HAB HIV Core Clinical Performance Measures for 

Adult/Adolescent Clients: Group 1

Performance Measure: CD4 T-Cell Count OPR-Related Measure: Yes 

www.hrsa.gov/performancereview/measures.htm

Percentage of clients with HIV infection who had 2 or more CD4 T-cell counts performed in the 

measurement year 

Numerator: Number of HIV-infected clients who had 2 or more CD4 T-cell counts performed at least 

3 months apart during the measurement year 

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

privileges1, i.e. MD, PA, NP at least once in the measurement year 

Patient 

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

Data Element: 

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

a. If yes, did the client have a CD4 count test conducted during the 

reporting period? (Y/N) 

a. If yes, list the quarters of these tests 

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 

National Goals, 

Targets, or 

Benchmarks 

for 

Comparison 

IHI Goal: 90%2

National HIVQUAL Data: 3 

2003 2004 2005 2006 

Top 10% 87.2% 87.7% 90.3% 87.5% 

Top 25% 74.2% 78.0% 76.6% 78.8% 

Median* 61.0% 62.7% 63.9% 62.5% 

*from HAB data base

Outcome 

Measures for 

Consideration 

° Rate of opportunistic infections in the measurement year 

° Rate of clients with progression to AIDS in the measurement year 

° Mortality rates 

Basis for Selection and Placement in Group 1: 

The CD4 T-cell count plays a vital role in determining the staging of HIV disease and indicating the need for 

prophylaxis against opportunistic infections. It continues to be used in decisions regarding initiation or 

adjustment of antiretroviral treatment. 

The most recent CD4 T-cell count is the strongest predictor of subsequent disease progression and survival, 

according to clinical trials and cohort studies data on patients receiving antiretroviral therapy.4 

Measure reflects important aspects of care that significantly impacts survival and mortality. Data collection is 

currently feasible and measure has a strong evidence base supporting the use.

US Public Health Service Guidelines: 

" In general, CD4 T-cell count should be determined every three to six months to (1) determine when to start 

antiretroviral in patients who do not meet the criteria for initiation; (2) assess immunologic response to 

July 2008 
HAB HIV Core Clinical Performance Measures for 

Adult/Adolescent Clients: Group 1

antiretroviral therapy; and (3) assess the need for initiating chemoprophylaxis for opportunistic infections." 3

References/Notes:

Guidelines state that CD4 T-cell counts should be measured at least every 3-4 months depending on the stage 

of the disease. The timeframe of 6 months was determined by clinical expert consensus for the purpose of 

this measure, but can and should be measured at more frequent intervals if needed. 

1

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

prescribe ARV therapy. 

2

IHI Measure reads, “Percent of Patients/Clients with a CD4 Count Test in the Past 4 Months” 

(http://www.ihi.org/IHI/Topics/HIVAIDS/HIVDiseaseGeneral/Measures/Percentof+patientswithaCD4countt

estinthepast4months.htm) 

3

National HIVQUAL data looks at the percent of clients who have a CD4 T-cell count done every four

months, not every six months. 

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

4

Panel 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; 1-

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

2007.

July 2008