INTRODUCTION:The Ending the HIV Epidemic (EHE) in the US initiative was launched by the US Department of Health and Human Services in 2019 with the goal of decreasing new HIV infections 90% by 2030. Increasing the use of HIV preexposure prophylaxis (PrEP) is one of the EHE strategies. We assessed the impact of EHE activities on PrEP use. METHODS:Using IQVIA real-world longitudinal prescription data and the National HIV Surveillance System data, we calculated jurisdiction-level PrEP to diagnosis ratios (PDRs) in the United States from 2016 to 2023. We assessed impact of EHE with a difference-in-difference analysis. RESULTS:The PDR increased from 3.0 to 14.7 in EHE jurisdictions, from 1.2 to 7.2 in EHE states, and from 2.5 to 13.4 in non-EHE jurisdictions. On average, no additional increase in the PDR was found for EHE counties compared with matched non-EHE counties, (adjusted difference-in-difference: 0.2, 95% confidence interval: -1.0 to 1.3), or for EHE states (adjusted difference-in-difference: 0.4, 95% CI: -1.6 to 2.4). CONCLUSIONS:Overall PrEP use increased markedly, with some EHE jurisdictions achieving greater increases than non-EHE jurisdictions with similar PDRs in 2019. The uneven increase in PrEP use in EHE jurisdictions underscores the need for jurisdiction-specific PrEP implementation strategies designed for the needs of each community. It also underscores the need for sufficient funding to accomplish EHE goals.

In 2014, the Centers for Disease Control and Prevention (CDC) expanded capacity to conduct infectious disease and economic modeling through the National Center for HIV, Viral Hepatitis, STD, and TB Prevention Epidemiologic and Economic Modeling Agreement (NEEMA). NEEMA brought together CDC scientists, academic partners, and public health practitioners at state and local levels to use epidemiologic and economic modeling to support the understanding of the efficiency, outcomes, cost-effectiveness, return on investment, and impact of programs and policies related to the center's disease foci, priority populations, and settings. In collaboration with state and local health departments, NEEMA activities included the development of tools to aid forecasting and decision-making. This article summarizes the scientific contributions and lessons learned from the NEEMA collaboration. During 2014-2024, NEEMA produced 136 peer-reviewed studies and 8 decision support tools. These studies have been cited 2697 times in peer-reviewed literature and referenced more than 70 times in policy documents. NEEMA has expanded the knowledge base on effective and cost-effective high-impact interventions for HIV, viral hepatitis, STD, and tuberculosis programs and continues to be responsive to changing needs for evidence to inform decision-making and policy.

It is estimated that over 111,000 people in the U.S. died from a drug overdose in the twelve-month period ending in July 2023. More than three-quarters of those deaths were attributed to opioids. Naloxone has long been available in healthcare facilities to reverse opioid overdose rapidly and safely but is not universally accessible for use in community settings where overdoses occur. We conducted a systematic literature review and meta-analysis to assess the effectiveness of overdose education and naloxone distribution (OEND) programs in three types of community settings to reduce overdose deaths among people who use opioids nonmedically. We systematically searched electronic databases, including Medline (OVID), Embase (OVID), Psycinfo (OVID), and Global Health (OVID), for peer-reviewed studies of OEND programs published during 2003–2018 (Group 1) that reported overdose outcomes individual level survivals or deaths immediately following naloxone administration. The PRISMA checklist guided screening, quality assessment, and data abstraction. We later identified studies published during 2018–2022 (Group 2), when drug usage and fentanyl-related overdose deaths notably increased, differed from earlier ones. We conducted meta-analyses on both Groups using random effects models to estimate summary survival proportions. Among the 44 Group 1 studies published during 2003–2018, survival did not differ by time (year), location, naloxone dose, or route of administration, but studies of OEND programs serving people who use drugs reported 98.3

