HAB HIV Core Clinical Performance Measures for 

Adult/Adolescent Clients: Group 1

Performance Measure: HAART OPR-Related Measure: Yes 

www.hrsa.gov/performancereview/measures.htm 

Percentage of clients with AIDS who are prescribed HAART 

Numerator: Number of clients with AIDS who were prescribed a HAART regimen1

 within the 

measurement year 

Denominator: 

Number of clients who: 

• have a diagnosis of AIDS (history of a CD4 T-cell count below 200 cells/mm3 or 

other AIDS-defining condition2), and 

• had at least one medical visit with a provider with prescribing privileges3, i.e. MD, 

PA, NP in the measurement year. 

Patient 

Exclusions: 1. Patients newly enrolled in care during last three months of the measurement year 

Data Element: 

1. Is the client diagnosed with CDC-defined AIDS? (Y/N) 

a. If yes, was the client prescribed HAART during the reporting period? 

(Y/N) 

Data Sources: 

• Ryan White Program Data Report, Section 2, Items 26 and 31 may provide data useful 

in establishing a baseline for this performance measure 

• Electronic Medical Record/Electronic Health Record 

• CAREWare, Lab Tracker, or other electronic data base. 

• HIVQUAL reports on this measure for grantee under review 

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

National Goals, 

Targets, or 

Benchmarks 

for 

Comparison 

IHI Goal: 90%4

CDC and HIVRN data consistent that 80% of those in care “eligible for ARVs” on tx. 

This includes CD4<350 and not just AIDS.5,6

National HIVQUAL Data:7,8

2003 2004 2005 2006 

Top 10% 100% 100% 100% 100% 

Top 25% 100% 100% 100% 100% 

Median* 100% 88.9% 95.7% 100% 

*from HAB data base

Outcome 

Measures for 

Consideration: 

° Rate of opportunistic infections in the measurement year 

° Rate of HIV-related hospitalizations in the measurement year 

° Mortality rates 

Basis for Selection and Placement in Group 1: 

“Randomized clinical trials provide strong evidence of improved survival and reduced disease progression by 

treating symptomatic patients and patients with CD4 T-cells <200 cells/mm3.”9 

Measure reflects important aspect of care that significantly impacts survival, mortality and hinders 

transmission. Data collection is currently feasible and measure has a strong evidence base supporting the use.

July 2008 
HAB HIV Core Clinical Performance Measures for 

Adult/Adolescent Clients: Group 1

US Public Health Service Guidelines: 

“Antiretroviral therapy is recommended for all patients with history of an AIDS-defining illness or severe 

symptoms of HIV infection regardless of CD4 T-cell count.” 10 

References/Notes:

1

Many authorities recommend two baseline CD4 T-cell measurements before decisions are made to initiate 

antiretroviral therapy because of wide variations in results. The test should be repeated yet a third time if 

discordant results are seen. The optimal time to initiate antiretroviral therapy among asymptomatic patients 

with CD4 T-cell counts >200 cells/mm3

 is unknown. This measure focuses strictly on the subset of patients 

for whom antiretroviral therapy is unequivocally recommended—those with a CD4 T-cell count below 200 

cells/mm3

 or history of another AIDS-defining condition. Asymptomatic patients with CD4 T-cell counts of 

201–350 cells/mm3 should be offered treatment. For asymptomatic patients with CD4 T-cell of >350 

cells/mm3 and plasma HIV RNA >100,000 copies/ml most experienced clinicians defer therapy but some 

clinicians may consider initiating treatment. (See reference 8 below) 

2

AIDS Defining conditions are noted in CDC. 1993 Revised classification system for HIV infection and 

expanded surveillance case definition for AIDS among adolescents and adults. MMWR 1992;41(no. RR-17). 

(http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm) 

3

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

prescribe ARV therapy. 

4

IHI Measure reads, “Percent of Patients with Appropriate ARV Therapy Management” 

http://www.ihi.org/IHI/Topics/HIVAIDS/HIVDiseaseGeneral/Measures/PercentofPatientswithAppropriateA

RVTherapyManagement.htm) 

5

 Gebo, JAIDS January 2005, vol. 38, pp. 96-103. 

6

 Teshale Abstract #167, CROI 2005. 

7

 The National HIVQUAL data may not be directly comparable due to varying exclusions. Indicator 

definitions can be accessed at http://www.hivguidelines.org/Content.aspx?PageID=53. 

8

http://www.hivguidelines.org/admin/files/qoc/hivqual/proj%20info/HQNatlAggScrs3Yrs.pdf

9

”HAART, CD4<200” 

(http://www.hivguidelines.org/admin/files/qoc/hivqual/proj%20info/HQNatlAggScrs3Yrs.pdf) 

10Panel on Antiretroviral Guidelines for Adult and Adolescents. Guidelines for the use of antiretroviral agents 

in HIV-infected adults and adolescents. Department of Health and Human Services. December 1, 2007; p. 9. 

Available at http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed December 12, 2007.

July 2008