Definition of a core set of quality indicators for the assessment of HIV/AIDS clinical care: a systematic review

Catumbela, Emanuel; Certal, Victor; Freitas, Alberto; Costa, Carlos; Sarmento, António; da Costa Pereira, Altamiro

doi:10.1186/1472-6963-13-236

BMC Health Services Research

Table 3 Quality indicators for the assessment of HIV/AIDS clinical care by name, type, indicators, and selection criteria

From: Definition of a core set of quality indicators for the assessment of HIV/AIDS clinical care: a systematic review

no.	Name	Type	Quality	American HIV treatment guidelines	European AIDS guidelines	Reference
	A. Baseline evaluation
1	CD4 cell count measurement	P	S	+	+	[23, 25, 27, 28, 30, 31]*
2	Appropriate viral load test timing	P	S	+	+	[25, 29, 31]*
3	Renal basic assessment (Creatinine, Blood urea nitrogen, )	P	G	+	+	[20, 31]
4	Complete blood count	P	G	+	+	[20, 23, 31]*
5	Chemistry analysis (Serum LDH , Sodium, Venous bicarbonate, Hypoxemia ratio, Serum albumin)	P	G	+	-	[24]
6	Proportion of patients with CD4 count greater than 200 cells/ul	O	S	+	+	[29, 30]*
7	Bilirubin	O	G	+	+	[24]
8	Admission body mass index	O	G	-	+	[24]
9	Ask about loss of appetite	P	G	-	+	[24]
10	Monitor patient’s weight	P	G	-	+	[22, 24]
11	CNS change	O	G	-	+	[21]
12	Complicated cough	O	G	-	-	[24]
13	Diarrhea	O	G	-	-	[24]
14	Heart rate	O	G	-	+	[24]
15	Rales	O	G	-	-	[20]
16	Respiratory rate	O	G	-	-	[21]
17	Lung examination	P	G	+	+	[24]
18	ECG performed in patients on methadone	P	S	-	+	[31]
19	Cardiovascular risk assessment	P	G	-	+	[31]
	B. Screening
20	Cervical cancer screening (basis and follow up)	P	G	+	+	[26, 28, 30]*
21	Hepatitis C screening (basis and follow up)	P	G	+	+	[25–27, 31]*
22	Hepatitis B testing ever (basis and follow up)	P	G	+	+	[25, 27]*
23	Tuberculosis screening	P	G	+	+	[22, 23, 25–28, 30, 31]*
24	Gonorrhea/chlamydia screening (at least once)	P	S	-	+	[23, 25, 27]**
25	Syphilis screening (annually)	P	S	-	+	[25, 27, 28, 30, 31]**
26	Injection drug use screening (annually)	P	G	-	+	[23, 27, 28]**
27	High-risk sexual behavior screening (annually)	P	G	-	+	[23, 27, 28]**
28	Papanicolau test in last year (for women only)	P	G	-	+	[23, 25]
	C. Immunization
29	Pneumococcal vaccine in previous 6 months if CD4 >200	P	G	-	+	[25, 27, 28, 31]**
30	Influenza vaccination (annually)	P	G	-	+	[26–28]**
31	Hepatitis B vaccination first dose received (if appropriate)	P	G	+	+	[25, 27, 28, 31]*
32	Hepatitis A vaccination	P	G	+	+	[28, 31]*
	D. Prophylaxis (patients with <200 lymphocyte CD4)
33	MAC prophylaxis	P	G	-	-	[23, 28]
34	PCP (pneumocystis jiroveci pneumonia) prophylaxis	P	G	-	-	[23, 25–28, 30, 31]
35	Toxoplasmosis prophylaxis	P	G	-	-	[23, 31]
36	TB prophylaxis if reactive PPD	P	G	+	-	[25]
37	Cryptococcosis prophylaxis for patients with CD4 <100 cells/ul	P	G	-	-	[30]
	E. HIV Monitoring
38	Non-detectable HIV viral load at 48 treatment weeks	O	S	+	+	[26, 31] *
39	Proportion of patients who received their fist-time CD4 count within 2 weeks after first HIV clinic visit	P	S	-	-	[28, 29]
40	Proportion of patients eligible for ART who are currently on ART	P	S	+	+	[29]
41	Proportion of patients on ART for whom adherence is measured on last three visits	P	S	-	-	[29, 31]
42	Proportion of patients on NVP who had LFT at least once within 1 month after initiation of NVP-based ART	P	S	-	-	[29]
43	Proportion of patients with previous ARV regimen change for whom reason for change in regime is documented	P	S	+	+	[29, 31] *
44	Proportion of patients on ARV with at least 95% (good) reported adherence on last visit	O	S	+	+	[29, 32] *
45	Achieving maximal viral control if prescribed ART	O	S	+	+	[27]
46	Achieving maximal viral control if prescribed ART or treatment plan documentation if maximal viral control not achieved.	O	S	+	+	[27]
47	proportion of patients with continued care	P	G	+	+	[29, 32] *
48	Visits in three quarters	P	G	+	-	[26, 28]
49	HIV counseling and test offered	P	S	+	+	[23, 31]*
50	Length of stay in hospital	P	G	-	-	[20]
51	Loss of follow up	P	G	+	-	[31, 32]**
52	Percent HIV/AIDS hospital mortality	O	S	-	-	[20]
53	HIV prevalence among pregnant women	P	S	+	+	[22]
	F. Therapy
54	Appropriately prescribed ART	P	S	+	+	[22, 23, 25–28, 30, 31]*
55	Proportion of patients on cotrimoxazole prophylaxis with at least 95% reported adherence on last visit	P	S	-	-	[24, 29]
56	Proportion of patients whose CD4 count is <350 cell/ul who are currently on cotrimoxazole prophylactic therapy	P	S	-	-	[29]
57	In patients with at most CD4 count <200 cells/microliter Prescribe an antibiotic or admit the patient to the hospital	P	S	-	-	[24]
58	Proportions of patients on ART who are started on ART within 2 weeks after clinical eligibility is confirmed	P	S	+	+	[29]
59	Proportion of either bedridden or ambulatory patients who have improvement in functional status	O	S	-	+	[29]
60	Proportion of HIV-positive clients given treatment for latent TB infection	P	S	+	+	[22, 30, 31]*
61	Proportion of HIV-positive registered TB patients given ART during TB treatment	P	S	+	+	[22]
62	Percent of HIV-positive patients in HIV care or treatment (pre-ART or ART) who started TB treatment	P	S	+	+	[22, 30]
63	Patient with HIV receiving Hepatitis C treatment	P	G	+	+	[31]
64	Co-management of Tuberculosis and HIV Treatment	P	S	+	+	[22]
65	Number of HIV-positive pregnant women who received antiretroviral to reduce risk of mother-to-child-transmission	P	S	+	+	[22]

Type of indicator: P – Process (50) and O – Outcome (15); Quality indicator: S – specific (29) and G – generic (36). American and European HIV treatment guidelines: (+) present; (−) absent.
Number of indicators by clinical area: A (19); B (9); C (4); D (5); E (16); F (12).
* Indicators that are in both guidelines and are used in more than one study.
** Indicators that are only in one guideline and are used in more than one study.

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ISSN: 1472-6963

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