HIV Screening

Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for HIV

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica Policy Research disclaims all liability for use or accuracy of any third-party codes contained in the specifications.
 
CPT(R) contained in the Measure specifications is copyright 2004-2018 American Medical Association. LOINC(R) copyright 2004-2018 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2018 International Health Terminology Standards Development Organisation. ICD-10 copyright 2018 World Health Organization. All Rights Reserved.

The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.

Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

None

None

None

Human immunodeficiency virus (HIV) is a communicable infection that leads to a progressive disease with a long asymptomatic period. There were an estimated 38,500 new HIV infections in the United States in 2015 (Centers for Disease Control and Prevention, 2018a). Without treatment, most persons develop acquired immunodeficiency syndrome (AIDS) within 10 years of HIV infection. Antiretroviral therapy (ART) delays this progression and increases the length of survival, but it is most effective when initiated during the asymptomatic phase. Persons living with HIV who use ART and achieve viral suppression can have a nearly normal life expectancy (Samji et al., 2013).  DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents recommends antiretroviral therapy for all HIV-infected individuals to reduce the risk of disease progression (regardless of CD4 cell count at diagnosis) (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2017).

CDC estimates that almost 15% of the 1.1 million adults and adolescents living with HIV infection in the United States are unaware of their infection (Centers for Disease Control and Prevention, 2018b). Among persons diagnosed with HIV in 2011, one quarter were diagnosed with Stage 3 HIV (AIDS) at the time of HIV diagnosis (Centers for Disease Control and Prevention, 2018c), which is when the median CD4 count at diagnosis is less than 200 cells/mm3 for persons aged greater than or equal to 6 years (Centers for Disease Control and Prevention, 2018a). HIV screening identifies infected persons who were previously unaware of their infection, which enables them to seek medical and social services that can improve their health and the quality and length of their lives. Additionally, using ART with high levels of medication adherence has been shown to substantially reduce risk for HIV transmission (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2017).

Based on the National Health Interview Survey, fewer than half of persons 18 and older reported ever having been tested for HIV as of 2017 (Blackwell et al., 2019).

The US Preventive Services Task Force recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened (A Recommendation) (Moyer, 2013). 

Since 2006, the CDC has recommended routine opt-out HIV screening (i.e., patient is notified that testing will be performed unless the patient declines) in healthcare facilities of adolescents and adults 13-64 years of age and HIV diagnostic testing of adolescents and adults with clinical signs or symptoms consistent with HIV infection (Centers for Disease Control and Prevention, 2006).

Higher score indicates better quality

Blackwell, D. L., & Villarroel, M. A. (2019). QuickStats: Age-adjusted percentage of adults aged greater than or equal to 18, who were ever tested for human immunodeficiency virus (HIV) infection, by U.S. census region—National Health Interview Survey, 2017. Morbidity and Mortality Weekly Report, 67(5152), 1432. doi: http://dx.doi.org/10.15585/mmwr.mm675152a6

Centers for Disease Control and Prevention. (2018a). Diagnoses of HIV infection in the United States and dependent areas, 2017. HIV Surveillance Report, 29. Retrieved from https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2017-vol-29.pdf

Centers for Disease Control and Prevention. (2018b). Estimated HIV incidence and prevalence in the United States, 2010–2015. HIV Surveillance Supplemental Report, 23(1). Retrieved from https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-23-1.pdf

Centers for Disease Control and Prevention. (2018c, June). Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2016. HIV Surveillance Supplemental Report, 23(4). Retrieved from https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-23-4.pdf

Centers for Disease Control and Prevention. (2006). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health care settings. Morbidity and Mortality Weekly Report, 55(RR-14), 1-17.

Moyer, V. A., on behalf of the U.S. Preventive Services Task Force. (2013). Screening for HIV: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 159(1), 51-60.

Panel on Antiretroviral Guidelines for Adults and Adolescents. (2017). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Retrieved from https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf

Samji, H., Cescon, A., Hogg, R. S., et al. (2013). Closing the gap: Increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One, 8, e81355.

None

This measure evaluates the proportion of patients aged 15 to 65 at the start of the measurement period who have documentation of having received an HIV test at least once on or after their 15th birthday and before their 66th birthday. In order to satisfy the measure, the reporting provider must have documentation of the administration of the laboratory test present in the patient's medical record. In cases where the HIV test was performed elsewhere, providers cannot rely on patient attestation or self-report to meet the measure requirements, as previous research has shown that patient self-report is an unreliable indicator of previous HIV testing history. Rather, providers must request documentation of those test results. If such documentation is not available, the patient should be considered still eligible for HIV screening. If such documentation is available, but cannot be provided in a standardized, structured format (such that the lab test and results can be readily incorporated as structured data within the EHR), providers should enter the information into their EHR as a laboratory test in a manner consistent with the EHR in use. If the specific Human Immunodeficiency Virus (HIV) Laboratory Test LOINC code of the test is not known, the entry should use the more generic code LOINC panel code [75622-1].

TBD

Patients 15 to 65 years of age at the start of the measurement period AND who had at least one outpatient visit during the measurement period

Equals Initial Population

Patients diagnosed with HIV prior to the start of the measurement period

Patients with documentation of an HIV test performed on or after their 15th birthday and before their 66th birthday

Not Applicable

None

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

NA