opioids (e.g., oxycontin, oxycodone, hydrocodone)

No

572

100.0

100.0100.0

Total

582

100

Disclaimer: The use of trade names is for identification only and does not imply endorsement by the Department of Health and Human Services or the Centers for Disease Control and Prevention. Abbreviation: CI, confidence interval. Note. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding. Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. *CV=0.36 a Numbers are unweighted. b Percentages are weighted percentages. c CIs incorporate weighted percentages.

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

Page 29

Table 15. Gynecological care and reproductive health among women--Medical Monitoring Project, Georgia, 20152017

No.a

%b

95% CIc

Papanicolaou (Pap) test, past 12 months

Yes

116

76.2

68.883.7

No

35

23.8

16.331.2

Pregnant since HIV diagnosis

Yes

38

27.2

19.235.2

No

112

72.8

64.880.8

Total

156

100

Abbreviation: CI, confidence interval. Note. Measures are self-reported. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding. Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. a Numbers are unweighted. b Percentages are weighted percentages. c CIs incorporate weighted percentages.

Georgia Medical Monitoring Project Surveillance Summary, 2015-2017

Page 30

Table 16. Sexual behavior during the 12 months before the interview among cisgender men and women--Medical Monitoring Project, Georgia, 2015-2017

Men

Women

Behavior

No.a

%b

95% CIc No.a %b

95% CIc

Engaged in anal sex with men

Receptive

Yes

153

38.2 33.243.2

3

-

-

No

255

61.8 56.866.8 148 97.8 95.3100.0

Insertive

Yes

152

38.4 33.443.5

-

-

-

No

256

61.6 56.566.6

-

-

-

Engaged in anal sex with women

Yes

8

-

-

-

-

-

No

408

98.3 97.199.5

-

-

-

Engaged in vaginal sex

Yes

88

21.2 17.125.3 80 54.5 45.963.1

No

322

78.8 74.782.9 72 45.5 36.954.1

Engaged in vaginal or anal sex

Yes

277

68.2 63.473.0 80 54.5 45.963.1

No

132

31.8 27.036.6 72 45.5 36.954.1

Number of vaginal or anal sex partners among

MSMd

Mean

4

-

Median

2

-

Range

170

-

MSWe

Mean

2

-

Median

1

-

Range

115

-

WSMf

Mean

-

1

Median

-

1

Range

-

14

Total

417

100

156 100

Abbreviations: CI, confidence interval; MSM, men who had sex with men; MSW, men who had sex only with women; WSM, women who

had sex with men.

Note. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding.

Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses.

a Numbers are unweighted.

b Percentages are weighted percentages.

c CIs incorporate weighted percentages.

d Among men who had anal sex with men in the 12 months before the interview.

e Among men who had vaginal or anal sex only with women in the 12 months before the interview.

f Among women who had vaginal or anal sex with men in the 12 months before the interview.

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Table 17. Sexual behavior during the 12 months before the interview among men who had sex with men (MSM), men who had sex only with women (MSW), and women who had sex with men (WSM)--Medical Monitoring Project, Georgia, 2015-2017

MSM

MSW

WSM

Behavior

No.a %b 95% CIc No.a %b 95% CIc No.a %b 95% CIc

Engaged in any high-risk sexd

Yes

27 9.3 5.812.8 4

-

- 13 10.3 4.416.2

No

249 90.7 87.294.2 127 96.1 92.299.9 134 89.7 83.895.6

Engaged in any high-risk sex among sexually active personsd

Yes

27 12.9 8.217.7 4

-

- 13 18.4 8.428.4

No

174 87.1 82.391.8 71 93.4 87.099.8 67 81.6 71.691.6

Percentages of sexually-active persons who used a prevention strategy with at least 1 partner Sex while sustainably virally suppressede

