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- Medical monitoring project surveillance summary, 2015-2018, revision : behavioral and clinical characteristics of persons receiving HIV care in Georgia
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- Georgia. Department of Public Health
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HIV infections--Treatment--Georgia--Periodicals
HIV infections--Treatment
HIV-positive persons--Care
Georgia
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Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
Behavioral and Clinical Characteristics of Persons with Diagnosed HIV Infection, Georgia Medical Monitoring Project, 2015-2018
HIV/AIDS Epidemiology Section Epidemiology Program Division of Health Protection Georgia Department of Public Health
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
Page 1
The Georgia Medical Monitoring Project Surveillance Summary, 2015-2018 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, 2015-2018 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 2015-2018, https://dph.georgia.gov/georgia-medical-monitoring-project-mmp, Published April 23, 2021, [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; Melissa Gousse, MPH; Timothy Lockhart, MPH, Shaunta Rutherford MPH, PhD; and Stephen Ray, MSPH.
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, 2018 Cycle (June 2018May 2019). HIV Surveillance Special Report 25. https://www.cdc.gov/hiv/library/reports/ hiv-surveillance.html. Published May 2020. Accessed 09/01/2020.
This report was prepared by the following staff of the Georgia Department of Public Health: Stephen Ray, MSPH; Pascale Wortley, MD, MPH; Cherie Drenzek, DVM, MS.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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Table of Contents
COMMENTARY ........................................................................................................................................................................ 5
HIGHLIGHTS OF ANALYSES .................................................................................................................................................. 5
TECHNICAL NOTES .................................................................................................................................................................. 9
REFERENCES .......................................................................................................................................................................... 10
TABLES................................................................................................................................................................................... 11
Table 1. Participants, by project area--Medical Monitoring Project, Georgia, 2015-2018 ......................................... 12
Table 2. Characteristics of participants and estimated percentages of persons living with diagnosed HIV infection by selected characteristics--Medical Monitoring Project, Georgia, 2015-2018............................................................... 13
Table 3. Stage of disease, CD4 counts, and viral suppression during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2018 ...................................................................................................................... 16
Table 4. Receipt and quality of, care--Medical Monitoring Project, Georgia, 2015-2018........................................... 17
Table 5. Sexually transmitted disease testing during the 12 months before the interview, by sexual activity-- Medical Monitoring Project, Georgia, 2015-2018 ........................................................................................................ 18
Table 6. Emergency department and hospital admission during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2018 ...................................................................................................................... 19
Table 7. Antiretroviral therapy (ART) use--Medical Monitoring Project, Georgia, 2015-2018 ................................... 20
Table 8. Antiretroviral therapy (ART) adherence among persons taking ART--Medical Monitoring Project, Georgia, 2015-2018 ..................................................................................................................................................................... 21
Table 9. Antiretroviral therapy (ART) prescription, ART dose adherence, durable viral suppression, and geometric mean CD4 count by subgroups--Medical Monitoring Project, Georgia, 2015-2018 ................................................... 23
Table 10. Depression and anxiety during the 2 weeks before the interview--Medical Monitoring Project, Georgia, 2015-2018 ..................................................................................................................................................................... 24
Table 11. Tobacco and electronic cigarette use--Medical Monitoring Project, Georgia, 2015-2018.......................... 25
Table 12. Alcohol use during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2018 ...................................................................................................................................................................................... 26
Table 13. Noninjection drug use during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2018 ..................................................................................................................................................................... 27
Table 14. Injection drug use during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2018 ..................................................................................................................................................................... 28
Table 15. Gynecological care and reproductive health among women--Medical Monitoring Project, Georgia, 20152018 .............................................................................................................................................................................. 29
Table 16. Sexual behavior during the 12 months before the interview among cisgender men and women--Medical Monitoring Project, Georgia, 2015-2018 ...................................................................................................................... 30
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, 2015-2018 ......................................................................................................................................... 31
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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Table 18. Met and unmet needs for ancillary services during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2018 ...................................................................................................................... 32 Table 19. Intimate partner violence and sexual violence--Medical Monitoring Project, Georgia, 2015-2018 ........... 34 Table 20. Prevention services received during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2018....................................................................................................................................................... 35 Table 21. National indicators: homelessness, HIV stigma, and high-risk sex--Medical Monitoring Project, Georgia, 2015-2018 ..................................................................................................................................................................... 36 Appendix: Methods and Definitions ..................................................................................................................................... 37 METHODS .......................................................................................................................................................................... 37 DEFINITIONS...................................................................................................................................................................... 39 HIV/AIDS RESOURCES: .......................................................................................................................................................... 44
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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COMMENTARY
At year-end 2018, an estimated 60,346 persons in Georgia were living with diagnosed HIV infection [1]. In 2018, the number of new HIV diagnoses in Georgia was 2,600 [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 2015-2018 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 20 project areas from 16 states and Puerto Rico which were funded to conduct data collection for MMP during the 2015-2018 cycles.
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, 2,000 persons considered to be residents of Georgia were sampled from NHSS for cycle years 20152018, and 758 participated (Table 1). Adjusted for eligibility, the response rates were 33% (2015), 43% (2016), 45% (2017), and 35.2% (2018).