Preexposure prophylaxis (PrEP) is highly effective in preventing HIV infections and is recommended for people without HIV who are at ongoing risk of HIV acquisition. In 2019, the U.S. launched the “Ending the HIV Epidemic in the U.S.” initiative, which aims to reduce by 90 % the number of annual new HIV infections. To monitor progress towards this goal, several national indicators have been established, one of which is PrEP coverage. Several ways to monitor PrEP use have been developed, each with its own advantages and disadvantages. We developed a method to estimate PrEP “need” in the U.S. that could be used as a denominator to estimate PrEP coverage. The “population need for PrEP” (PPN) is estimated based on the number of people needed to treat (NNT) with PrEP to prevent an additional HIV infection in subpopulations whose annual HIV incidence is ≥ 1 %. This is done in three steps: 1) calculating NNT for each transmission group using 1 % incidence threshold and clinical trial-and cohort-generated evidence of the degree of PrEP effectiveness in each transmission group, 2) estimating the proportion of new HIV infections in subpopulations with incidence at least 1 % from epidemiologic data, 3) multiplying estimates from steps 1 and 2 with the number of new HIV infections for each transmission group from Surveillance. The estimates for each transmission group are then added together, and the number of current PrEP users is finally added to this estimate to produce PPN. This method is relatively easy to calculate and can provide public health authorities at the national, state, or local level with pragmatic estimates of PrEP “need” among different demographic or transmission groups, which can help with planning, resource allocation, and monitoring progress.

No vaccines and few chemoprophylaxis options exist for the prevention of bacterial sexually transmitted infections (STIs) (specifically syphilis, chlamydia, and gonorrhea). These infections have increased in the United States and disproportionately affect gay, bisexual, and other men who have sex with men (MSM) and transgender women (TGW). In three large randomized controlled trials, 200 mg of doxycycline taken within 72 hours after sex has been shown to reduce syphilis and chlamydia infections by >70% and gonococcal infections by approximately 50%. This report outlines CDC's recommendation for the use of doxycycline postexposure prophylaxis (doxy PEP), a novel, ongoing, patient-managed biomedical STI prevention strategy for a selected population. CDC recommends that MSM and TGW who have had a bacterial STI (specifically syphilis, chlamydia, or gonorrhea) diagnosed in the past 12 months should receive counseling that doxy PEP can be used as postexposure prophylaxis to prevent these infections. Following shared decision-making with their provider, CDC recommends that providers offer persons in this group a prescription for doxy PEP to be self-administered within 72 hours after having oral, vaginal, or anal sex. The recommended dose of doxy PEP is 200 mg and should not exceed a maximum dose of 200 mg every 24 hours.Doxy PEP, when offered, should be implemented in the context of a comprehensive sexual health approach, including risk reduction counseling, STI screening and treatment, recommended vaccination and linkage to HIV PrEP, HIV care, or other services as appropriate. Persons who are prescribed doxy PEP should undergo bacterial STI testing at anatomic sites of exposure at baseline and every 3-6 months thereafter. Ongoing need for doxy PEP should be assessed every 3-6 months as well. HIV screening should be performed for HIV-negative MSM and TGW according to current recommendations.

Sugarman, Jeremy MD, MPH, MA; Taylor, Holly A. MPH, PhD; Bachmann, Laura H. MD, MPH; Barbee, Lindley A. MD, MPH; Cahill, Sean PhD; Celum, Connie MD, MPH; Luetkemeyer, Anne F. MD; Mayer, Kenneth H. MD; Mena, Leandro MD, MPH; Mermin, Jonathan MD, MPH; Upshur, Ross MD, MA, MSc; Aral, Sevgi PhD, MS, MA Author Information

Reports of mpox are rising in Africa where the disease is endemic and in new countries where the disease has not been previously seen. The 2022 global outbreak of clade II mpox and an ongoing outbreak of the more lethal clade I mpox highlight the pandemic potential for monkeypox virus. Waning population immunity after the cessation of routine immunization for smallpox plays a key role in the changing epidemiologic patterns of mpox. Sustained human-to-human transmission of mpox is occurring widely in the context of insufficient population immunity, fueling genetic mutations that affect the accuracy of some diagnostic tests and that could lead to changing virulence. Additional research should address complex challenges for control of mpox, including improved diagnostics and medical countermeasures. The availability of vaccines should be expanded not only for outbreak response but also for broader routine use for persons in mpox-endemic countries.