Yes

114 55.8 48.563.0 47 61.3 49.672.9 44 51.8 39.764.0

No Condom-protected sexf

88 44.2 37.051.5 28 38.7 27.150.4 36 48.2 36.060.3

Yes

141 70.9 64.377.4 56 74.3 63.884.7 54 64.5 52.176.8

No

60 29.1 22.635.7

Condomless sex with a partner on PrEPg

19 25.7 15.336.2 25 35.5 23.247.9

Yes

11 -

- 1

-

- -

-

-

No

191 95.1 92.198.0 73 99.0 97.1100.0 -

-

-

Sex with an HIV positive partnerh

Yes

137 69.3 62.775.9 20 25.8 15.636.0 25 30.4 19.241.6

No

65 30.7 24.137.3 55 74.2 64.084.4 55 69.6 58.480.8

Total

277 100

131 100

149 100

Abbreviations: CI, confidence interval; PrEP, preexposure prophylaxis. Note. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding. Persons who reported no anal, vaginal or oral sex in the 12 months before the interview were categorized according to self-reported sexual orientation. This table does not include information on women who had sex with women only, women who had sex with transgender persons only, or men who had sex with transgender persons only. Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. a Numbers are unweighted. b Percentages are weighted percentages. c CIs incorporate weighted percentages. d Vaginal or anal sex with at least 1 HIV-negative or unknown status partner while not sustainably virally suppressed, a condom was not used, and the partner was not on PrEP. PrEP use was only measured among the 5 most recent partners. e HIV viral load <200 copies/mL documented in the medical record at every measure in the past 12 months before the interview. f Condoms were consistently used with at least 1 vaginal or anal sex partner. g At least 1 HIV-negative condomless-sex partner was on PrEP. PrEP use was only measured among the 5 most recent partners and was reported by the HIV-positive partner. h Sex with at least 1 HIV-positive partner.

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Table 18. Met and unmet needs for ancillary services during the 12 months before the interview--Medical

Monitoring Project, Georgia, 2015-2017

Persons who needed but did

Persons who received services not receive services by time of

interview

No.a

%b

95% CIc

No.a

%b

95% CIc

Dental care

Yes

287 50.0 45.654.3

174 30.5 26.434.5

No

286 50.0 45.754.4

399 69.5 65.573.6

HIV case management services

Yes

251 43.3 38.947.6

61 11.1

8.214.0

No

320 56.7 52.461.1

510 88.9 86.091.8

Medicine through ADAP

Yes

245 41.6 37.345.9

20 3.7

1.95.5

No

320 58.4 54.162.7

545 96.3 94.598.1

Supplemental Nutrition Assistance Program (SNAP) or Special Supplemental Nutrition Program for

Women, Infants, and Children (WIC)

Yes

229 39.3 35.143.6

94 16.4 13.219.5

No

344 60.7 56.464.9

479 83.6 80.586.8

Professional help remembering to take HIV medicines on time or correctly (adherence support services)

Yes

196 32.6 28.636.7

3 -

-

No

372 67.4 63.371.4

565 99.6 99.1100.0

Mental health services

Yes

150 25.7 22.029.4

59 10.6

7.813.4

No Meal or food servicesd

422 74.3 70.678.0

513 89.4 86.692.2

Yes

104 17.1 14.020.3

66 12.0

9.114.9

No

469 82.9 79.786.0

507 88.0 85.190.9

Transportation assistance

Yes

96 15.8 12.719.0

62 10.6

7.913.3

No

476 84.2 81.087.3

510 89.4 86.792.1

HIV peer group support

Yes

59

9.1 6.811.5

47 8.0

5.710.4

No

511 90.9 88.593.2

523 92.0 89.694.3

Patient navigation services

Yes

51

8.2 5.910.5

30 5.1

3.27.1

No

519 91.8 89.594.1

540 94.9 92.996.8

Shelter or housing services

Yes

45

7.7 5.410.0

83 13.8 10.916.8

No

527 92.3 90.094.6

489 86.2 83.289.1

Drug or alcohol counseling or treatment

Yes

28

4.5

2.86.3

16 2.8

1.44.2

No

545 95.5 93.797.2

557 97.2 95.898.6

Domestic violence services

Yes

2

-

-

2 -

-

No

571 99.5 98.9100.0

571 99.7 99.3100.0

Interpreter services

Yes

2

-

-

1 -

-

No

572 99.7 99.2100.0

573 99.8 99.5100.0

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Total

582

100

582 100

Abbreviations: CI, confidence interval; ADAP, AIDS Drug Assistance Program.

Note. Persons could report receiving or needing more than 1 service. Numbers might not add to total because of missing data.

Percentages might not sum to 100 because of rounding.

Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. Values with an

absolute confidence interval width 0.30 and values with an absolute confidence interval width of between 0.05 and 0.30 and a

relative confidence interval width >130% are marked with an asterisk and should be interpreted with caution.

a Numbers are unweighted.

b Percentages are weighted percentages.

c CIs incorporate weighted percentages.

d Includes services such as soup kitchens, food pantries, food banks, church dinners, or food delivery services.