Sociodemographic Characteristics
An estimated 75% of persons were male, 24% were female and about 1% were transgender (Table 2). Nearly half (44%) identified themselves as heterosexual or straight; 43% as lesbian or gay; 11% as bisexual; and 2% as another sexual orientation. An estimated 70% were black or African American, 20% were white, and 5% were Hispanic or Latino. Two-thirds (67%) were aged at least 40 years, and 54% 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 7%. About 13% of persons indicated that they moved in with other people due to financial issues and approximately 38% of peoples indicated moving one or
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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more times in the past 12 months. An estimated 98% had health insurance or coverage for antiretroviral therapy (ART) medications: 41% had coverage through the Ryan White HIV/AIDS Program, 30% had Medicaid, 40% had private health insurance, and 29% had Medicare. An estimated 38% had a disability, 45% were unemployed, and 36% had household incomes at or below the federal poverty threshold. An estimated 21% received Supplemental Security Income (SSI) and 26% received Social Security Disability Insurance (SSDI).
Clinical Characteristics
According to the CDC stage of disease classification for HIV infection [8], an estimated 54% of persons had ever had stage 3 (AIDS) disease (Table 3). An estimated 10% 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 581 cells/L, and the median geometric mean CD4 count was 563 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 61% had undetectable viral loads at all measurements during the past 12 months (sustained viral suppression).
Use of Health Care Services
Overall, 98% 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 60% were retained in care during the past 24 months. An estimated 83% 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, 37% had a prescription for PCP prophylaxis documented in the medical record.
Among sexually active persons, an estimated 50% were tested for gonorrhea, 49% for chlamydia, 66% for
syphilis, and 46% for all 3 sexually transmitted diseases (STDs) (Table 5).
An estimated 46% 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 92% of persons were currently taking ART based on self-report (Table 7). Among the estimated 2% of persons without a history of ART use, 79%* had never taken ART because a health care provider advised a delay in treatment. Among the estimated 8% of persons with a history of ART use who were not currently taking ART, 50%* were not taking ART due to money or insurance problems. (* indicating percentage should be interpreted with caution)
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 (42%) and a change in one's daily routine or being out of town (32%).
Clinical Characteristics by Subgroups
The estimated prevalence of ART prescription documented in a medical record was 84% among males and 82% among females (Table 9). An estimated 82% of blacks or African Americans were prescribed ART, compared with 75%* of Hispanics or Latinos and 86% of whites. The estimated prevalence of ART prescription was 75% among persons aged 18 to 29 years and 87% among those aged 50 years or older.
The estimated prevalence of sustained viral suppression was 61% among males and 58% among females. An estimated 57% of blacks or African Americans had sustained viral suppression, compared with 50%* of Hispanics or Latinos and 76% of whites. The estimated prevalence of sustained viral suppression was 40%
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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among persons aged 18 to 29 years and 70% 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 19%, including 9% with major depression (Table 10). Based on the total PHQ-8 symptom score (see the appendix), an estimated 16% 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 22%, including 8% with severe anxiety.
The estimated prevalence of current smoking was 34%: 28% of persons smoked daily, and 3% less than monthly (Table 11). The estimated prevalence of alcohol use was 66%: 6% of persons drank alcohol daily, 19% weekly, 11% monthly, and 28% less than monthly (Table 12). An estimated 15% 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, 6% used poppers (amyl nitrite), 5% used cocaine, 3% used methamphetamines, and 3% used prescription opioids. Almost all persons did not use injection drugs for nonmedical purposes (Table 14).
Gynecologic and Reproductive Health
Among females, 95% reported receiving a Papanicolaou (Pap) test in the past three years (Table 15). An estimated 26% of females reported being pregnant at least once since testing positive for HIV infection.
Sexual Behavior
An estimated 40% of men had receptive anal sex with men, 39% had insertive anal sex with men, and 21% had vaginal sex (Table 16). An estimated 30% of men did not have vaginal or anal sex. Among women, 57% had
vaginal sex, and 43% did not have vaginal or anal sex. Among men who had sex with men, an estimated 8% engaged in high-risk sex, compared with 9% of women who had sex with men (Table 17). In terms of prevention strategies among sexually active persons, an estimated 59% of men who had sex with men engaged in sex while sustainably virally suppressed, 71% had condom-protected sex, and 68% had sex with an HIVpositive partner. Among sexually active men who had sex only with women, 58% engaged in sex while sustainably virally suppressed, 74% had condomprotected sex, and 25% had sex with an HIV-positive partner. Among sexually active women who had sex with men, 54% engaged in sex while sustainably virally suppressed, 57% had condom-protected sex, and 32% had sex with an HIV-positive partner.
Met and Unmet Need for Ancillary Services
An estimated 51% of persons received dental care; 45% received HIV case management services; 41% 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 30% of persons had unmet needs for dental care; 16% for SNAP or WIC; 13% for shelter or housing services; 12% for meal or food services; 9% for mental health services; 10% for HIV case management services; 10% for transportation assistance; 8% for HIV peer group support; and 5% for patient navigation services.
Intimate Partner Violence and Sexual Violence
An estimated 25% of persons had ever been physically hurt by a romantic or sexual partner, including 4% who experienced this in the past 12 months (Table 19). An estimated 16% of persons had ever been threatened with harm or physically forced to have unwanted sex.
Prevention Activities
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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An estimated 55% of persons received counseling from a physician, nurse, or other health care worker about HIV and STD risk reduction; 30% 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 50% 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 37. An estimated 8% of persons engaged in high-risk sex.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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TECHNICAL NOTES
POPULATION OF INFERENCE
For the 2015, 2016, 2017, and 2018 Medical Monitoring Project (MMP) data collection cycles (data collected June 1, 2015-May 31, 2016; June 1, 2016May 31, 2017; June 1, 2017-May 31, 2018, June 1, 2018May 31, 2019 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 and 2018 cycle) or $75 (2016 and 2017 cycles) in cash or the equivalent for participation.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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REFERENCES
1. Georgia Department of Public Health, HIV/AIDS Epidemiology Section HIV Surveillance Summary, Georgia 2018, https://dph.georgia.gov/data-fact-sheetsummaries, Published February 2020, Accessed: 07/08/2020.