In September 2022, CDC funded a nationwide program, Together TakeMeHome (TTMH), to expand distribution of HIV self-tests (HIVSTs) directly to consumers by mail through an online ordering portal. To publicize the availability of HIVSTs to priority audiences, particularly those disproportionately affected by HIV, CDC promoted this program through established partnerships and tailored resources from its Let's Stop HIV Together social marketing campaign. The online portal launched March 14, 2023, and through March 13, 2024, distributed 443,813 tests to 219,360 persons. Among 169,623 persons who answered at least one question on a postorder questionnaire, 67.9% of respondents were from priority audiences, 24.1% had never previously received testing for HIV, and 24.8% had not received testing in the past year. Among the subset of participants who initiated a follow-up survey, 88.3% used an HIVST themselves, 27.1% gave away an HIVST, 11.7% accessed additional preventive services, and 1.9% reported a new positive HIVST result. Mailed HIVST distribution can quickly reach large numbers of persons who have never received testing for HIV or have not received testing as often as is recommended. TTMH can help to achieve the goal of diagnosing HIV as early as possible and provides a path to other HIV prevention and care services. Clinicians, community organizations, and public health officials should be aware of HIVST programs, initiate discussions about HIV testing conducted outside their clinics or offices, and initiate follow-up services for persons who report a positive or negative HIVST result.

BackgroundThe 2022 mpox outbreak has infected over 30 000 people in the USA, with cases declining since mid-August. Infections were commonly associated with sexual contact between men. Interventions to mitigate the outbreak included vaccination and a reduction in sexual partnerships. Understanding the contributions of these interventions to decreasing cases can inform future public health efforts.MethodsWe fit a dynamic network transmission model to mpox cases reported by Washington DC through 10 January 2023. This model incorporated both vaccine administration data and reported reductions in sexual partner acquisition by gay, bisexual or other men who have sex with men (MSM). The model output consisted of daily cases over time with or without vaccination and/or behavioural adaptation.ResultsWe found that initial declines in cases were likely caused by behavioural adaptations. One year into the outbreak, vaccination and behavioural adaptation together prevented an estimated 84% (IQR 67% to 91%) of cases. Vaccination alone averted 79% (IQR 64% to 88%) of cases and behavioural adaptation alone averted 25% (IQR 10% to 42%) of cases. We further found that in the absence of vaccination, behavioural adaptation would have reduced the number of cases, but would have prolonged the outbreak.ConclusionsWe found that initial declines in cases were likely caused by behavioural adaptation, but vaccination averted more cases overall and was key to hastening outbreak conclusion. Overall, this indicates that outreach to encourage individuals to protect themselves from infection was vital in the early stages of the mpox outbreak, but that combination with a robust vaccination programme hastened outbreak conclusion.

As of December 31, 2022, a total of 29,939 monkeypox (mpox) cases* had been reported in the United States, 93.3% of which occurred in adult males. During May 10-December 31, 2022, 723,112 persons in the United States received the first dose in a 2-dose mpox (JYNNEOS)† vaccination series; 89.7% of these doses were administered to males (1). The current mpox outbreak has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) and racial and ethnic minority groups (1,2). To examine racial and ethnic disparities in mpox incidence and vaccination rates, rate ratios (RRs) for incidence and vaccination rates and vaccination-to-case ratios were calculated, and trends in these measures were assessed among males aged ≥18 years (males) (3). Incidence in males in all racial and ethnic minority groups except non-Hispanic Asian (Asian) males was higher than that among non-Hispanic White (White) males. At the peak of the outbreak in August 2022, incidences among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) males were higher than incidence among White males (RR = 6.9 and 4.1, respectively). Overall, vaccination rates were higher among males in racial and ethnic minority groups than among White males. However, the vaccination-to-case ratio was lower among Black (8.8) and Hispanic (16.2) males than among White males (42.5) during the full analytic period, indicating that vaccination rates among Black and Hispanic males were not proportionate to the elevated incidence rates (i.e., these groups had a higher unmet vaccination need). Efforts to increase vaccination among Black and Hispanic males might have resulted in the observed relative increased rates of vaccination; however, these increases were only partially successful in reducing overall incidence disparities. Continued implementation of equity-based vaccination strategies is needed to further increase vaccination rates and reduce the incidence of mpox among all racial and ethnic groups. Recent modeling data (4) showing that, based on current vaccination coverage levels, many U.S. jurisdictions are vulnerable to resurgent mpox outbreaks, underscore the need for continued vaccination efforts, particularly among racial and ethnic minority groups.