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Table 19. Intimate partner violence and sexual violence--Medical Monitoring Project, Georgia, 2015-2017

No.a

%b

95% CIc

Was ever slapped, punched, shoved, kicked, choked or otherwise physically hurt by a romantic or sexual partner

Yes

141

24.4

20.728.1

No

426

75.6

Was slapped, punched, shoved, kicked, choked or otherwise physically hurt by a romantic or sexual partner, past 12 months

71.979.3

Yes

18

3.1

1.74.6

No

549

96.9

95.498.3

Was ever threatened with harm or physically forced to have unwanted vaginal, anal, or oral sex

Yes

77

14.2

No

493

85.8

11.117.3 82.788.9

Was threatened with harm or physically forced to have unwanted vaginal, anal, or oral sex, past 12 months

Yes

4

-

-

No

566

99.2 98.4100.0

Total

582

100

Abbreviation: CI, confidence interval. Note. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding. Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. a Numbers are unweighted. b Percentages are weighted percentages. c CIs incorporate weighted percentages.

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Table 20. Prevention services received during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2017

No.a

%b

95% CIc

One-on-one HIV/STD risk-reduction conversation with physician, nurse, or other health care worker

Yes

298

51.5 47.255.9

No

274

48.5 44.152.8

One-on-one HIV/STD risk-reduction conversation with outreach worker, counselor, or prevention program worker

Yes

166

28.8 24.832.7

No

405

71.2 67.375.2

Attended an organized HIV/STD risk-reduction session involving a small group of people

Yes

73

12.1

9.314.9

No

499

87.9 85.190.7

Received free condoms

Yes

275

47.3 42.951.6

No

298

52.7 48.457.1

Total

582

100

Abbreviation: CI, confidence interval. Note. Persons could report receiving more than 1 prevention service. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding. Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. a Numbers are unweighted. b Percentages are weighted percentages. c CIs incorporate weighted percentages.

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Table 21. National indicators: homelessness, HIV stigma, and high-risk sex--Medical Monitoring Project, Georgia, 2015-2017

Homeless in the 12 months preceding the interview
among persons receiving HIV care in the past 12 monthsa

HIV stigmab

Engaged in any high-risk sexc

Gender Male

No.d Row %e 33 8.0

95% CIf 5.310.7

No.d

Row Interquartile median range

score

404 34.8 21.052.5

No.d 31

Row %e
7.6

95% CIf 4.910.2

Female Transgenderg

8

-

0

-

- 146 45.1 31.760.0 13 9.9 4.315.6

-

8 50.7* 43.455.1 1 -

-

Sexual orientation Lesbian or gay

15 6.6 3.29.9 218 33.7 20.748.0 23 10.0 6.014.0

Heterosexual or straight Bisexual

17 7.1 3.710.5 269 41.4 26.056.2 16 6.8 3.310.2

8

-

- 58 38.4 20.758.8 5 -

-

Other sexual orientation Race/ethnicity American Indian/Alaska Native Asian

2

-

0

-

0

-

- 12 51.3* 31.557.8 1 -

-

-

2

-

-

1

-

- 0 -

-

- 0 -

-

Black/African American

35 9.5 6.412.6 401 37.8 22.854.9 27 7.0 4.39.7

Hispanic/Latinoh

3

-

- 26 35.0* 13.954.3 4 -

-

Native Hawaiian/Other

0

-

-

1

-

- 0 -

-

Pacific Islander

White

1

-

- 101 39.1 24.851.9 11 -

-

Multiple races

3

-

- 27 40.3* 20.960.8 3 -

-

Age at time of interview (yr)