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.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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TABLES
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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Table 1. Participants, by project area--Medical Monitoring Project, Georgia, 2015-2018
Project area
No. Sampled No. Participating % participatinga
Georgia
2000
758
Note. Percentages might not sum to 100 because of rounding. a Not adjusted for eligibility.
37.9
% of total 4.7
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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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, 2015-2018
No.a
%b
95% CIc
Gender
Male
540
75.1
Female
205
23.6
Transgenderd
12
1.3
Sexual orientation
Lesbian or gay
297
43,1
Heterosexual or straight
357
44.1
Bisexual
75
10.8
Other sexual orientation
16
2.0
Race/ethnicity
American Indian/Alaska Native
-
-
Asian
-
-
Black/African American
554
70.3
Hispanic/Latinoe
35
4.9
Native Hawaiian/Other Pacific Islander
-
-
White
139
20.2
Multiple races
35
4.2
Age at time of interview (yr)
1824
20
2.8
2529
65
8.4
3034
74
10.2
3539
76
11.4
4044
77
10.2
4549
92
12.4
5054
141
17.5
5559
119
14.3
6064
48
6.9
65
46
5.8
Education
Less than high school
112
13.0
High school diploma or GED
187
24.8
More than high school
451
62.1
Country or territory of birth
United States or U.S. territory
719
95.9
Foreign born
30
4.1
Time since HIV diagnosis (yr)
<5
136
18.3
59
200
27.8
10
418
53.9
Homeless at any time, past 12 monthsf
Yes
60
7.3
No
690
92.7
Moved in with other people because of financial problems, past 12 monthsm
Yes
28
12.9
No
148
87.1
Number of times moved, past 12 monthsm
0
104
63.3
71.978.3 20.426.7
0.62.1
39.247.0 40.247.9
8.313.4 1.03.0
66.673.9 3.26.7 17.023.5 2.75.6
1.54.0 6.410.5 7.912.6 8.813.9 7.812.5 9.915.0 14.620.4 11.716.8
4.79.1 4.17.6
10.515.6 21.528.2 58.465.9
94.397.4 2.65.7
15.321.3 24.331.4 50.057.7
5.59.2 90.894.5
7.917.9 82.192.1
55.571.1
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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1
46
25.1
2 or more
26
11.6
Evicted from housing, past 12 monthsm
Yes
-
-
No
175
99.5
Incarcerated > 24 hours, past 12 months
Yes
43
5.0
No
707
95.0
Health insurance or coverage for antiretroviral medications, past 12 monthsg
Yes
737
97.9
No
11
-
Type of health insurance or coverage for antiretroviral medications, past 12 months
Ryan White
Yes
323
40.7
No
415
59.3
Medicaid
Yes
234
30.0
No
513
70.0
Private health insurance
Yes
280
39.1
No
459
60.9
Medicare
Yes
222
29.1
No
520
70.9
Other public insurance
Yes
25
3.2
No
712
96.8
Tricare/CHAMPUS or Veterans Administration
Yes
30
5.1
No
705
94.9
Insurance type unknownh
Yes
-
-
No
733
99.2
Any disabilityi
Yes
298
38.1
No
452
61.9
Received Supplemental Security Income (SSI), past 12 months
Yes
166
20.8
No
576
79.2
Received Social Security Disability Insurance (SSDI), past 12 months
Yes
191
25.5
No
550
74.5
Perception of general healthm
Poor
-
-
Fair
35
19.0
Good
77
45.7
Very good
32
19.0
Excellent
23
11.3
Went without food due to lack of money, past 12 months
Yes
141
19.2
No
609
80.8
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
18.032.1 7.116.1
98.5100.0
3.56.5 93.596.5
96.699.2 -
36.944.5 55.563.1
26.433.6 66.473.6
35.242.9 57.164.8
25.632.7 67.374.4
1.94.5 95.598.1
3.17.1 92.996.9
98.599.9
34.341.8 58.265.7
17.623.9 76.182.4
22.128.9 71.177.9
12.625.4 37.354.0 12.425.6
6.616.0
16.122.3 77.783.9
Page 14
Employment statusj
Employed
317
43.9
40.147.8
Unemployed
345
44.6
40.848.5
Student
19
2.5
1.33.6
Retired
69
9.0
6.711.2
Combined yearly household income (US$)k
019,999
334
45.8
41.849.7
20,00039,999
180
25.3
21.928.8
40,00074,999
113
16.9
13.820.0
75,000
77
12.0
9.314.6
Poverty guidelinesl
Above poverty threshold
437
64.1
60.367.9
At or below poverty threshold
267
35.9
32.139.7
Total
758
100
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 a
denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a
relative CI 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 person 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 medications (including antiretroviral medications). h Unknown insurance type means that the person had health insurance or coverage for medications (including 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 2017 guidelines were used for persons interviewed in 2018 and the 2018 guidelines were used for
persons interviewed in 2019. More information regarding HHS poverty guidelines can be found at https://aspe.hhs.gov/frequently-asked-
questions-related-poverty-guidelines-and-poverty.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
Page 15
Table 3. Stage of disease, CD4 counts, and viral suppression during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2018
No.a
%b
95% CIc
HIV infection stage 3 (AIDS)d
Yes
434
53.7
