Performance Measure: HIV Drug Resistance Testing Before Initiation of Therapy

National Quality Forum #: None

Description: Percentage of patients, regardless of age, with a diagnosis of HIV who had an HIV drug resistance test performed¹ before initiation² of HIV antiretroviral therapy (ART) if therapy started during the measurement year

Numerator: Number of patients who had an HIV drug resistance test performed at any time before initiation of HIV ART

Denominator: Number of patients, regardless of age, with a diagnosis of HIV who

• Were prescribed HIV ART during the measurement year for the first time
• Had a medical visit with a provider with prescribing privileges³ at least once in the measurement year

Patient Exclusions: None

Data Elements:

1. Does the patient, regardless of age, have a diagnosis of HIV/AIDS? (Y/N)
   
   1. If yes, was the patient seen by a provider with prescribing privileges during the measurement year? (Y/N)
      
      1. If yes, was HIV ART prescribed during the measurement year for the first time? (Y/N)
         1. If yes, was an HIV drug resistance test performed at any time prior to prescribing ART? (Y/N)
            
            1. If yes, list date

National goals, target, or benchmarks for comparison

The HIV Quality Measures (HIVQM) Module is a tool within the Ryan White HIV/AIDS Services Report portal. It allows recipients to enter aggregate data specific to HRSA HAB Performance Measures. The HIVQM Module allows recipients to conduct point-in-time benchmarking across Ryan White HIV/AIDS Programs that use the module.

Department of Health and Human Services Clinical Practice Guidelines

Adult guidelines

"HIV drug-resistance testing is recommended at entry into care for persons with HIV to guide selection of the initial antiretroviral therapy (ART) regimen (AII). If therapy is deferred, repeat testing should be considered at the time of ART initiation (CIII).

"Genotypic, rather than phenotypic, testing is the preferred resistance testing to guide therapy in antiretroviral (ARV)-naïve patients (AIII)."⁴

Pediatric guidelines

"Testing at the Time of Switching Antiretroviral Regimens…If the regimen is switched because the regimen is failing (see "Recognizing and Managing Antiretroviral Treatment Failure in Management of Children Receiving Antiretroviral Therapy"), resistance testing should be performed while a patient is still receiving the failing regimen. This optimizes the chance of identifying resistance mutations, because resistant strains may revert to wild type within a few weeks of stopping ARV drugs (see "Drug-Resistance Testing" in the Adult and Adolescent Antiretroviral Guidelines). Clinicians should consider performing phenotypic resistance testing, including co-receptor tropism testing, in addition to genotypic viral resistance testing in children who have experienced prolonged or repeated periods of viral nonsuppression on multiple ARV regimens.

Table 3 of the HHS Guidelines provide a sample schedule for clinical and laboratory monitoring of children before and after initiation of ART. In addition, it is recommended that genotype resistance testing should be performed, if not already completed."⁵

Use in other federal programs

None

References/notes

¹ HIV drug resistance testing may occur either during or prior to the measurement year, as long as it is performed before ARV therapy is initiated.

² The focus of the measure is on initiation of first antiretroviral regimen for HIV treatment, not prophylaxis or re-initiation.

³ A "provider with prescribing privileges" is a health care professional who is certified in his/her jurisdiction to prescribe medications.

⁴ Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV (PDF - 4 MB). Department of Health and Human Services. Available online. Accessed August 2022. C-12.

⁵ Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection (PDF - 5 MB). Department of Health and Human Services. Available online. Accessed February 2023. D-5 through D-6.