1829

7

-

- 58 38.0 22.155.9 13 21.6 10.832.4

3039

15 12.4 6.318.4 109 40.3 31.158.1 14 12.3 6.018.6

4049

5

-

- 127 37.0 22.054.0 7 -

-

50

15 6.2 3.09.3 265 36.9 20.153.3 11 -

-

Total

42 7.7 5.410.0 559 38.1 23.154.4 45 8.2 5.810.6

Abbreviation: CI, confidence interval; PrEP, preexposure prophylaxis [footnotes only]. Note. Numbers might not add to total because of missing data. Percentages might not sum to 100 because of rounding. Excluded are values with a coefficient of variation 0.30, "don't know" responses, and skipped (missing) responses. Values with a denominator sample size <30 are marked with an asterisk and should be interpreted with caution. a Living on the street, in a shelter, in a single-roomoccupancy hotel, or in a car. b Ten-item scale ranging from 0 (no stigma) to 100 (high stigma) that measures 4 dimensions of HIV stigma: personalized stigma, disclosure concerns, negative self-image, and perceived public attitudes about people living with HIV. c Vaginal or anal sex with at least 1 HIV-negative or unknown status partner while not sustainably virally suppressed, a condom was not used, and the partner was not on PrEP. PrEP use was only measured among the 5 most recent partners. d Numbers are unweighted. e Percentages are weighted percentages. f CIs incorporate weighted percentages. g Persons were classified as transgender if sex at birth and gender reported by the person were different, or if the person chose transgender in response to the question about self-identified gender. h Hispanics or Latinos might be of any race. Persons are classified in only 1 race/ethnicity category.

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Appendix: Methods and
Definitions
METHODS
The Medical Monitoring Project (MMP) uses a stratified, 2-stage sampling design. States were sampled first, with probability proportional to size (PPS). All 50 states, the District of Columbia, and Puerto Rico (defined as primary sampling units [PSUs]) were eligible for selection. From these 52 PSUs, 20 were selected by using PPS sampling based on AIDS prevalence at the end of 2002. According to the PPS sampling method, states with a higher AIDS prevalence had a higher probability of selection, and those with a lower AIDS prevalence had a lower probability of selection [1]. Six municipal jurisdictions receive separate funding for HIV surveillance (Chicago, Illinois; Houston, Texas; Los Angeles County, California; New York City, New York; Philadelphia, Pennsylvania; and San Francisco, California); these areas were included with the state for first-stage sampling and constituted a city-state unit. If a state included a city with independent HIV surveillance authority (e.g., Texas, which includes Houston), selection of the state included selection of the city (i.e., city-state units were selected together). In 2004, 19 states (including the 6 separately funded areas within those states) and Puerto Rico were selected from the 52 PSUs, resulting in 26 MMP project areas. Because of funding constraints for the 2009 data collection cycle, 3 project areas (Maryland, Massachusetts, and South Carolina) were randomly selected to discontinue participation in MMP, and the total number of MMP areas was reduced to 23. An analysis carried out in 2014 found that the original measure of size with which states were originally sampled (i.e., AIDS prevalence in 2002) was still a reasonable proxy for the distribution of HIV prevalence in 2010 (the most recent year for which prevalence estimates were available at the time). Consequently, we concluded that the selected sample of states was still sufficiently representative of the

population of persons with diagnosed HIV and that selecting a new sample for the 2015 and subsequent
data collection cycles was unwarranted. In addition, the change in the sampling frame and the availability of national totals from the National HIV Surveillance System (NHSS) presented new options for calibrating weights, further lessening the need for any adjustments to the sample of states. At the second stage, persons with a reported diagnosis in NHSS were sampled after the selection of the states. The sampling frame was the national case surveillance data set containing records submitted to the Centers for Disease Control and Prevention (CDC) as of December 31, the year prior to the data collection cycle. This national data set was divided into 24 separate frame files according to the most recently reported residence information, with 1 frame for each of the 23 project areas and 1 residual file for all non-MMP project areas. Individuals were eligible for sampling if their vital status was alive, they were aged 18 years, and they were residents of the United States. Records in the NHSS are deidentified (under provisions of CDC's Assurance of Confidentiality) and include only limited information about where the person currently resides, lacking the more exact address information contained in local case surveillance systems. CDC staff drew simple random samples from the 23 project area frame files, and project area staff then linked their samples to local case surveillance systems and extracted contact information for use in locating sampled persons, whom they then attempted to recruit.
Nonresponse Analysis and Weighting
Data used to generate national estimates were weighted for the probability of selection based upon known probabilities of selection of states and individuals within states. In addition, data were weighted to adjust for nonresponse by using predictors of response, including sex, race/ethnicity, age of most recent contact information, transmission category, and the person's receipt of care as documented by lab-