49.857.6
No
320
46.3
42.450.2
Geometric mean CD4 count (cells/L)
0199
68
10.1
7.612.5
200349
93
14.7
11.817.6
350499
106
16.8
13.620.0
500
357
58.4
54.362.6
Lowest CD4 count (cells/L), past 12 months
049
30
4.7
2.96.4
50199
60
8.8
6.611.1
200349
111
17.3
14.220.4
350499
123
18.9
15.622.2
500
307
50.3
46.154.5
Viral suppression
Most recent viral load documented undetectable or <200 copies/mL
533
69.2
65.672.9
Most recent viral load documented detectable, 200 copies/mL, or missing/unknown
225
30.8
27.134.4
Durable viral suppression
All viral load measurements documented undetectable or <200 copies/mL
470
61.2
57.465.0
Any viral load 200 copies/mL or missing/unknown
288
38.8
35.042.6
Total
758
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 definition for HIV infectionUnited States, 2014. MMWR 2014;63(RR03):110. https://www.cdc.gov/mmwr/indrr-2014.html. Accessed July 2, 2019. 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. Values with a denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a relative CI 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 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.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
Page 16
Table 4. Receipt and quality of, care--Medical Monitoring Project, Georgia, 2015-2018
No.a
%b
95% CIc
Ever received outpatient HIV cared
Yes
754
99.4
98.9100.0
No
-
-
-
Received outpatient HIV care, past 12 monthsd
Yes
742
97.5
96.099.0
No
13
2.5
1.04.0
Received outpatient HIV care, past 24 monthsd
Yes
749
99.2
98.499.9
No
-
-
-
Retained in care, past 12 monthse
Yes
597
79.8
76.483.1
No
134
20.2
16.923.6
Retained in care, past 24 monthse
Yes
437
59.9
56.163.8
No
292
40.1
36.243.9
Prescribed ART, past 12 monthsf
Yes
643
83.3
80.386.4
No
115
16.7
13.619.7
Prescribed PCP prophylaxis, past 12 monthsg
Yes
33
37.4
26.848.1
No
54
62.6
51.973.2
Prescribed MAC prophylaxis, past 12 monthsh
Yes
-
-
-
No
23
80.5
65.995.2
Received influenza vaccination, past 12 months
Yes
588
77.9
74.681.2
No
159
22.1
18.825.4
Total
758
100
Abbreviations: 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. Values with a
denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30
and a relative CI 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 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, 2015-2018
Page 17
Table 5. Sexually transmitted disease testing during the 12 months before the interview, by sexual activity-- Medical Monitoring Project, Georgia, 2015-2018
Total population
Sexually activea persons only
No.b
%c
95% CId
No.b
%c
95% CId
Gonorrheae
Yes, received test
319
45.1
41.149.1
225
49.6
44.654.6
No test documented Chlamydiaf
388
54.9
50.958.9
224
50.4
45.455.4
Yes, received test
318
45.0
41.048.9
224
49.4
44.454.4
No test documented Syphilisg
389
55.0
51.159.0
225
50.6
45.655.6
Yes, received test
451
63.8
60.067.7
301
66.1
61.270.9
No test documented
256
36.2
32.340.0
148
33.9
29.138.8
Gonorrhea, chlamydia, and syphilis
Yes, received all 3 tests
283
40.6
36.644.5
206
45.7
40.750.7
All 3 tests not documented
424
59.4
55.563.4
243
54.3
49.359.3
Total
758
100
486
100
Abbreviations: CI, confidence interval; DFA, direct fluorescent antibody [footnotes only]; EIA, enzyme immunoassay [footnotes only]; ELISA, enzyme-linked immunoassay [footnotes only]; FTA-ABS, fluorescent treponemal antibody absorbed [footnotes only]; MHA-TP, microhemagglutination assay for antibody to Treponema pallidum [footnotes only]; NAAT, nucleic acid amplification test [footnotes only]; RPR, rapid plasma reagin [footnotes only]; TP-PA, T. pallidum particle agglutination [footnotes only]; TPHA, T. pallidum hemagglutination assay [footnotes only]; VDRL, Venereal Disease Research Laboratory [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. Values with a denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a relative CI width >130% are marked with an asterisk and should be interpreted with caution. 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, 2015-2018
Page 18
Table 6. Emergency department and hospital admission during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2018
No.a
%b
95% CIc
Number of visits to emergency department
0
411
54.5
50.658.3
1
161
22.0
18.725.2
24
145
19.9
16.723.2
5
28
3.6
2.25.0
Number of hospital admissions
0
585
78.3
75.181.6
1
109
15.0
12.217.9
24
42
5.7
3.87.5
5
-
-
-
Total
758
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. Values with a denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a relative CI 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.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
Page 19
Table 7. Antiretroviral therapy (ART) use--Medical Monitoring Project, Georgia, 2015-2018
No.a
%b
95% CIc
Ever taken ART
Yes
734
97.6
96.398.9
No
14
2.4
1.13.7
Currently taking ART
Yes
696
92.3
90.194.5
No
52
7.7
5.59.9
Reasons for never taking ARTd
Health care provider never discussed taking ART with person
