HAB HIV Core Clinical Performance Measures for 

Adult/Adolescent Clients: Group 3

Final: April 2009  Page 21 

Performance Measure: Toxoplasma Screening OPR-Related Measure: No 

Percentage of clients1 with HIV infection for whom Toxoplasma screening2 was performed at least once since 

the diagnosis of HIV infection3

Numerator: Number of HIV-infected clients who have documented Toxoplasma status in health record 

Denominator: Number of HIV-infected clients who had a medical visit with a provider with prescribing 

privileges4

 at least once in the measurement year 

Patient 

Exclusions: 1. Patients with known toxoplasmic disease, e.g. Toxoplasma gondii encephalitis 

Data Elements: 

1. Is the client HIV-infected? (Y/N) 

a. If yes, is there documentation of the client’s Toxoplasma status in the 

health record? (Y/N) 

Data Sources: 

 Electronic Medical Record/Electronic Health Record 

CAREWare, Lab Tracker or other electronic data base 

Medical record data abstraction by grantee of a sample of records 

Billing records 

National Goals, 

Targets, or 

Benchmarks 

for 

Comparison: 

None available at this time 

Outcomes 

Measures for 

Consideration: 

 Toxoplasmosis-related mortality rates in the clinic population 

 Incidence of Toxoplasmosis in the clinic population 

Basis for Selection and Placement in Group 3: 

Toxoplasmic disease appears to occur almost exclusively because of reactivation of latent tissue cysts. 

Clinical disease is rare among patients with CD4 counts >200 cells/uL. The greatest risk is among patients 

with a CD4 cell count < 50/uL. HIV-infected patients with Toxoplasma gondii encephalitis (TE) are almost 

uniformly seropositive for anti-toxoplasma IgG antibodies.5 

The measure is placed in Group 3 because it overlaps and focuses on similar aspects of care (prophylaxis) 

previously captured in measures included in Group 1. Certain geographic regions have lower rates of 

toxoplasmic disease. 

US Public Health Guidelines: 

“HIV-infected persons should be tested for immunoglobulin G (IgG) antibody to Toxoplasma soon after the 

diagnosis of HIV infection to deter latent infection with T. gondii (strength of recommendation: BIII).”6

“Toxoplasma-seronegative persons who are not taking a PCP prophylactic regimen known to be active 
HAB HIV Core Clinical Performance Measures for 

Adult/Adolescent Clients: Group 3

Final: April 2009  Page 22 

against TE should be retested for IgG antibody to Toxoplasma when their CD4+ counts decline to <100/uL to 

determine whether they have seroconverted and are therefore at risk for TE (strength of recommendation: 

CIII).”7

References/Notes: 

1

 “Clients” refers to all clients aged 13 years and older. 

2

Toxoplasma screening refers to testing for the presence of anti-toxoplasma immunoglobulin G (IgG) 

antibodies to detect latent infection with Toxoplasma gondii. 3

Unless there is concern about ongoing exposure, annual re-screening is not generally recommended. 

4

A “provider with prescribing privileges” is a health care professional who is certified in their jurisdiction to 

prescribe medications. 

5

Centers for Disease Control and Prevention. Guidelines for Prevention and Treatment of Opportunistic 

Infections in HIV-Infected Adults and Adolescents. June 18, 2008; 1-134. 

(http://aidsinfo.nih.gov/contentfiles/Adult_OI.pdf) 

6

Ibid 

7

Ibid