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oratory test results in NHSS records. In 2016, frame data extracted from NHSS provided information for all sampled persons in MMP, regardless of response to the interview or from the medical record abstraction. These
data provided descriptive information about all sampled persons for assessing how person characteristics were associated with nonresponse and were the source of data used for nonresponse analysis and weighting.
Eligibility and Response Classifications
Persons were eligible for participation if, as of the sampling date, they had received a diagnosis of HIV, were aged 18 years, alive, and a resident of an MMP project area. Sampled persons were presumed to be eligible based on their information in NHSS unless data from another source contradicted this status. Persons were classified into 4 categories: (1) eligible respondents, (2) contacted nonrespondents, (3) nonrespondents who were not contacted, and (4) ineligible persons. These categories were used in calculating final response rates and contact rates in accordance with standard formulas [2].
Weighting Overview
For the 2015-2017 MMP cycles, sets of weights at the national level of analysis were produced independently of the local levels of analysis. Base weights were applied, and statistical adjustments were then made for multiplicity and nonresponse at the person level. These nonresponse adjustments distributed the base weights of nonresponding persons to responding persons, so that the sum of the adjusted weights equaled the sum of the base weights. After adjusting for nonresponse, the weights were then poststratified to population totals from the NHSS frame. Extreme weights were trimmed and the weights were adjusted to the same population totals. For the weighting process, an updated sampling frame was created by returning to the source of surveillance records approximately a year later, during which time additional information may have become available for persons reported to NHSS and additional diagnoses may have been reported. This

updated frame added to the frame all records that would have been eligible if their information had met the inclusion criteria; primarily, these were diagnoses that occurred during the year prior to the MMP sampling date (for the 2016 cycle, December 31, 2015),
but had not yet been reported on the date the initial sample was drawn. Additionally, some persons were found to have had multiple records pertaining to them at the time of sampling, which were later identified as duplicate records. In some cases, updated information indicated that a person originally judged eligible and included on the original frame was ineligible.
Adjustments for unequal selection probabilities
The base weight was the inverse probability of selection for the person, which varied by project area. A person who was sampled from one jurisdiction, but lived in another area at the time of sampling, retained the original base weight. Prior to weighting, such crossjurisdictional records were grouped with their project area of residence at the time of sampling. This moving of records had no effect on the national weights, but did affect the project area weight totals, increasing some slightly while decreasing others.
Adjustments for multiplicity
A multiplicity factor was applied to the person weight for persons with records found to be present more than once when the original frame was compared to the updated frame. This factor, which accounts for some persons' multiple opportunities for being sampled, was capped at 2.0 and was applicable for only 56 persons.
Adjustments for nonresponse
A nonresponse adjustment factor was then applied to the base weight. This factor makes use of information available for every sampled case from the NHSS frame data: personal demographics, HIV exposure category, laboratory data, and diagnosis data. Definitions of weighting classes were based on variables that were determined in bivariate analyses to be significantly related to response at the national or project area level.

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For the national adjustment factor, weighting classes were based on variables related to response: sex at birth, age of most recent contact information, and the person's frequency of receipt of care (as indicated by NHSS records). For local project area data, the factors
used for this adjustment varied, depending on the results of bivariate analyses. Within weighting classes, the adjustment for nonresponse was the ratio of the sum of the multiplicity-adjusted base weights for eligible sampled cases to the sum of these weights for eligible respondents.
Poststratification
The updated sampling frame provided information on the size and characteristics of the population with diagnosed HIV, which was used for poststratification to known distributions. A count of records on this updated frame provided an updated total population size estimate. Poststratifying to this total forced the samplebased estimate of population size to conform and corrected for late reports. This adjustment was performed within classes defined by key demographics (age, race/ethnicity, and gender), so that the weight sum was preserved in each class.
Trimming
After poststratification, the need for trimming the adjusted weights, so as not to inflate variance, was assessed. Where the design effect due to weighting (measured as 1 + CV2, where CV is the coefficient of variation of the weights) exceeded 1.75, we capped the weights at the median weight plus 4 times the interquartile range of the weights, then redistributed the excess to preserve the weight total. This was implemented in 4 project areas, but was not needed for national weights. The effect of other weighting adjustments, however, reduced weight totals through the exclusion of sampled persons found to be ineligible, while approximately maintaining the proportional distributions of the factors used in the poststratification.

