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Clinical Measures for Ryan White Part C: Early
Intervention Services
| HIV Clinical
Performance Measure: # 10 |
| Stated
Performance Measure: Percentage
of clients with HIV infection who had completed
the vaccination series for Hepatitis B |
| Numerator: |
Number
of clients with HIV infection who:
- were seen within the measurement
year, and
- were ever recognized by the grantee
to lack written, dated records (e.g.,
personal, school, physician, or immunization
registry) as evidence of vaccination,
and
- ever had documented susceptibility
to Hepatitis B virus or had unknown
Hepatitis B virus status, and
- ever completed the vaccination series
for Hepatitis B[1][2]
|
| Denominator:
|
Number of
clients with HIV infection who:
- were seen within the measurement
year, and
- were ever recognized by the grantee
to lack written and dated records (e.g.,
personal, school, physician, or immunization
registry) as evidence of vaccination,
and
- ever had documented susceptibility
to Hepatitis B virus or had unknown
Hepatitis B virus status
|
| Data
Sources: |
- Electronic Medical Record/Electronic
Health Record
- CAREWare, Lab Tracker, or other electronic
data base
- 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 |
- Published date from the HIV Outpatient
Study (HOPS) reports 17% of patients
with HIV infection who were eligible
for vaccination received at least 3
doses of vaccine.[3]
- “Hepatitis B vaccination coverage
among adults at high risk…[was]
45% in 2004.”[4]
|
| Basis
for Selection: |
Hepatitis
B virus (HBV) is the leading cause of
chronic liver disease worldwide. In developed
countries, HBV is transmitted primarily
through sexual contact and injection-drug
use. Even though risk factors are similar,
HBV is transmitted more efficiently than
HIV-1. Although up to 90% of HIV-1–infected
persons have at least one serum marker
of previous exposure to HBV, only approximately
10% have chronic hepatitis B, as evidenced
by the detection of hepatitis B surface
antigen (HBsAg) in the serum persisting
for a minimum of 6 months.[5]
HIV-1 infection is associated with an
increased risk for the development of
chronic hepatitis B after HBV exposure.
Limited data indicate that co-infected
patients with chronic hepatitis B infection
have higher HBV DNA levels and are more
likely to have detectable hepatitis B
e antigen (HBeAg), accelerated loss of
protective hepatitis B surface antibody
(anti-HBs), and an increased risk for
liver-related mortality and morbidity.[6],[7]
There is a protective antibody response
in approximately 30%-55% of healthy adults
aged <40 years after the first dose
of vaccine. After age 40, the proportion
of persons with a protective antibody
response after a 3-dose vaccination regimen
declines. In addition to age, other host
factors (e.g., smoking, obesity, genetic
factors, and immune suppression) contribute
to decreased vaccine response. Response
to hepatitis B vaccination also is reduced
in other immunocompromised persons (e.g.,
HIV-infected persons, hematopoietic stem-cell
transplant recipients, and patients undergoing
chemotherapy).
|
| US Public
Health Guidelines: |
| “Several
liver-associated complications that are
ascribed to flares in HBV activity or
toxicity of antiretroviral agents can
affect the treatment of HIV in patients
with HBV coinfection. Therefore, providers
should know the HBV status of all patients
with HIV. For patients who are HBV negative,
prophylaxis is recommended. This consists
[of] 3 doses of vaccine for “all
susceptible patients (i.e., antihepatitis
B core antigen-negative).”6 (6/14/02)
|
| References/Notes: |
1 Patients
in the middle of the vaccination series
on 12/31/x would not be captured in the
numerator in year x. They would, if the
series was completed on schedule, be captured
in year x+1.
2 Centers
for Disease Control and Prevention. A Comprehensive
Immunization Strategy to Eliminate Transmission
of Hepatitis B Virus Infection in the United
States; Recommendations of the Advisory
Committee on Immunization Practices (ACIP)
Part II: Immunization of Adults. MMWR 2006;55(No.
RR-16):[Table 2 on p. 10 recommends use
of a higher dose of vaccine for “Hemodialysis
patients and other immunocompromised persons
aged >20 yrs” and Box 5 on p. 15
lists recommended schedules] (http://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf)
3 Tedaldi
EM, Baker RK, Moorman AC, Wood KC, Fuhrer
J, McCabe RE, Holmberg SD; HIV Outpatient
Study (HOPS) Investigators. Hepatitis A
and B vaccination practices for ambulatory
patients infected with HIV. Clinical Infectious
Diseases. 2004 May 15;38(10):1478-84. (http://www.journals.uchicago.edu/CID/journal/issues/v38n10/32448/32448.web.pdf)
4 Centers
for Disease Control and Prevention. Hepatitis
B Vaccination Coverage Among Adults —United
States, 2004. MMWR 2006;55:509-11 (http://www.cdc.gov/mmwr/PDF/wk/mm5518.pdf)
5 Centers
for Disease Control and Prevention. Treating
opportunistic infections among HIV-infected
adults and adolescents: recommendations
from CDC, the National Institutes of Health,
and the HIV Medicine Association/Infectious
Diseases Society of America. MMWR 2004;53(No.
RR-15). (http://aidsinfo.nih.gov/ContentFiles/TreatmentofOI_AA.pdf)
6 Guidelines
for the Use of Antiretroviral Agents in
HIV-1-Infected Adults and Adolescents (http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf)
7 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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