Performance Measure: Tuberculosis Screening

National Quality Forum #: None

Description: Percentage of patients aged 3 months and older with a diagnosis of HIV/AIDS for whom there was documentation that a tuberculosis (TB) screening test¹ was performed and results interpreted (for tuberculin skin tests) at least once since the diagnosis of HIV infection²

Numerator: Patients for whom there was documentation that a TB screening test was performed and results interpreted at least once since the diagnosis of HIV infection

Denominator: All patients aged 3 months and older with a diagnosis of HIV/AIDS, who had at least two visits during the measurement year, with at least 90 days in between each visit

Patient Exclusions: Documentation of Medical Reason for not performing a TB screening test (e.g., patients with a history of positive PPD or treatment for TB)

Data Elements:

1. Does the patient, aged three months and older, have a diagnosis of HIV/AIDS? (Y/N)
   
   1. If yes, did the patient have at least two medical visits during the measurement year, with at least 90 days in between each visit? (Y/N)
      
      1. If yes, has the patient had tuberculosis (TB) screening test performed and results interpreted (for tuberculin skin tests) at least once since the diagnosis of HIV infection? (Y/N)

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

"All persons with HIV should be tested for LTBI at the time of HIV diagnosis, regardless of their epidemiological risk of TB exposure (AII)… Persons with negative diagnostic tests for LTBI, advanced HIV infection (CD4 cell count <200 cells/mm³), and without indications for initiating empiric LTBI treatment (i.e., no recent exposure to a culture-confirmed TB case) should be retested for LTBI once they start ART and attain a CD4 count ≥200 cells/mm³ to ensure that the initial test result was a true negative result. Annual testing for LTBI using TST is recommended for persons with HIV who are at high risk for repeated or ongoing exposure to persons with active TB disease (AIII)."³

Pediatric guidelines

"Because HIV-infected children are at high risk of TB, annual LTBI testing is recommended beginning at ages 3 to 12 months and annually thereafter for those who tested negative in the past (AIII), depending on the local epidemiology, region of birth, and travel history."⁴

American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention guidelines

• "We recommend performing an interferon-γ release assay (IGRA) rather than a tuberculin skin test (TST) in individuals 5 years or older who meet the following criteria: (1) are likely to be infected with Mtb, (2) have a low or intermediate risk of disease progression, (3) it has been decided that testing for LTBI is warranted, and (4) either have a history of BCG vaccination or are unlikely to return to have their TST read (strong recommendation, moderate-quality evidence). Remarks: A TST is an acceptable alternative, especially in situations where an IGRA is not available, too costly, or too burdensome.
• We suggest performing an IGRA rather than a TST in all other individuals 5 years or older who are likely to be infected with Mtb, who have a low or intermediate risk of disease progression, and in whom it has been decided that testing for LTBI is warranted (conditional recommendation, moderate-quality evidence). Remarks: A TST is an acceptable alternative, especially in situations where an IGRA is not available, too costly, or too burdensome."¹

Use in other federal programs

None

References/notes

¹ David M. Lewinsohn, Michael K. Leonard, Philip A. LoBue, David L. Cohn, Charles L. Daley, Ed Desmond, Joseph Keane, Deborah A. Lewinsohn, Ann M. Loeffler, Gerald H. Mazurek, Richard J.O’Brien, Madhukar Pai, Luca Richeldi, Max Salfinger, Thomas M. Shinnick, Timothy R. Sterling, David M. Warshauer, Gail L. Woods. "Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children (PDF - 3 MB)." Clin Infect Dis 2017; 64 (2): e1-e33.

² The HIV/AIDS Bureau did not develop this measure. This measure was developed by the National Committee on Quality Assurance. Measure details available at: National Quality Forum: Endorsement Summaries.

³ Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV (PDF - 5 MB). National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Available online. Accessed August 2022. V-2.

⁴ Panel on Opportunistic Infections in Children with and Exposed to HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Children with and Exposed to HIV (PDF - 4 MB). Department of Health and Human Services. Available online. Accessed August 2022. V-4.