| HIV Clinical
Performance Measure: # 2 |
| Stated
Performance Measure: Percentage
of clients with HIV infection who had a
CD4+ test done at least every 6 months |
| Numerator: |
Number of clients
who had CD4+ counts measured at least twice
in the measurement year, <6 months apart
|
| Denominator:
|
Number of clients with HIV
infection who were seen within the measurement
year |
| Data Sources: |
- 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%[1]
- National HIVQUAL Data:
[2]
| |
2003 |
2004 |
2005 |
Top
10% |
87.2% |
87.7% |
90.3% |
Top
25% |
74.2% |
78.0% |
76.6% |
Median* |
61.0% |
62.7% |
63.9% |
|
| Basis
for Selection: |
The CD4+ cell
count plays a vital role in determining
the staging of HIV disease and indicating
the need for prophylaxis against opportunistic
infections. It continues to be used in decisions
regarding initiation or adjustment of antiretroviral
treatment.
The most recent CD4+ cell count is the strongest
predictor of subsequent disease progression
and survival, according to clinical trials
and cohort studies data on patients receiving
antiretroviral therapy. [3]
|
| US Public
Health Guidelines: |
"In general,
CD4+ count should be determined every three
to six months to (1) determine when to start
antiretroviral in patients who do not meet
the criteria for initiation; (2) assess
immunologic response to
antiretroviral therapy; and (3) assess the
need for initiating chemoprophylaxis for
opportunistic infections."3 (10/10/06)
|
| References/Notes: |
1 IHI Measure
reads, “Percent of Patients/Clients
with a CD4 Count Test in the Past 4 Months”
(http://www.ihi.org/IHI/Topics/HIVAIDS/HIVDiseaseGeneral/Measures/Percentof+patientswithaCD4counttestinthepast4months.htm)
2 Data
is for a measure that looks at the percent
of clients who have a CD4+ count done every
four months, not every six months.
(http://www.hivguidelines.org/admin/files/qoc/hivqual/proj%20info/HQNatlAggScrs3Yrs.pdf)
3 Guidelines
for the Use of Antiretroviral Agents in
HIV-1-Infected Adults and Adolescents (http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf)
The Department of Health and Human Services
Panel on Antiretroviral Guidelines for Adults
and Adolescents (the Panel), a working group
of the Office of AIDS Research Advisory
Council, develops these guidelines, which
outline current understanding of how clinicians
should use antiretroviral drugs to treat
adults and adolescents with HIV infection.
The Panel considers new evidence and adjusts
recommendations accordingly. The guidelines
for the frequency of CD4+ and Viral Load
testing have changed over time. The measure
on this detail sheet reflects the Guidelines
as of October 2006. |
