HAB HIV Core Clinical Performance Measures for 

Adult/Adolescent Clients: Group 3

Final: April 2009  Page 5 

Performance Measure: Hepatitis B Screening OPR-Related Measure: Yes 

www.hrsa.gov/performancereview/measures.htm 

Percentage of clients1 with HIV infection who have been screened for Hepatitis B virus infection status

Numerator: Number of HIV-infected clients who have documented Hepatitis B infection status2

 in the 

health record 

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

privileges3 at least once in the measurement year 

Patient 

Exclusions: 1. Patients with documentation of complete Hepatitis B vaccination 

Data Elements: 

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

a. If yes, is there documentation of Hepatitis B infection 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. 

Outcome 

Measures for 

Consideration: 

 Hepatitis-related mortality rates in the clinic population 

Basis for Selection and Placement in Group 3: 

Hepatitis B virus (HBV) is the leading cause of chronic liver disease worldwide. In developed countries, 

HBV is transmitted primarily through sexual contact and injection drug use. Even though risk factors are 

similar, HBV is transmitted more efficiently than HIV-1. Up to 90% of HIV-1–infected persons have at least 

one serum marker of previous exposure to HBV, and approximately 10% have chronic Hepatitis B, as 

evidenced by the detection of hepatitis B surface antigen (HBsAg) in the serum persisting for a minimum of 6 

months.4

It is not clear that treatment of hepatitis B virus (HBV) improves the course of HIV, nor is there evidence that 

treatment of HIV alters the course of HBV. However, several liver-associated complications that are ascribed 

to flares in HBV activity or toxicity of antiretroviral agents can affect the treatment of HIV in patients with 

HBV coinfection.5 Therefore, providers should know the HBV status of all patients with HIV. This also will 

guide the choice of medications for HIV treatment in the context of any possible HBV treatment. For 

patients who are HBV negative, prophylaxis is recommended.6
HAB HIV Core Clinical Performance Measures for 

Adult/Adolescent Clients: Group 3

Final: April 2009  Page 6 

The measure is placed in Group 3 because it focuses on similar aspects of care (HBV and HCV) previously 

captured in measures included in Group 2. 

US Public Health Guidelines: 

“All HIV-infected persons should be tested for HBV infection. Initial testing should be performed because 

these will identify the majority of patients with chronic hepatitis B or who need vaccination to prevent 

infection.”7 

“It is not clear that treatment of hepatitis B virus (HBV) improves the course of HIV, nor is there evidence 

that treatment of HIV alters the course of HBV. However, several liver-associated complications that are 

ascribed to flares in HBV activity or toxicity of antiretroviral agents can affect the treatment of HIV in 

patients with HBV coinfection.”8 

References/Notes:

1

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

2 Markers of Hepatitis B infection include Hep B Surface Antigen, Hep B e Antigen, Hep B e Antibody or 

Hep B DNA. 

3

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

prescribe medications. 

4

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) 

5 Panel on Antiretroviral Guidelines for Adult and Adolescents. Guidelines for the Use of Antiretroviral 

Agents in HIV-1-Infected Adults and Adolescents. Department of Health and Human Services. January 29, 

2008; 1-128. (http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf) 

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) 

7

 Panel on Antiretroviral Guidelines for Adult and Adolescents. Guidelines for the Use of Antiretroviral 

Agents in HIV-1-Infected Adults and Adolescents. Department of Health and Human Services. January 29, 

2008; 1-128. (http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf) 

8

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)