Monkeypox (mpox) is a serious viral zoonosis endemic in west and central Africa. An unprecedented global outbreak was first detected in May 2022. CDC activated its emergency outbreak response on May 23, 2022, and the outbreak was declared a Public Health Emergency of International Concern on July 23, 2022, by the World Health Organization (WHO),* and a U.S. Public Health Emergency on August 4, 2022, by the U.S. Department of Health and Human Services.† A U.S. government response was initiated, and CDC coordinated activities with the White House, the U.S. Department of Health and Human Services, and many other federal, state, and local partners. CDC quickly adapted surveillance systems, diagnostic tests, vaccines, therapeutics, grants, and communication systems originally developed for U.S. smallpox preparedness and other infectious diseases to fit the unique needs of the outbreak. In 1 year, more than 30,000 U.S. mpox cases were reported, more than 140,000 specimens were tested, >1.2 million doses of vaccine were administered, and more than 6,900 patients were treated with tecovirimat, an antiviral medication with activity against orthopoxviruses such as Variola virus and Monkeypox virus. Non-Hispanic Black (Black) and Hispanic or Latino (Hispanic) persons represented 33% and 31% of mpox cases, respectively; 87% of 42 fatal cases occurred in Black persons. Sexual contact among gay, bisexual, and other men who have sex with men (MSM) was rapidly identified as the primary risk for infection, resulting in profound changes in our scientific understanding of mpox clinical presentation, pathogenesis, and transmission dynamics. This report provides an overview of the first year of the response to the U.S. mpox outbreak by CDC, reviews lessons learned to improve response and future readiness, and previews continued mpox response and prevention activities as local viral transmission continues in multiple U.S. jurisdictions (Figure).

Background The 2022 mpox outbreak infected over 30,000 people in the United States. Infections were commonly associated with sexual contact between men. Interventions included vaccination and reductions in sexual partnerships. We estimated the averted infections attributable to each intervention using mathematical modeling. Methods We fit a dynamic network transmission model to mpox cases reported by the District of Columbia through January 2023. We incorporated vaccine administration data and reported reductions in sexual partnerships among gay, bisexual, or other men who have sex with men (MSM). Model output consisted of predicted cases over time with or without vaccination and/or behavior change. Results We estimated initial case reductions were due to behavior change. Vaccination alone averted 64% [IQR:57%-72%] and behavior change alone averted 21% [IQR:11%-29%] of cases. Vaccination and behavior change together averted 80% [IQR:74%-85%] of cases. In the absence of vaccination, behavior change reduced cumulative cases but also prolonged the outbreak. Conclusions Initial case declines were likely caused by behavior change, but vaccination averted more cases overall. Overall, this indicates that encouraging individuals to protect themselves was vital in the early outbreak, but that combination with a robust vaccination program was ultimately required for control.

With the passing of Dawn Kristen Smith, MD, MS, MPH, on 31 October 2022, the HIV world lost a champion for HIV prevention. Dr. Smith was an influential, prolific and pioneering researcher, epidemiologist and public health professional. Her distinguished career focused on using scientific research to answer the most important questions in HIV prevention and health equity. Among her many accomplishments, Dr. Smith was at the forefront of the development and implementation of pre-exposure prophylaxis (PrEP) for HIV. Her visionary work moved PrEP to become an essential HIV prevention tool. She served as the lead U.S. Centers for Disease Control and Prevention (CDC) investigator of the first PrEP safety study, a clinical trial of PrEP efficacy in Botswana, and developed CDC's PrEP guidelines that ushered in the PrEP paradigm shift. She conducted studies that illuminated the disproportionate impact of HIV on communities that had traditionally been underrepresented in U.S. research studies, including women, children of persons with HIV, persons who inject drugs and persons in Black/African American communities. During her tenure as a CDC scientist, Dr. Smith always focused on eliminating health disparities in HIV with her studies and making HIV treatment and prevention available to persons in disproportionately affected populations. Dr. Dawn Smith. Photo credit: U.S. Centers for Disease Control and Prevention. Dr. Smith came to CDC in 1993 as an Epidemic Intelligence Officer. Some of her many accomplishments include: estimating condom effectiveness; leading the development of the first U.S. guidelines on the use of antiretroviral post-exposure prophylaxis; identifying gaps in PrEP access and use; increasing understanding of racial, ethnic and economic disparities in access and use of PrEP; increasing understanding of PrEP implementation needs using mathematical modelling; and assessing awareness, knowledge and use of PrEP. She authored more than 100 peer-reviewed publications and book chapters and presented at numerous conferences. In a highly cited paper, she estimated the number of persons with PrEP indications at the national, state and county levels in the United States [1]. This work provided a denominator for the PrEP coverage indicator used by the CDC and U.S. Department of Health and Human Services to monitor the effectiveness of the U.S. “Ending the HIV Epidemic” initiative and to guide HIV prevention resource allocation decisions. Dr. Smith was the principal investigator of a key study that provided information about real-world PrEP provision and adherence in community health centres. She also led a study of social networks of Black men who have sex with men with newly diagnosed HIV infection in Alabama, and an analysis of the association between PrEP uptake and HIV incidence in the United States. Up until the end, she was on the front lines of public health, leading the Epidemiology Task Force in CDC's mpox response. Her work estimating PrEP need in the United States informed the development of national goals for mpox vaccine. Dr. Smith also supported capacity-building for PrEP implementation in clinical and health department settings. She developed tools to make clinicians and public health workers aware of resources to help pay for PrEP care; clinician training materials; and evidence-based risk assessment tools for populations disproportionately affected by HIV. While Dr. Smith's most recent work has focused on PrEP, she was also a champion of women's health and HIV prevention and treatment for women during her entire career. In earlier years, Dr. Smith was a principal investigator of the landmark Human Immunodeficiency Virus Epidemiology Research (HER) Study, a cohort study of HIV infection in U.S. women. She also conducted research on the relationship of injectable hormonal contraception and HIV transmission, the use of vaginal microbicides for HIV prevention and interventions to eliminate mother-to-child transmission of HIV. Dawn was an inspirational, respected and beloved colleague, friend, teacher and mentor, providing insightful guidance and support. She provided a quintessential example of scientific integrity, intellectual rigour and dedication to public health. She used scientific inquiry to examine and bolster arguments, always with the goal of increasing health equity. Her sudden loss is felt deeply by her family and the broader HIV community. While we grieve the loss of this public health legend and social justice warrior, her legacy lives on through every person who did not get HIV because they had access to, and used, PrEP. There are no competing interests from the authors. APK conceptualized the manuscript and wrote the first draft. RNF reviewed and edited the manuscript. KHM conceptualized the manuscript, reviewed and edited it. JM reviewed and edited the manuscript. The authors are grateful to all of Dawn's colleagues, friends, and family for inspiring this tribute. U.S. CDC Disclaimer: The opinions expressed in this article are those of the authors, and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