Yes
-
-
-
No
8
78.8*
52.5100.0
Health care provider said person should not start taking ART
Yes
6
62.5*
30.694.3
No
-
-
-
Money or insurance problems
Yes
-
-
-
No
7
62.2*
29.395.2
Person doesn't believe he/she needs ART
Yes
-
-
-
No
7
72.7*
44.8100.0
Person thinks ART would make him/her feel sick or harm him/her
Yes
-
-
-
No
7
68.0*
37.698.3
Person decided not to take ART for some other reason
Yes
-
-
-
No
6
65.9*
35.895.9
Reasons for not currently taking ART, among those persons with a history of ART used
Health care provider never discussed restarting ART with person
Yes
-
-
-
No
33
82.1*
66.697.6
Health care provider said person should not take ART
No
38
100.0
Money or insurance problems
Yes
16
49.8*
32.367.3
No
22
50.2*
32.767.7
Person doesn't believe he/she needs ART
Yes
-
-
-
No
30
74.8*
58.491.1
Person thinks ART would make him/her feel sick or harm him/ her
Yes
-
-
-
No
29
76.4
62.190.7
Person decided not to take ART for some other reason
Yes
15
34.9*
18.851.0
No
23
65.1*
49.081.2
Total
758
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. Values with a denominator sample size <30,
values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a relative CI width >130% are marked with an asterisk
and should be interpreted with caution. a,b,c Numbers are unweighted. Percentages are weighed percentages. Cis incorporate weighed percentages. d Persons could select more than 1 response for reasons not taking ART.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
Page 20
Table 8. Antiretroviral therapy (ART) adherence among persons taking ART--Medical Monitoring Project, Georgia,
2015-2018
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
409
58.6
54.662.6
12
179
26.0
22.429.6
35
75
11.0
8.513.6
610
15
1.9
0.92.8
11+
17
2.5
1.33.8
How well did you do at taking your HIV medicines in the way you were supposed to?
Very poor
-
-
-
Poor
-
-
-
Fair
32
4.6
2.86.3
Good
95
13.7
10.916.6
Very good
199
28.1
24.531.7
Excellent
349
50.7
46.754.8
How often did you take your HIV medicines in the way you were supposed to?
Never
-
-
-
Rarely
-
-
-
Sometimes
14
1.7
0.7-2.6
Usually
33
4.8
3.06.6
Almost always
184
27.0
23.430.6
Always
452
64.6
60.768.5
How often were you troubled by ART side effects?
Never
464
65.6
61.769.5
Rarely
115
17.5
14.320.6
About half the time
53
8.4
6.010.8
Most of the time
31
4.1
2.65.6
Always Reasons for last missed ART dosed
Had a problem paying for HIV medicinese
28
4.4
2.76.1
Yes
16
10.0
4.915.0
No
119
90.0
Had a problem getting a prescription or a refill for HIV medicinese
85.095.1
Yes
25
17.1
10.423.9
No
110
82.9
76.189.6
In the hospital or too sick to take HIV medicines
Yes
43
6.0
4.17.8
No
612
94.0
92.295.9
Fell asleep early or overslept
Yes
188
29.0
25.332.8
No
466
71.0
67.274.7
Change in your daily routine or were out of town
Yes
199
31.7
27.835.6
No
456
68.3
64.472.2
Had side effects from your HIV medicines
Yes
60
9.5
7.112.0
No
594
90.5
88.092.9
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
Page 21
Felt depressed or overwhelmed
Yes
78
12.4
9.615.1
No
577
87.6
84.990.4
Was drinking or using drugs
Yes
39
6.1
4.18.1
No
616
93.9
91.995.9
Forgot to take HIV medicines
Yes
262
41.6
37.645.7
No
393
58.4
54.362.4
Did not feel like taking HIV medicines
Yes
52
7.5
5.39.6
No
604
92.5
90.494.7
Total
696
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. Values with a denominator
sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a relative CI 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 report more than 1 reason for missed last dose.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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, 2015-2018
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
460 83.7 80.187.2 283
57.0 52.361.7 337 61.8 57.466.3 395 91.3 88.893.9
Female
171 81.5 75.387.7 121
64.9 57.372.6 124 58.4 50.965.9 151 86.1 80.292.1
Transgenderf
11 95.8 87.6100.0
-
-
- 9 79.2* 56.9100.0
9 81.9* 59.2100.0
Sexual orientation
Lesbian or gay
250 82.7 77.887.5 153
57.3 51.063.7 179 60.8 54.866.8 210 92.0 88.895.3
Heterosexual or straight
301 82.7 78.287.2 207
61.2 55.567.0 227 61.8 56.367.3 267 88.2 84.392.1
Bisexual
64 83.8 73.993.7
40
55.6 42.968.2 48 60.8 48.473.3
54 90.1 82.497.7
Other sexual orientation
16 100.0
-
-
-
- 10 64.3* 40.887.9
13 80.4* 60.4100.0
Race/ethnicity
American Indian/Alaska Native
-
-
-
-
-
-
-
-
-
-
-
-
Asian
-
-
-
-
-
-
-
-
-
-
-
-
Black/African American
467 82.1 78.485.8 280
55.3 50.660.0 329 57.2 52.761.7 402 88.6 85.591.6
Hispanic/Latinog
27 74.7* 57.691.8
20 50.4* 31.869.1 19 50.1* 31.868.4
25 95.6 87.1100.0
Native Hawaiian/Other Pacific
-
-
-
-
-
-
-
-
-
-
-
-
Islander
White
111 86.4 80.192.7
83
69.5 60.978.1 96 76.3 68.783.9
96 93.5 89.198.0
Multiple races
35 100.0
-
23 67.2* 49.784.7 23 66.0* 48.683.3
30 90.6 81.499.7
Age at time of interview (yr)
1829
66 75.1 64.885.4
33
