| HIV Clinical
Performance Measure: # 11 |
| Stated
Performance Measure: Percentage
of clients with HIV infection who had completed
the vaccination series for Hepatitis B |
| Numerator: |
Number
of clients (ages > 13 years) with AIDS
(history of a CD4+ count below 200/µL[1]
or other AIDS-defining condition[2])
who:
- were seen within the measurement
year, and
- were prescribed a HAART regimen within
the measurement year
|
| Denominator:
|
Number of
clients (ages > 13 years) with AIDS
(history of a CD4+ count below 200/µL
or other AIDS-defining condition) who
were seen within the measurement year
|
| Data
Sources: |
- CADR, Section 2, Items 26 and 31
may provide data useful in establishing
a baseline for this performance measure
- Electronic Medical Record/Electronic
Health Record
- CAREWare, Lab Tracker, or other electronic
data base.
- HIVQUAL reports on this measure for
grantee under review
- Medical record data abstraction by
grantee of a sample of records that
is negotiated with the OPR Review Team.
|
| National Goals, Targets,
or Benchmarks for Comparison |
- • IHI Goal: 90%[3]
• According to CDC Adult/Adolescent
Spectrum of HIV Disease database containing
records for over 60,000 persons with
HIV infection, 79% of persons eligible
receive antiretroviral therapy[4]
• National HIVQUAL Data:[5]
| |
2003 |
2004 |
2005 |
| Top
10% |
100% |
100%
|
100% |
| Top
25% |
100% |
100% |
100% |
| Median* |
100% |
88.9% |
95.7 |
*from HAB data base
|
| Basis
for Selection: |
Basis
for Selection: “Randomized clinical
trials provide strong evidence of improved
survival and reduced disease progression
by treating symptomatic patients and patients
with <200 CD4+ T cells/µL.”[6] |
| US Public
Health Guidelines: |
| “Antiretroviral
therapy is recommended for all patients
with history of an AIDS-defining illness
or severe symptoms of HIV infection regardless
of CD4+ T cell count.”[7]
(5/4/06) |
| References/Notes: |
1 Many
authorities recommend two baseline CD4+
measurements before decisions are made to
initiate antiretroviral therapy because
of wide variations in results. The test
should be repeated yet a third time if discordant
results are seen. The optimal time to initiate
antiretroviral therapy among asymptomatic
patients with CD4+ T cell counts >200
cells/µL is unknown. This measure
focuses strictly on the subset of patients
for whom antiretroviral therapy is unequivocally
recommended—those with a CD4+ count
below 200/µL or history of another
AIDS-defining condition. Asymptomatic patients
with CD4+ T cell counts of 201–350
cells/µL should be offered treatment.
For asymptomatic patients with CD4+ T cell
of >350 cells/µL and plasma HIV
RNA >100,000 copies/ml most experienced
clinicians defer therapy but some clinicians
may consider initiating treatment. (See
reference 6 below)
2
AIDS Defining conditions are noted in CDC.
1993 Revised classification system for HIV
infection and expanded surveillance case
definition for AIDS among adolescents and
adults. MMWR 1992;41(no. RR-17). (http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm)
3 IHI Measure
reads, “Percent of Patients with Appropriate
ARV Therapy Management”
(http://www.ihi.org/IHI/Topics/HIVAIDS/HIVDiseaseGeneral/Measures/PercentofPatientswithAppropriateARVTherapyManagement.htm)
4 Teshale
E, Kamimoto L, Harris N, Li J, Wang H, and
McKenna M. Estimated Number of HIV-infected
Persons Eligible for and Receiving HIV Antiretroviral
Therapy, 2003--United States. Oral presentation
at 12th Conference on Retroviruses and Opportunistic
Infections, Boston, MA 2005. (http://www.retroconference.org/2005/cd/Abstracts/24468.htm)
5 ”HAART,
CD4<200” (http://www.hivguidelines.org/admin/files/qoc/hivqual/proj%20info/HQNatlAggScrs3Yrs.pdf)
6 Guidelines
for the Use of Antiretroviral Agents in
HIV-1-Infected Adults and Adolescents (p.
9) (http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf).
7 Ibid.
(p. 8).
|