More than 30,000 monkeypox (mpox) cases were reported in the United States during the 2022 multinational outbreak; cases disproportionately affected gay, bisexual, and other men who have sex with men (MSM). Substantial racial and ethnic disparities in incidence were also reported (1). The national mpox vaccination strategy* emphasizes that efforts to administer the JYNNEOS mpox vaccine should be focused among the populations at elevated risk for exposure to mpox (2). During May 2022-April 2023, a total of 748,329 first JYNNEOS vaccine doses (of the two recommended) were administered in the United States.† During the initial months of the outbreak, lower vaccination coverage rates among racial and ethnic minority groups were reported (1,3); however, after implementation of initiatives developed to expand access to mpox vaccination,§ coverage among racial and ethnic minority groups increased (1,4). A shortfall analysis was conducted to examine whether the increase in mpox vaccination coverage was equitable across all racial and ethnic groups (5). Shortfall was defined as the percentage of the vaccine-eligible population that did not receive the vaccine (i.e., 100% minus the percentage of the eligible population that did receive a first dose). Monthly mpox vaccination shortfalls were calculated and were stratified by race and ethnicity; monthly percent reductions in shortfall were also calculated compared with the preceding month's shortfall (6). The mpox vaccination shortfall decreased among all racial and ethnic groups during May 2022-April 2023; however, based on analysis of vaccine administration data with race and ethnicity reported, 66.0% of vaccine-eligible persons remained unvaccinated at the end of this period. The shortfall was largest among non-Hispanic Black or African American (Black) (77.9%) and non-Hispanic American Indian or Alaska Native (AI/AN) (74.5%) persons, followed by non-Hispanic White (White) (66.6%) and Hispanic or Latino (Hispanic) (63.0%) persons, and was lowest among non-Hispanic Asian (Asian) (38.5%) and non-Hispanic Native Hawaiian and other Pacific Islander (NH/OPI) (43.7%) persons. The largest percentage decreases in the shortfall were achieved during August (17.7%) and September (8.5%). However, during these months, smaller percentage decreases were achieved among Black persons (12.2% and 4.9%, respectively), highlighting the need for a focus on equity for the entirety of a public health response. Achieving equitable progress in JYNNEOS vaccination coverage will require substantial decreases in shortfalls among Black and AI/AN persons.