45.3 33.357.3 36 40.1 29.350.9
59 90.2 83.297.2
3039
126 82.1 75.089.3
66
46.2 37.355.2 83 53.6 45.062.2 106 87.3 81.193.4
4049
142 82.1 75.588.7
87
59.1 50.567.8 105 60.7 52.568.9 117 87.8 82.093.6
50
309 86.7 82.790.7 223
66.9 61.572.4 246 70.4 65.375.5 274 92.1 89.195.1
Total
643 83.3 80.386.4 409
58.6 54.662.6 470 61.2 57.465.0 556 89.9 87.592.4
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. g Hispanics or Latinos might be of any race. Persons are classified in only 1 race/ethnicity category.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
Page 23
Table 10. Depression and anxiety during the 2 weeks before the interview--Medical Monitoring Project, Georgia, 20152018
No.a
%b
95% CIc
Depression based on DSM-IV criteriad
No depression
603
81.4
78.484.3
Other depression
74
9.4
7.211.6
Major depression
68
9.2
7.011.5
Moderate or severe depression (PHQ-8 score 10)
Yes
116
15.6
12.818.4
No
629
84.4
81.687.2
Anxietye
No anxiety
580
78.3
75.181.4
Mild anxiety
42
5.7
3.97.5
Moderate anxiety
64
8.1
6.110.1
Severe anxiety
60
7.9
5.810.0
Total
758
100
Abbreviations: CI, confidence interval; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th edition; GAD-7, Generalized Anxiety Disorder 7-item Scale [footnotes only]; 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. Values with a denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a relative CI 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 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 GAD7 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 1014; and "mild anxiety" was defined as having a score of 59.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
Page 24
Table 11. Tobacco and electronic cigarette use--Medical Monitoring Project, Georgia, 2015-2018
No.a
%b
95% CIc
Smoked 100 cigarettes (lifetime)
Yes
362
49.6
45.753.5
No
383
50.4
46.554.3
Cigarette smoking status
Never smoked
383
50.4
46.554.3
Former smoker
113
15.4
12.518.2
Current smoker
249
34.2
30.537.9
Frequency of current cigarette smoking
Never
496
65.8
62.169.5
Daily
203
27.7
24.231.2
Weekly
15
2.4
1.03.8
Monthly
-
-
-
Less than monthly
23
3.1
1.84.4
Smoked 50 cigars, cigarillos, or little filtered cigars (lifetime)
Yes
132
18.1
15.121.2
No
614
81.9
78.884.9
Cigars, cigarillos, or little filtered cigars smoking status
Never smoked
614
81.9
78.884.9
Former smoker
61
8.4
6.110.6
Current smoker
71
9.8
7.412.1
Frequency of current cigars, cigarillos, or little filtered cigars smoking
Never
675
90.2
87.992.6
Daily
17
2.3
1.23.5
Some days
25
3.6
2.15.2
Rarely
29
3.8
2.45.2
Electronic cigarette smoking status
Never used electronic cigarettes
530
70.6
67.074.2
Used electronic cigarettes, but not in the past 30 days
164
22.5
19.225.8
Used electronic cigarettes in the past 30 days
51
6.9
4.98.9
Total
758
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. Values with a denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a relative CI 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.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
Page 25
Table 12. Alcohol use during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2018
No.a
%b
95% CIc
Any alcohol used
Yes
477
65.5
61.769.2
No
268
34.5
30.838.3
Frequency of alcohol use
Daily
45
6.3
4.48.2
Weekly
144
19.4
16.322.4
Monthly
86
11.4
9.013.9
Less than monthly
202
28.3
24.831.9
Never Binge drinking past 30 dayse
268
34.5
30.838.3
Yes
106
14.5
11.717.3
No
636
85.5
82.788.3
Total
758
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. Values with a denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a relative CI 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 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, 2015-2018
Page 26
Table 13. Noninjection drug use during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2018
No.a
%b
95% CIc
Use of any noninjection drugsd
Yes
221
30.3
26.733.9
No
524
69.7
66.173.3
Noninjection drugsd used
Marijuana
Yes
199
27.3
23.830.7
No
546
72.7
69.376.2
Crack
Yes
17
1.9
1.02.8
No
728
98.1
97.299.0
Cocaine that is smoked or snorted
Yes
39
5.4
3.67.2
No
706
94.6
92.896.4
Methamphetamine (e.g., crystal meth, tina, crank, ice)
Yes
17
2.5
1.33.6
No
728
97.5
96.498.7
Amphetamine (e.g., speed, bennies, uppers)
Yes
-
-
-
No
738
98.9
98.199.7
Club drugs (e.g., Ecstasy or X, ketamine or Special K, GHB or Liquid Ecstasy)
Yes
15
2.2
1.03.3
No
730
97.8
96.799.0
Amyl nitrite (poppers)
Yes
38
6.1
4.18.1
No
707
93.9
91.995.9
Prescription opioids (e.g., oxycodone, hydrocodone, Vicodin, Percocet)e
Yes
21
3.0
1.74.4
No
724
97.0
95.698.3
Prescription tranquilizers (e.g., Valium, Ativan, Xanax, downers, nerve pills)e
Yes
16
2.1
1.13.2
No
729
97.9
96.898.9
Total
758
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. Values with a
denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a
relative CI width >130% are marked with an asterisk and should be interpreted with caution.
