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  5. Performance Measure: Gap in HIV Medical Visits

Performance Measure: Gap in HIV Medical Visits

National Quality Forum #: 2080

Description: Percentage of patients, regardless of age, with a diagnosis of HIV who did not have a medical visit in the last 6 months of the measurement year

Numerator: Number of patients in the denominator who did not have a medical visit in the last 6 months of the measurement year

Denominator: Number of patients, regardless of age with a diagnosis or HIV who had at least one medical visit in the first 6 months of the measurement year

Patient Exclusions: Patients who died at any time during the measurement year

Data Elements:

  1. Does the patient, regardless of age, have a diagnosis of HIV? (Y/N)

    1. If yes, did the patient have at least one medical visit in the first 6 months of the measurement year? (Y/N)

      1. If yes, did the patient have one or more medical visits in the last 6 months of the measurement year?

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

"Several laboratory tests are important for the initial evaluation of people with HIV upon entry into care, and before and some tests should be performed before and after initiation or modification of antiretroviral therapy (ART) to assess the virologic and immunologic efficacy of ART and to monitor for laboratory abnormalities that may be associated with antiretroviral (ARV) drugs. Table 3 outlines recommendation on the frequency of testing from the Panel on Antiretroviral Guidelines for Adults and Adolescents. As noted in the table, some tests may be repeated more frequently if clinically indicated."1

Pediatric guidelines

"Within 1 to 2 weeks of initiating therapy, children should be evaluated either in person, through telemedicine, or by telephone. During this evaluation, clinicians should identify clinical AEs and provide support for adherence. Many clinicians plan additional contacts (in person, through telemedicine, by telephone, or via email/texts/apps) with children and caregivers to support adherence during the first few weeks of therapy...

After the initial phase of ART initiation (1-3 months), clinicians should assess a patient’s adherence to the regimen and the regimen’s effectiveness (as measured by CD4 count and plasma viral load) every 3 to 4 months. Additionally, clinicians should review a patient’s history of toxicities and evaluate a patient for any new AEs using physical examinations and the relevant laboratory tests. If laboratory evidence of toxicity is identified, testing should be performed more frequently until the toxicity resolves.

Table 5 below provides one proposed general monitoring schedule, which should be adjusted based on the specific ARV regimen that a child is receiving.

A patient’s baseline CD4 count affects how rapidly CD4 count improves after ART initiation; children with very low CD4 counts may take longer than 1 year to achieve their highest values after viral load suppression.

Studies have critically evaluated the frequency of laboratory monitoring in both adults and children, particularly CD4 count and plasma viral load. These studies support less frequent monitoring in stable patients who have been consistently virologically suppressed for ≥ 1 year…

Follow-up clinical and laboratory monitoring can be conducted through in-person and/or telemedicine visits. Additional arrangements, coordination, and follow-up of the laboratory testing (e.g., using local laboratory or primary care provider’s office) may be required for telemedicine visits."2

Use in other federal programs

This measure is linked to an exact or similar indicator(s) within the National HIV/AIDS Strategy (2022-2025).

References/notes:

1 Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV (PDF - 4 MB). Department of Health and Human Services. Available online. Accessed August 2022. C-1.

2 Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection (PDF - 6 MB). Department of Health and Human Services. Available online. Accessed February 2023. D-4 through D-5.

Date Last Reviewed: