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Clinical Measures for Ryan White Part C: Early
Intervention Services
| HIV Clinical
Performance Measure: # 4 |
| Stated
Performance Measure: Percentage
of women with HIV infection who had a Pap
screening in the measurement year |
| Numerator: |
Number
of female clients with HIV infection who:
- were >18 years old in the measurement
year [1],
and
- were seen within the measurement
year, and
- had a PAP screening done within the
measurement year
|
| Denominator:
|
Number of
female clients with HIV infection who:
- were >18 years old in the measurement
year, and
- were seen within the measurement
year
|
| Data
Sources: |
- CADR, Section 5, Items 42 and 52
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%[2]
- National HIVQUAL Data: [3]
| |
2003 |
2004 |
2005 |
| Top
10% |
100% |
99.1%
|
100% |
| Top
25% |
84.3% |
86.7% |
87.0% |
| Median* |
73.3% |
70.0% |
74.3% |
*from HAB data base |
| Basis
for Selection: |
Human
Papillomavirus (HPV) is a common infection
in the general population. Current evidence
suggests that over 50% of sexually active
adults have been infected with one or more
HPV types. According to population-based
prospective studies, HPV precedes the development
of cervical cancer.
[4]
Cervical cancer may be the most common AIDS-related
malignancy in women. Although not a common
diagnosis in women in the general population,
according to New York City AIDS Surveillance
data from 1990 to 1995, the observed cervical
cancer cases in HIV-positive women were
two to three times higher than the expected
number of cases.[5],
[6] Findings such as these resulted
in the inclusion of cervical cancer in the
Centers for Disease Control and Prevention
(CDC) expanded definition of AIDS.
[7] When compared with HIV-negative
women, HIV-positive women with invasive
cervical cancer present at more advanced
stages and with cancer metastasizing to
unusual locations. HIV- positive women
have poorer responses to standard therapy
and have higher recurrences and death
rates, as well as shorter intervals to
recurrence or death.[8],
[9]
The CDC currently recommends that HIV-positive
women have a complete gynecologic evaluation,
including a Pap smear, as part of their
initial HIV evaluations, or upon entry
to prenatal care, and another Pap smear
six months later. If both smears are negative,
annual screening is recommended thereafter
in asymptomatic women. The CDC further
recommends more frequent screenings (every
six months) for women with symptomatic
HIV infection, prior abnormal Pap smears,
or signs of HPV infection. [10],
[11]
Cervical cancer can often be prevented
or detected in its earliest stages through
effective screening with a Pap smear and
avoidance of known risk factors. This
accentuates the importance of routine
gynecological care, which includes Pap
smears for HIV-infected women.[12] |
| US Public
Health Guidelines: |
| "In accordance
with the recommendation of the Agency for
Health Care Policy and Research, the Pap
smear should be obtained twice during the
first year after diagnosis of HIV infection
and, if the results are normal, annually
thereafter"
[13] (6/14/02). |
| References/Notes: |
1 Onset
of sexual activity is not reliably reported
or recorded. The lower age bracket of 18
years is selected for performance measurement
purposes only and should not be interpreted
as a recommendation about the age at which
screening should begin to occur.
2
IHI Measure reads,
“Percent of Female Patients/Clients
with an Annual Papanicolaou (Pap) Test”
(http://www.ihi.org/IHI/Topics/HIVAIDS/HIVDiseaseGeneral/Measures/PercentofPatientswithPAPSmearinLastSixMonths.htm)
3 ”Annual
pelvic exam” (http://www.hivguidelines.org/admin/files/qoc/hivqual/proj%20info/HQNatlAggScrs3Yrs.pdf)
4 Davis,
AT. Cervical dysplasia in women infected
with the human immunodeficiency virus (HIV):
a correlation with HIV viral load and CD4
count. Gynecologic Oncology. 2001; 80(3):350–354.
5 Approximately
16,000 new cases of cervical cancer are
diagnosed each year, and about 4,800 women
die from this disease annually. Clinical
Guide to Clinical Preventive Services: Report
of the U.S. Preventive Services Task Force.
Chapter 9.
6 Chiasson,
MA. Declining AIDS mortality in New York
City. New York City Department of Health.
Bull NY Acad. Med. 1997; 74:151–152.
7 Centers
for Disease Control and Prevention (CDC).
1993. Revised classification system for
HIV infection and expanded surveillance
case definition for AIDS among adolescents
and adults. MMWR. 1992; 41(RR-17). (http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm)
8 Ibid.
9 U.S.
Department of Health and Human Services.
Anderson, JA, editor. Guide to the Clinical
Care of Women with HIV; 2001.
10
http://www.niaid.nih.gov/factsheets/womenhiv.htm
11 The
interval for each patient should be recommended
by the physician based on risk factors,
i.e., early onset of sexual history, a history
of multiple sex partners, low socioeconomic
status, and, for women infected with HIV,
more frequent screening, according to the
established guidelines.
12 Kjaer,
S. Type specific persistence of high risk
human papillomavirus (HPV) as indicator
of high grade cervical squamous intraepithelial
lesions in young women: population based
prospective follow-up study, Brit Med J.
2002; 325: 572–578.
13
Centers for Disease Control
and Prevention. Guidelines for Preventing
Opportunistic Infections Among HIV-Infected
Persons — 2002 Recommendations of
the U.S. Public Health Service and the Infectious
Diseases Society of America. MMWR 2002;51(No.
RR-8) (http://www.cdc.gov/mmwr/PDF/rr/rr5108.pdf
or http://aidsinfo.nih.gov/ContentFiles/OIpreventionGL.pdf) |
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