Persons could report taking more than 1 noninjection drug.
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 Not prescribed, or prescribed but taken more than directed.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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Table 14. Injection drug use during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2018
No.a
%b
95% CIc
Use of any injection drugs
Yes
-
-
-
No
734
98.4
97.499.4
Injection drugs used
Cocaine
Yes
-
-
-
No
742
99.6
99.2100.0
Heroin
Yes
-
-
-
No
743
99.7
99.3100.0
Heroin and cocaine (speedball)
No
745
100.0
-
Methamphetamine (e.g., crystal meth, tina, crank, ice)
Yes
-
-
-
No
736
98.7
97.899.6
Amphetamine (e.g., speed, bennies, uppers)
Yes
-
-
-
No
742
99.6
99.1100.0
Prescription opioids (e.g., oxycontin, oxycodone, hydrocodone)
No
745
100.0
-
Total
758
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. Values with a denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a relative CI width >130% are marked with an asterisk and should be interpreted with caution. Persons could report taking more than 1 injection drug. a Numbers are unweighted. b Percentages are weighted percentages. c CIs incorporate weighted percentages.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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Table 15. Gynecological care and reproductive health among women--Medical Monitoring Project, Georgia, 20152018
No.a
%b
95% CIc
Papanicolaou (Pap) test, past 3 yearsd
Yes
45
95.3
89.9100.0
No
-
-
-
Pregnant since HIV diagnosis
Yes
46
26.1
19.133.2
No
152
73.9
66.880.9
Total
205
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. Values with a denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a relative CI 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 Or since HIV diagnosis for women with a diagnosis within the past 3 years. This variable is new for the 2018 cycle. The results shown do not include data from 2015-2017.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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Table 16. Sexual behavior during the 12 months before the interview among cisgender men and women--Medical Monitoring Project, Georgia, 2015-2018
Men
Women
Behavior
No.a
%b
95% CIc No.a %b
95% CIc
Engaged in anal sex with men
Receptive
Yes
209
40.3 35.844.9
-
-
-
No
318
59.7 55.164.2 194 96.8 93.999.7
Insertive
Yes
201
38.5 34.043.0
-
-
-
No
324
61.5 57.066.0
-
-
-
Engaged in anal sex with women
Yes
-
-
-
-
-
-
No
530
98.3 97.099.6
-
-
-
Engaged in vaginal sex
Yes
114
21.4 17.625.1 110 57.1 49.764.6
No
415
78.6 74.982.4 90 42.9 35.450.3
Engaged in vaginal or anal sex
Yes
368
70.5 66.474.7 110 57.1 49.764.6
No
160
29.5 25.333.6 90 42.9 35.450.3
Number of vaginal or anal sex partners among
MSMd
Mean
4
-
Median
2
-
Range
170
-
MSWe
Mean
2
-
Median
1
-
Range
125
-
WSMf
Mean
-
1
Median
-
1
Range
-
16
Total
540
100
205 100
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. Values with a
denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a
relative CI 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 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.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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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, 2015-2018
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
32 7.9 5.210.7
-
-
- 14 8.5 3.813.3
No
332 92.1 89.394.8 152 93.3 88.498.2 181 91.5 86.796.2
Engaged in any high-risk sex among sexually active personsd
Yes
32 10.7 7.014.4
-
-
- 14 14.7 6.922.6
No
239 89.3 85.693.0 85 89.0 81.296.9 96 85.3 77.493.1
Percentages of sexually-active persons who used a prevention strategy with at least 1 partner Sex while sustainably virally suppressede
Yes
160 58.5 52.264.9 56 57.5 46.668.3 65 54.4 44.064.9
No
113 41.5 35.147.8 38 42.5 31.753.4 45 45.6 35.156.0
Condom-protected sexf
Yes
191 70.8 65.076.7 68 73.8 64.583.2 67 57.2 46.667.8
No
81 29.2 23.335.0 25 26.2 16.835.5 42 42.8 32.253.4
Condomless sex with a partner on PrEPg
Yes
21 7.0 4.010.1
-
-
- -
-
-
No Sex with an HIV positive partnerh
250 93.0 89.996.0
93 99.3 97.8100.0 108 98.0 95.2100.0
Yes
185 67.9 61.973.9 26 25.4 16.434.4 35 32.0 22.141.9
No
88 32.1 26.138.1 68 74.6 65.683.6 75 68.0 58.177.9
Total
368 100
161 100
197 100
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. Values with a denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a relative CI 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 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 HIVpositive 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, 2015-2018
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
379 51.0 47.154.9
226 29.6 26.033.1
No
367 49.0 45.152.9
520 70.4 66.974.0
HIV case management services
Yes
346 45.2 41.349.0
76 10.3
7.812.7
No
398 54.8 51.058.7
668 89.7 87.392.2
Medicine through ADAP
Yes
323 40.7 36.944.5
25 3.7
2.15.3
No
415 59.3 55.563.1
713 96.3 94.797.9
Supplemental Nutrition Assistance Program (SNAP) or Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC)
Yes
299 39.2 35.543.0
119 15.5 12.818.3
No
447 60.8 57.064.5
627 84.5 81.787.2
Professional help remembering to take HIV medicines on time or correctly (adherence support services)
Yes
265 33.9 30.237.5
-
-
-
No
476 66.1 62.569.8
738 99.7 99.3100.0
Mental health services
Yes
191 25.6 22.229.0
71 9.3
7.111.6
No Meal or food servicesd
554 74.4 71.077.8
674 90.7 88.492.9
Yes
125 15.6 12.918.2
87 11.8
9.314.3
No
621 84.4 81.887.1
659 88.2 85.790.7
Transportation assistance
Yes
131 16.7 13.819.6
79 9.9
7.712.2
No HIV peer group support
614 83.3 80.486.2
666 90.1 87.892.3
Yes
81
9.7 7.511.8
60 7.6
5.59.6
No
661 90.3 88.292.5
682 92.4 90.494.5
