Examination of Incidence of Sexually Transmitted Infections in the Ending the HIV Epidemic Priority Counties of the U.S., 2005-2019

Abstract

Abstract Background The incidence of sexually transmitted infections (STIs) has been increasing in the U.S. and this trend has continued alongside expanding/changing HIV-prevention strategies, moving from reliance solely on behavioral interventions like condoms to biomedical methods like oral and injectable antiretroviral pre-exposure prophylaxis (PrEP). In 2019, the Ending the HIV Epidemic (EHE) initiative was released to prioritize resource allocation to the 50 jurisdictions in the U.S. with the highest HIV incidence, providing an opportunity to monitor STI incidence in a national group of discrete, geographic units and identify trends and differences across jurisdictions. Objectives & Design Using existing data from the U.S. CDC and Census Bureau, a retrospective analysis was conducted to examine the incidence of STIs in 49 of the 50 EHE priority counties between 2005-2019. This timeframe was divided into two time periods representing a before and after entry into the biomedical era of HIV-prevention: P1 (2005-2011) and P2 (2012-2019). Key Results A total of 49 EHE counties were included in this analysis, representing 27.4% of the total U.S. population. Entry into the biomedical HIV-prevention era was associated with an increase in STI incidence in 28 EHE counties and a decrease in 14 EHE counties. The greatest percent increase in total STI incidence was in the District of Columbia (+12.1%; IRR = 1.121, [1.115, 1.127], p < .001) and the greatest percent decrease was identified in Orleans Parish, LA (-8.7%; IRR = 0.913, [0.908, 0.919], p < .001). Conclusions Rising STI rates in the biomedical era of HIV-prevention represent missed opportunities for comprehensive sexual and preventive healthcare. County-level data provide actionable insight for reducing STI incidence. The EHE counties that have experienced decreases in STI incidence while being in the biomedical era may provide models of best practice which may be scaled in other jurisdictions.