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  • Measure Summary
  • NQMC:010893
  • Aug 2010

HIV diagnostic testing: percentage of exposed infants born to HIV-infected women who received recommended virologic diagnostic testing for exclusion of HIV infection in the measurement year.

Health Resources and Services Administration (HRSA). HAB HIV performance measures: pediatrics. Rockville (MD): Health Resources and Services Administration (HRSA); 2010 Aug 19. 30 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of exposed infants born to human immunodeficiency virus (HIV)-infected women who received recommended virologic diagnostic testing for exclusion of HIV infection in the measurement year.

Rationale

Human immunodeficiency virus (HIV)-related morbidity and mortality has dropped dramatically due to advances in HIV/acquired immune deficiency syndrome (AIDS) treatment. But reductions are uneven across HIV-infected populations due to unequal access to care and variable quality of services provided. Quality management seeks to enhance the quality of HIV care provided and increase access to services. They do so by measuring how health and social services meet established professional standards and user expectations.

HIV virologic testing should be performed at a minimum at ages 14 to 21 days, 1 to 2 months and 4 to 6 months.

Antibiotic prophylaxis against Pneumocystis jirovecii pneumonia (PCP) is recommended for infants with indeterminate HIV infection starting at 4 to 6 weeks of life or until they are determined to be uninfected. Diagnostic testing allows PCP prophylaxis to be avoided or stopped if confirmed uninfected (Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children, 2010).

U.S. Public Health Guidelines

"HIV infection should be diagnosed using HIV deoxyribonucleic acid (DNA) polymerase chain reaction (PCR) or ribonucleic acid (RNA) virologic assays. Maternal HIV antibody crosses the placenta and will be detectable in all HIV-exposed infants up to 18 months of age; therefore standard antibody tests should not be used for HIV diagnosis in newborns. HIV virologic testing should be performed at a minimum at ages 14 to 21 days, 1 to 2 months, and 4 to 6 months. Some experts also perform a virologic test at birth, especially if the woman has not had good virologic control during pregnancy or if adequate follow-up of the infant may not be assured. A positive HIV virologic test should be confirmed as soon as possible with a second HIV virologic test on a different specimen. Two positive HIV tests constitute a diagnosis of HIV infection" (Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children, 2010).

Definitive exclusion of HIV infection in nonbreastfed infants may be based on two negative virologic tests at greater than or equal to 1 month and greater than or equal to 4 months of age (Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children, 2010).

Evidence for Rationale

Health Resources and Services Administration (HRSA). Deliver HIV/AIDS care: quality of care. [internet]. Rockville (MD): Health Resources and Services Administration (HRSA); [accessed 2016 Jun 23].

Health Resources and Services Administration (HRSA). HAB HIV performance measures: pediatrics. Rockville (MD): Health Resources and Services Administration (HRSA); 2010 Aug 19. 30 p.

Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the use of antiretroviral agents in pediatric HIV infection. Bethesda (MD): Department of Health and Human Services (DHHS); 2010 May 24. various p.

Primary Health Components

Human immunodeficiency virus (HIV); virologic diagnostic testing; infants

Denominator Description

Number of human immunodeficiency virus (HIV)-perinatally exposed infants who:

  • Were 6 to 12 months of age at any point in the measurement year; and
  • Who had a medical visit with a provider with prescribing privileges at least once in the measurement year

See the related "Denominator Inclusions/Exclusions" field.

Numerator Description

Number of human immunodeficiency virus (HIV)-perinatally exposed infants who had at least two virologic diagnostic tests performed at appropriate time points by age of six months to definitively exclude HIV infection (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age between 6 and 12 months

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Staying Healthy

IOM Domain

Effectiveness

Timeliness

Case Finding Period

The measurement year

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of human immunodeficiency virus (HIV)-perinatally exposed infants who:

  • Were 6 to 12 months of age at any point in the measurement year; and
  • Who had a medical visit with a provider with prescribing privileges at least once in the measurement year

Note:

  • A "provider with prescribing privileges" is a health care professional who is certified in his/her jurisdiction to prescribe medications.
  • Refer to the original measure documentation for additional data elements.

Exclusions

  • Patients who were newly enrolled after six months of age
  • Patients diagnosed with HIV infection

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Number of human immunodeficiency virus (HIV)-perinatally exposed infants who had at least two virologic diagnostic tests performed at appropriate time points* by age of six months to definitively exclude HIV infection

*Definitive exclusion of HIV infection in a nonbreastfed infant is based on two or more negative virologic tests, with one obtained at age greater than or equal to 1 month and one at greater than or equal to 4 months.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Registry data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Diagnostic testing to exclude HIV infection in exposed infants.

Measure Collection Name

HIV/AIDS Bureau (HAB) Performance Measures

Measure Set Name

Pediatrics

Submitter

Health Resources and Services Administration - Federal Government Agency [U.S.]

Developer

Health Resources and Services Administration - Federal Government Agency [U.S.]

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Unspecified

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2010 Aug

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

Health Resources and Services Administration (HRSA). HAB HIV performance measures: pediatrics. Rockville (MD): Health Resources and Services Administration (HRSA); 2010 Aug 19. 30 p.

Measure Availability

Source available from the Health Resources and Services Administration (HRSA) Web site External Web Site Policy.

For more information, contact the HRSA HIV/AIDS Bureau (HAB) at 5600 Fishers Lane, Rockville, MD 20857; E-mail: HIVmeasures@hrsa.gov; Web site: www.hrsa.gov/index.html External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on July 8, 2016.

Copyright Statement

No copyright restrictions apply.

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