Design variables and variance estimation
Nationally, design variables indicating strata and cluster membership for each participating person accounted for the sample design. Many states were sampled with certainty, because of their higher AIDS prevalence, and
each of these was defined as its own stratum. Elsewhere, strata were created by grouping 2 to 3 states (PSUs in the stratified PPS design) that had similar selection probabilities. Multiple project areas within certainty states were effectively substrata, and each project area remained its own stratum. For certainty PSUs, the participant was the cluster. For the strata composed of noncertainty states, the state was the cluster. For local estimates, variance estimation was conditional on the initial sampling of states as PSUs, meaning that this stage of sampling was ignored. Participants were treated as having come from a simple random sample with replacement, although the various adjustment factors induced unequal weights.
DEFINITIONS
Sociodemographic Characteristics
Gender: Categories were male, female, and transgender. Participants were classified as transgender if reported sex at birth and current gender as reported by the participant were not the same or if the participant answered "transgender" to the inter-view question regarding self-identified gender. Health insurance, including coverage for antiretroviral therapy (ART) medications: Participants were asked whether they had health insurance or coverage for ART medications during the 12 months before the interview. Responses to these questions were combined and categorized as private health insurance, Medicaid, Medicare, Ryan White HIV/AIDS Program, Tricare/ CHAMPUS and Veterans Administration coverage, insurance classified as other public health insurance, and unknown insurance. Participants could select more than 1 response for health insurance, including coverage for ART medications.

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Federal poverty guidelines: Participants were asked about their combined monthly or yearly household income (in US$) from all sources during the 12 months before the interview. The number of persons meeting the current federal poverty threshold was determined by using the U.S. Department of Health and Human Services poverty guidelines that corresponded to the calendar year for which income was asked. These guidelines are issued yearly for the 48 contiguous states and Washington, D.C., and are an indicator used for determining eligibility for many federal and state programs. The 2015 guidelines [3] were used for participants interviewed in 2016, and the 2016 guidelines [4] were used for persons interviewed in 2017. Because the poverty guidelines are not defined for the territory of Puerto Rico, the guidelines for the contiguous states and Washington, D.C., were used for this jurisdiction. Participants were asked to specify the range of their income, and household income was assumed to be the midpoint of the income range.
Clinical Characteristics
CDC stage of disease classification for HIV infection: Defined according to CDC's 2014 revised surveillance case definition for HIV infection [5]. Information from NHSS was used to determine the most advanced HIV disease stage ever reached by participants.
Use of Health Care Services
Outpatient HIV medical care: Defined as documentation of any of the following: encounter with an HIV care provider, viral load test result, CD4 test result, HIV resistance test or tropism assay, ART prescription, PCP prophylaxis, or MAC prophylaxis. All were measured through documentation in the person's medical record; an encounter with an HIV care provider was also measured based on interview self-report. Persons were considered to be retained in care if they had 2 elements of outpatient HIV care at least 90 days apart in each 12-month period reviewed. ART prescription: Defined as a prescription in the medical record, during the 12 months before the interview, of any of the following medications: abacavir, amprenavir, atazanavir, cobicistat, darunavir, delavirdine, didanosine, dolutegravir, efavirenz,

elvitagravir, emtricitabine, enfuvirtide, etravirine, fosamprenavir, indinavir, lamivudine, lopinavir/ritonavir, maraviroc, nelfinavir, nevirapine, raltegravir, rilpivirine, ritonavir, saquinavir, stavudine, tenofovir alafenamide, tenofovir disoproxil fumarate, tipranavir, or zidovudine. Persons with no medical record abstraction were considered to have no documentation of ART prescription. Pneumocystis pneumonia (PCP) prophylaxis: Defined as documentation in the medical record that prophylaxis for PCP was prescribed among persons with a CD4 count of <200 cells/L in the 12 months before the interview [6]. Persons prescribed regimens typically given as PCP prophylaxis (trimethoprimsulfamethoxazole, dapsone with or without pyrimethamine and leucovorin, aerosolized pentamidine, and atovaquone) were not presumptively categorized as having received PCP prophylaxis unless this was specifically stated in the medical record or no length of time was specified for the course of treatment. Mycobacterium avium complex (MAC) prophylaxis: Defined as documentation in the medical record that prophylaxis for MAC disease was prescribed among persons with a CD4 count of <50 cells/L in the 12 months before the interview [6]. Persons prescribed regimens typically given as MAC prophylaxis (azithromycin with or without ethambutol and/or rifabutin, clarithromycin with or without ethambutol and/or rifabutin, and rifabutin with or without azithromycin or azithromycin along with ethambutol) were not presumptively categorized as having received MAC prophylaxis unless this was specifically stated in the medical record or no length of time was specified for the course of treatment. Influenza vaccination: Participants were asked whether they had received seasonal influenza vaccine during the 12 months before the interview. Neisseria gonorrhoeae testing: Defined as documentation in the medical record, during the 12 months before the interview, of a result from culture, Gram stain, enzyme immunoassay (EIA), nucleic acid amplification test (NAAT), or nucleic acid probe.

