HAB HIV Core Clinical Performance Measures: 

Adult/Adolescent Clients Group 2

HAB HIV Core Clinical Performance Measures for 

Adult/Adolescent Clients: Group 2 

Performance Measure: Adherence Assessment & 

Counseling 

OPR-Related Measure: Yes 

www.hrsa.gov/performancereview/measures.htm 

Percentage of clients with HIV infection on ARVs who were assessed and counseled1,2 for adherence two or 

more times in the measurement year 

Numerator: Number of HIV-infected clients, as part of their primary care, who were assessed and 

counseled for adherence two or more times at least three months apart 

Denominator: Number of HIV-infected clients on ARV therapy who had a medical visit with a provider 

with prescribing privileges3

 at least once in the measurement year 

Patient 

Exclusions: 

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

2. Patients who initiated ARV therapy during last six months of the year 

Data Element: 

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

a. If yes, was the client on ARVs?(Y/N) 

i. If the client was on ARVs, did he/she receive adherence 

counseling during the measurement year? (Y/N). 

1. If yes, list the quarters of these visits. 

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%4 

National HIVQUAL Performance Data:5

2003 2004 2005 2006 

Top 10% 95.8% 92.0% 97.5% 98.4% 

Top 25% 82.7% 79.2% 88.3% 91.6% 

Mean* 57.5% 39.7% 46.8% 55.7% 

*from HAB data base 

Outcome 

Measures for 

Consideration: 

o Percent of undetectable viral loads among patients on ARV in the measurement year 

o Percent of patients with ARV-resistance developed during therapy in the measurement 

year 

o Mortality rates 

o Incidence of HIV-related hospitalizations in the clinic population 

o Incidence of clients with progression to AIDS in the clinic population 

Basis for Selection and Placement in Group 2: 

“Adherence is a key determinant in the degree and duration of virologic suppression. Among studies 

reporting on the association between suboptimal adherence and virologic failure, nonadherence among 

patients on HAART was the strongest predictor for failure to achieve viral suppression below the level of 

detection. HIV viral suppression, reduced rates of resistance, and improved survival have been correlated 

with high rates of adherence to antiretroviral therapy. 

August 1, 2008 Page 1 
HAB HIV Core Clinical Performance Measures: 

Adult/Adolescent Clients Group 2

Prior to writing the first prescriptions, clinicians need to assess the patient’s readiness to take medication. 

Patients need to understand that the first regimen is the best chance for long-term success. Resources need to 

be identified to assist in success. Interventions can also assist with identifying adherence education needs and 

strategies for each patient.”6 

Measure reflects important aspect of care that impacts HIV-related morbidity and focuses on treatment 

decisions that affect a sizable population. Although discussions of the importance of adherence to ARVs is 

important to begin prior to initiation of treatment, there is no standard of care for discussions to occur every 6 

months for patients who may be years away from ARV treatment. 

US Public Health Guidelines: 

"...adherence counseling and assessment should be done at each clinical encounter"7(10/10/06) 

References/Notes:

1

Assessment of adherence includes: 1) patient reports of adherence by: a) quantifiable scales, e.g. missed 3 

out of 10 doses; b) qualitative scale, e.g. Likert scale; or 2) quantification such as pharmacy dispensing 

records, pill counts or direct observation therapy. 

2

Adherence counseling can be provided by any member of the multidisciplinary primary care team. 

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/Clients Assessed for Adherence to Antiretroviral (ARV) Therapy in 

the Past 4 Months” 

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

rAdherencetoAntiretroviralARVTherapyinthePast4Months.htm) 

5

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

6

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents 

[April 7, 2005] (http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL04072005001.pdf) 

7

Ibid 

August 1, 2008 Page 2