HAB HIV Core Clinical Performance Measures for 

Adult/Adolescent Clients: Group 3

Final: April 2009  Page 11 

Performance Measure: MAC Prophylaxis OPR-Related Measure: No 

Percentage of clients1 with HIV infection with CD4 count < 50 cells/mm3 who were prescribed 

Mycobacterium avium Complex (MAC) prophylaxis2

 within the measurement year 

Numerator: Number of HIV-infected clients with CD4 count < 50 cells/mm3 who were prescribed 

MAC prophylaxis 

Denominator: 

Number of HIV-infected clients who had a: 

 CD4 count < 50 cells/mm3 ; and 

 medical visit with a provider with prescribing privileges3 at least once in the 

measurement year 

Patient 

Exclusions: 1. Patients who have disseminated MAC 

Data Elements: 

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

a. If yes, was the CD4 count < 50 cells/mm3? (Y/N) 

i. If yes, was MAC prophylaxis subsequently prescribed? 

Data Sources: 

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 

Billing records 

National Goals, 

Targets, or 

Benchmarks 

for 

Comparison: 

National HIVQUAL Data:4

 2003 2004 2005 2006 2007 

Top 10% 100% 100% 100% 100% 100% 

Top 25% 100% 100% 100% 100% 100% 

Mean* 86.5% 84.7% 85.7% 83.1% 84.6% 

*from HAB data base 

Outcome 

Measures for 

Consideration: 

 Incidence of MAC disease in the clinic population 

 MAC-related mortality rates in the population assessed 

Basis for Selection and Placement in Group 3: 

MAC disease is an opportunistic infection that can cause severe illness in people with advanced AIDS but 

rarely affects others. The risk of disseminated MAC (DMAC) is directly related to the severity of 

immunosuppression. DMAC typically occurs in persons with CD4 counts < 50 cells/mm3 and its frequency 

increases as the CD4 count declines. In the absence of antibiotic prophylaxis, DMAC occurs in up to 40% of 

AIDS patients with CD4 counts of < 50 cells/mm.5 

The measure was placed in Group 3 because it focuses on similar aspects of care (prophylaxis) previously 
HAB HIV Core Clinical Performance Measures for 

Adult/Adolescent Clients: Group 3

Final: April 2009  Page 12 

captured in measures included in Groups 1 & 2. 

US Public Health Guidelines: 

“Adults and adolescents who have HIV infection should receive chemoprophylaxis against disseminated 

MAC disease if they have CD4 count < 50 cells/mm.3”6

References/Notes: 

1

 “Clients” includes all clients aged 13 years and older.

2

Current regimens for preventing MAC can be found at: 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) 

3

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

prescribe medications. 

4 MAC Prophylaxis 

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

5

 National AIDS Education & Training Centers (2006). Clinical Manual for Management of the HIV-Infected 

Adult. 

6

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)