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Chlamydia trachomatis testing: Defined as documentation in the medical record, during the 12 months before the interview, of a result from culture direct fluorescent antibody (DFA), EIA or enzyme-linked immunoassay (ELISA), NAAT, or nucleic acid probe. Syphilis testing: Defined as documentation in the
medical record, during the 12 months before the interview, of a result from nontreponemal serologic tests (rapid plasma reagin [RPR], Venereal Disease Research Laboratory [VDRL]), treponemal serologic tests (Treponema pallidum hemagglutination assay [TPHA], T. pallidum particle agglutination [TP-PA], microhemagglutination assay for antibodies to T. pallidum [MHA-TP], Chemiluminescence Immunoassay [CIA], fluorescent treponemal antibody absorption [FTAABS] tests), polymerase chain reactions (PCR), or darkfield microscopy.
Self-reported ART Medication Use and Adherence
ART adherence: Participants were asked about their adherence to ART in the 30 days before the interview using questions from a 3-item scale developed by Wilson and colleagues [7]. Participants were asked about how many days they missed at least 1 dose of their HIV medicines, how often they took their HIV medicines in the way they were supposed to, and how good a job they did at taking their HIV medicines in the way they were supposed to during the 30 days before the interview.
Depression and Substance Use
Depression: Participants were asked questions from the Patient Health Questionnaire (PHQ-8), an 8-item scale used to measure frequency of depressed mood in the preceding 2 weeks [8]. The PHQ-8 has the following question: "Over the last 2 weeks, how often have you been bothered by any of the following problems?" The respondent is then asked about the following problems: (1) little interest or pleasure in doing things (anhedonia); (2) feeling down, depressed, or hopeless; (3) trouble falling/staying asleep, or sleeping too much; (4) feeling tired or having little energy; (5) poor appetite or overeating; (6) feeling bad about yourself or that you are a failure or have let yourself or your family down; (7) trouble concentrating on things, such as reading the

newspaper or watching television; and (8) moving or speaking so slowly that other people could have noticed, or being fidgety or restless or moving around a lot more than usual. Response categories were "not at all," "several days," "more than half the days," and "nearly every day," with points (03) assigned to each response category, respectively. The PHQ-8 responses were scored by using 2 methods. Method 1: an algorithm involving criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR) [9], for diagnosing major depression was used to classify adults with diagnosed HIV as having major depression, other depression, or no depression. To meet the criteria for major depression, a participant must have experienced 5 or more symptoms at least "more than half the days," and one of the symptoms must be anhedonia or feelings of hopelessness. For other depression, a participant must have experienced 2 to 4 symptoms at least "more than half the days," and one of the symptoms must be anhedonia or feelings of hopelessness. Method 2: scores for each response category were summed to produce a total score between 0 and 24 points. Current depression of moderate or severe intensity was defined as a total score of 10. Anxiety: Participants were asked questions from the Generalized Anxiety Disorder Scale (GAD-7), a 7-item scale used to screen for and measure the severity of generalized anxiety disorder [10]. The GAD-7 has the following question: "Over the last 2 weeks, how often have you been bothered by any of the following problems?" The respondent is then asked about the following problems: (1) feeling nervous, anxious, or on edge; (2) not being able to stop or control worrying; (3) worrying too much about different things; (4) trouble relaxing; (5) being so restless that it is hard to sit still; (6) becoming easily annoyed or irritable; and (7) feeling afraid as if something awful might happen. Responses were scored according to criteria from the DSM-IV-TR [9]. Response categories were "not at all," "several days," "more than half the days," and "nearly every day," with points (03) assigned to each response category, respectively. Scores for each response

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category were summed to produce a total score between 0 and 21 points. "Severe anxiety" was defined as having a score of 15; "moderate anxiety" was defined as having a score of 1014; and "mild anxiety" was defined as having a score of 59. Alcohol use: Participants were asked about alcohol use during the 30 days and the 12 months before the interview. A drink was defined as 12 ounces of beer, a 5-ounce glass of wine, or a 1.5- ounce shot of liquor. Binge drinking: Defined as 5 drinks in a single sitting for men and 4 drinks in a single sitting for women in the past 30 days.
Sexual Behavior
Prevention modalities: Reported behaviors that decrease the likelihood of HIV transmission to a sexual partner, including
o Sex while sustainably virally suppressed: Vaginal or anal sex and the person's HIV viral load was documented in the medical record as <200 copies/mL at every measure in the past 12 months before the interview.
o Condom-protected sex: Condoms were consistently used with at least 1 vaginal or anal sex partner.
o Condomless sex with a partner on preexposure prophylaxis (PrEP): At least 1 HIV-negative condomless-sex partner was on PrEP. PrEP use was only measured among the 5 most recent partners and was reported by the HIVpositive partner.
o Sex with an HIV-positive partner: Vaginal or anal sex with at least 1 HIVpositive partner.
High-risk sex: Vaginal or anal sex with at least 1 HIVnegative or unknown status partner while not sustainably virally suppressed, when a condom was not used, and the partner was not known to be taking PrEP.
Met and Unmet Needs for Ancillary Services
Met need: Defined as an ancillary service (e.g., HIV case management service, dental care, mental health