Patient navigation services Yes
73
8.8 6.710.8
35 4.5
2.96.2
No
669 91.2 89.293.3
707 95.5 93.897.1
Shelter or housing services
Yes
59
7.5
5.59.4
109 13.3 10.915.8
No
686 92.5 90.694.5
636 86.7 84.289.1
Drug or alcohol counseling or treatment
Yes
33
4.1
2.65.5
18 2.4
1.33.5
No Domestic violence services
712 95.9 94.597.4
727 97.6 96.598.7
Yes
-
-
-
-
-
-
No
742 99.0 97.9100.0
742 99.6 99.2100.0
Total
758
100
758 100
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.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
Page 32
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, 2015-2018
No.a
%b
95% CIc
Was ever slapped, punched, shoved, kicked, choked or otherwise physically hurt by a romantic or sexual partner
Yes
188
25.4
21.928.8
No
552
74.6
71.278.1
Was slapped, punched, shoved, kicked, choked or otherwise physically hurt by a romantic or sexual partner, past 12 months
Yes
28
3.8
2.35.2
No
712
96.2
94.897.7
Was ever threatened with harm or physically forced to have unwanted vaginal, anal, or oral sex
Yes
111
15.7
12.818.7
No
631
84.3
81.387.2
Was threatened with harm or physically forced to have unwanted vaginal, anal, or oral sex, past 12 months
Yes
-
-
-
No
737
99.3
98.799.9
Total
758
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. Values with a denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a relative CI 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.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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Table 20. Prevention services received during the 12 months before the interview--Medical Monitoring Project, Georgia, 2015-2018
No.a
%b
95% CIc
One-on-one HIV/STD risk-reduction conversation with physician, nurse, or other health care worker
Yes
409
54.8 50.958.7
No
337
45.2 41.349.1
One-on-one HIV/STD risk-reduction conversation with outreach worker, counselor, or prevention program worker
Yes
226
29.6 26.133.1
No
519
70.4 66.973.9
Attended an organized HIV/STD risk-reduction session involving a small group of people
Yes
94
12.1
9.614.6
No
652
87.9 85.490.4
Received free condoms
Yes
376
50.0 46.153.9
No
371
50.0 46.153.9
Total
758
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. Values with a denominator sample size <30, values with an absolute CI width 0.30, and values with an absolute CI width between 0.05 and 0.30 and a relative CI 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.
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Table 21. National indicators: homelessness, HIV stigma, and high-risk sex--Medical Monitoring Project, Georgia, 2015-2018
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 45 7.7
95% CIf 5.510.0
No.d 522
Row Interquartile median range score
33.4 20.350.8
No.d 40
Row %e
7.5
95% CIf 5.19.8
Female
12 6.3 2.610.0 194 44.5 31.159.6 14 8.3 3.712.9
Transgenderg
-
-
- 12 51.1 43.363.4
- -
-
Sexual orientation Lesbian or gay
20 6.0 3.38.6 291 32.5 20.548.1 27 8.5 5.311.7
Heterosexual or straight
24 7.2 4.310.1 344 39.8 25.456.3 21 7.4 4.010.7
Bisexual
11 12.1 5.119.2 74 32.0 19.056.4
-
-
-
Other sexual orientation
-
-
- 16 51.5 32.166.8
- -
-
Race/ethnicity
American Indian/Alaska Native
-
-
-
2 62.5 62.565.9
- -
-
Asian
-
-
-
1 55.0 55.055.0
- -
-
Black/African American
49 9.1 6.611.6 531 36.9 22.654.3 34 6.8 4.49.2
Hispanic/Latinoh
-
-
- 34 31.8 13.052.6
- -
-
Native Hawaiian/Other Pacific
-
-
-
1 37.5 37.537.5
- -
-
Islander
White
-
-
- 125 37.6 24.652.0
- -
-
Multiple races
-
-
- 35 37.7 17.459.7
- -
-
Age at time of interview (yr) 1829
11 14.1 6.222.1 82 36.7 24.450.9 16 19.2 10.428.0
3039
19 11.2 6.316.2 143 38.9 28.456.9 17 10.7 5.715.8
4049
-
-
- 163 35.9 21.253.8
- -
-
50
21 6.1 3.58.7 341 35.4 19.952.9
-
-
-
Total
59 7.5 5.69.5 729 36.9 22.653.8 55 7.7 5.69.8
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.
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
Page 36
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 laboratory 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
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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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 2015-2018 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 2017 cycle, December 31, 2016),
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 84 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. 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
Georgia Medical Monitoring Project Surveillance Summary, 2015-2018
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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. 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
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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 2017 guidelines [4] were used for persons interviewed in 2018. 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. 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
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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 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
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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 public 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.
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 2018 Annual Update of the HHS Poverty Guidelines for the 48 Contiguous States and the District of Columbia. https://aspe.hhs.gov/computations-2017-annualupdate-hhs-poverty-guidelines-48-contiguous-states-
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and-district-columbia. Published 2017. Accessed November 11, 2020.
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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