More than 30,000 monkeypox (mpox) cases have been diagnosed in the United States since May 2022, primarily among gay, bisexual, and other men who have sex with men (MSM) (1,2). In recent months, diagnoses have declined to one case per day on average. However, mpox vaccination coverage varies regionally, suggesting variable potential risk for mpox outbreak recurrence (3). CDC simulated dynamic network models representing sexual behavior among MSM to estimate the risk for and potential size of recurrent mpox outbreaks at the jurisdiction level for 2023 and to evaluate the benefits of vaccination for preparedness against mpox reintroduction. The risk for outbreak recurrence after mpox reintroduction is linearly (inversely) related to the proportion of MSM who have some form of protective immunity: the higher the population prevalence of immunity (from vaccination or natural infection), the lower the likelihood of recurrence in that jurisdiction across all immunity levels modeled. In contrast, the size of a potential recurrent outbreak might have thresholds: very small recurrences are predicted for jurisdictions with mpox immunity of 50%-100%; exponentially increasing sizes of recurrences are predicted for jurisdictions with 25%-50% immunity; and linearly increasing sizes of recurrences are predicted for jurisdictions with <25% immunity. Among the 50 jurisdictions examined, 15 are predicted to be at minimal risk for recurrence because of their high levels of population immunity. This analysis underscores the ongoing need for accessible and sustained mpox vaccination to decrease the risk for and potential size of future mpox recurrences.

Human immunodeficiency virus (HIV) self-testing has emerged as a tool to increase the proportion of people to know their status. Since the first HIV self-test was approved in 2012 by the US Food and Drug Administration (FDA), global access to HIV self-tests has been bolstered by public-private partnerships to ensure equitable access in low- and middle-income countries. However, no company has applied for FDA clearance in a decade. We highlight the potential benefits to reclassifying HIV self-tests from class III to class II.

Introduction: Over 2 million adults in the United States have hepatitis C virus (HCV) infection, and it contributes to approximately 14,000 deaths a year. Eight to 12 weeks of highly effective direct-acting antiviral (DAA) treatment, which can cure >= 95% of cases, is recommended for persons with hepatitis C. Methods: Data from HealthVerity, an administrative claims and encounters database, were used to construct a cohort of adults aged 18-69 years with HCV infection diagnosed during January 30, 2019-October 31, 2020, who were continuously enrolled in insurance for >= 60 days before and >= 360 days after diagnosis (47,687). Multivariable logistic regression was used to assess the association between initiation of DAA treatment and sex, age, race, payor, and Medicaid restriction status; adjusted odds ratios (aORs) and 95% CIs were calculated. Results: The prevalence of DAA treatment initiation within 360 days of the first positive HCV RNA test result among Medicaid, Medicare, and private insurance recipients was 23%, 28%, and 35%, respectively; among those treated, 75%, 77%, and 84%, respectively, initiated treatment within 180 days of diagnosis. Adjusted odds of treatment initiation were lower among those with Medicaid (aOR = 0.54; 95% CI = 0.51-0.57) and Medicare (aOR = 0.62; 95% CI = 0.56-0.68) than among those with private insurance. After adjusting for insurance type, treatment initiation was lowest among adults aged 18-29 and 30-39 years with Medicaid or private insurance, compared with those aged 50-59 years. Among Medicaid recipients, lower odds of treatment initiation were found among persons in states with Medicaid treatment re-strictions (aOR = 0.77; 95% CI = 0.74-0.81) than among those in states without restrictions, and among persons whose race was coded as Black or African American (Black) (aOR = 0.93; 95% CI = 0.88-0.99) or other race (aOR = 0.73; 95% CI = 0.62-0.88) than those whose race was coded as White. Conclusions and Implications for Public Health Practice: Few insured persons with diagnosed hepatitis C receive timely DAA treatment, and disparities in treatment exist. Unrestricted access to timely DAA treatment is critical to reducing viral hepatitis-related mortality, disparities, and transmission. Treatment saves lives, prevents transmission, and is cost saving.

variola virus that causes smallpox, causes a zoo-notic disease with an unknown animal reservoir. Clinical manifestations of monkeypox include a prodrome of fever, lymphadenopathy, headache, and malaise 1 to 2 weeks after infection, progressing to a centrifugal rash that includes vesicles and pustules, sometimes number-ing in the hundreds or thousands (1). Monkeypox virus infection can be transmitted through cutaneous routes during close or intimate contact with a person whose lesions are not yet crusted over and healed, via fomites that have had contact with a person with monkeypox, and by respiratory droplets among people with close, sustained face-to-face contact.