service) received during the 12 months before the interview. Unmet need: Defined as an ancillary service that the participant reported as needed, but not received, during the 12 months before the interview.
Division of HIV/AIDS Prevention National Indicators
Measures in this section are used by CDC's Division of HIV/AIDS Prevention for national monitoring and evaluation purposes. Homelessness among persons receiving HIV care: Defined as living on the street, in a shelter, in a singleroomoccupancy hotel, or in a car at any time during the 12 months before the interview among person who received any outpatient HIV medical care in the 12 months before the interview. HIV stigma: Defined as the median score on a 10-item scale ranging from 0 (no stigma) to 100 (high stigma) that measures 4 dimensions of HIV stigma: personalized stigma, disclosure concerns, negative self-image, and perceived public attitudes about people with HIV [11]. High-risk sex: See "Sexual Behavior" section.
ETHICS STATEMENT
In accordance with guidelines for defining public health research [12], CDC determined MMP was pub-lic health surveillance used for disease control, pro-gram, or policy purposes. Local institutional review board approval was obtained at participating states and territories when required. Informed consent was obtained from all interviewed participants.
REFERENCES
1. Frankel MR, McNaghten A, Shapiro MF, et al. A probability sample for monitoring the HIV-infected population in care in the U.S. and in selected states. Open AIDS J 2012;6:6776. doi:10.2174/1874613601206010067.
2. The American Association for Public Opinion Research. Standard Definitions: Final dispositions of case codes and outcome rates for surveys. 9th ed. https://www.aapor.org/Standards-Ethics/StandardDefinitions-(1).aspx. Revised 2016. Accessed January 11, 2019.

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3. U.S. Department of Health and Human Services. 2015 Poverty guidelines. https://aspe.hhs.gov/2015-povertyguidelines. Published 2015. Accessed January 2, 2019.
4. U.S. Department of Health and Human Services. Computations for the 2016 poverty guidelines. https://aspe.hhs.gov/computations-2016-povertyguidelines. Published 2016. Accessed January 11, 2019.
5. CDC [Selik RM, Mokotoff ED, Branson B, Owen SM, Whitmore S, Hall HI]. Revised surveillance case definition for HIV infection--United States, 2014. MMWR 2014;63(RR-03):110. https://www.cdc.gov/mmwr/indrr_2014.html. Accessed January 11, 2019.
6. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. https://go.usa.gov/vdGA. Updated October 25, 2018. Accessed January 11, 2019.
7. Wilson IB, Lee Y, Michaud J, Fowler FJ Jr, Rogers WH. Validation of a new three-item self-report measure for medication adherence. AIDS Behav 2016;20(11):2700 2708.
8. Kroenke K, Strine TW, Spitzer RL, et al. The PHQ-8 as a measure of current depression in the general population. J Affect Disord 2009;114(13):163173. doi:10.1016/j.jad.2008.06.026.
9. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Associa-tion; 2000.
10. Spitzer RL, Kroenke K, Williams JB, Lwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166(10):10921097.
11. Wright K, Naar-King S, Lam P, Templin T, Frey M. Stigma scale revised: reliability and validity of a brief measure of stigma for HIV+ youth. J Adolesc Health 2007;40(1):9698. doi:10.1016/j.jadohealth.2006.08.001.
12. CDC. Distinguishing public health research and public health nonresearch. https://go.usa.gov/vdwz. Published July 2010. Accessed January 11, 2019.
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HIV/AIDS RESOURCES:

Georgia CAPUS Resource Hub https://www.gacapus.com/r/

Georgia Department of Public Health http://dph.georgia.gov/what-hiv-and-aids
Medical Monitoring Project https://www.cdc.gov/hiv/statistics/systems/mm p/index.html

Centers for Disease Control and Prevention http://www.cdc.gov/hiv/

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