BVCOG HRSA/HAB Tier 2 and 3 Performance Measures

1. BVCOGHRSA/HAB Tier 2 and 3Performance Measures Lisa Cornelius, MD, MPH July 2010

2. An estimated 850,000 to 950,000 people are infected with HIV in the United States.

5. Adherence Tb Cervical Cancer Hepatitis B Hepatitis C Influenza Pneumococcal MAC prophylaxis Screening and Vaccination Measures

8. Adherence Assessment % of clients with HIV infection on ARVs who were assessed and counseled for adherence 2 or more times in the measurement year

9. DiPerrri HARRT in the New Century Sept 2004 S4-7

12. Tuberculosis (Tb) Screening % of clients with HIV infection who received testing with results documented for latent Tb infection (LTBI) since HIV diagnosis

13. Tb and HIV • At least 1/3 of HIV-infected patients worldwide are infected with Tb • 8-10% of patients develop clinical disease each year • 456,000 deaths from Tb in HIV-infected patients each year worldwide Swaminathan CID 2010;50(10):1377-86

14. Tb and HIV • Without treatment, HIV and TB can work together to shorten the life of the person infected. • Someone with untreatedLTBIand HIV infection is much more likely to develop active TB disease during his lifetime than someone without HIV infection. • Among people with LTBI, HIV infection is the strongest known risk factor for progressing to active TB disease. • A person who has both HIV infection and active TB disease has an AIDS-defining condition. http://www.cdc.gov/tb/topic/TBHIVcoinfection/default.htm

17. Cervical Cancer Screening % of women with HIV infection who have a Pap screening in the measurement year

22. Viral Hepatitis (B and C) Screening % of clients who have been screened for HCV and HBV infection at least once since diagnosis of HIV infection

24. Hepatitis B Vaccination % of clients with HIV infection who completed the vaccination series for HBV

26. HBV and HIV • Both are bloodborne viruses transmitted primarily through sexual contact and injection drug use. • Because of these shared modes of transmission, a high proportion of adults at risk for HIV infection are also at risk for HBV infection. • HIV-positive persons who become infected with Hepatitis B virus (HBV) are at increased risk for developing chronic HBV infection and should be tested. • In addition, persons who are co-infected with HIV and HBV can have serious medical complications, including an increased risk for liver-related morbidity and mortality. • The Advisory Committee on Immunization Practices recommends universal Hepatitis B vaccination of susceptible patients with HIV/AIDS. http://www.cdc.gov/hepatitis/Populations/hiv.htm

27. HCV and HIV • 1/4 of HIV-infected persons in the United States are also infected with Hepatitis C virus (HCV). • HCV is a bloodborne virus transmitted through direct contact with the blood of an infected person. Thus, coinfection with HIV and HCV is common (50%–90%) among HIV-infected injection drug users. • HCV is one of the most important causes of chronic liver disease in the United States and HCV infection progresses more rapidly to liver damage in HIV-infected persons. • HCV infection may also impact the course and management of HIV infection. http://www.cdc.gov/hepatitis/Populations/hiv.htm

28. Influenza Vaccination % of clients with HIV infection who have received influenza vaccination within the measurement period

29. Influenza and HIV • People with HIV/AIDS are considered at increased risk from serious influenza-related complications. • Studies have shown an increased risk for heart- and lung-related hospitalizations in people infected with HIV during influenza season and a higher risk of influenza-related death in HIV-infected people. • Other studies have indicated that influenza symptoms might be prolonged and the risk of influenza-related complications higher for certain HIV-infected people. • Because influenza can result in serious illness, HIV-infected persons are recommended for vaccination. During the setting of vaccine shortage, people with HIV/AIDS are among the priority groups that should get flu shots. http://www.cdc.gov/flu/protect/hiv-flu.htm

30. Prevention &Control of Seasonal Influenza with Vaccines –Recommendations of the Advisory Committee on Immunization Practices (ACIP) 2009. MMWR 2009 Jul 24; Early Release:1-52.

31. CDC’s Advisory Committee on Immunization Practices (ACIP) • A panel of immunization experts voted on February 24, 2010 to expand the recommendation for annual influenza vaccination to include all people aged 6 months and older. • The expanded recommendation is to take effect in the 2010 – 2011 influenza season. • The new recommendation seeks to remove barriers to influenza immunization and signals the importance of preventing influenza across the entire population. http://www.cdc.gov/media/pressrel/2010/r100224.htm

32. Pneumococcal Vaccination % of clients with HIV infection who ever received pneumococcal vaccine

33. Pneumococcal Pneumonia • Globally, pneumonia causes more deaths than any other infectious disease, such as AIDS, malaria or tuberculosis. • Certain people are more likely to become ill with pneumonia. • This includes adults 65 years of age or older and children less than 5 years of age. • People up through 64 years of age who have underlying medical conditions (like diabetes or HIV/AIDS) and • people 19 through 64 who smoke cigarettes or have asthma are also at increased risk for getting pneumonia. • In the U.S., the most common bacterial cause of pneumonia is Streptococcus pneumoniae (pneumococcus) http://www.cdc.gov/Features/Pneumonia/

34. The 1997 ACIP recommendations for prevention of pneumococcal disease. Available at: http://www.cdc.gov/mmwr/PDF/rr/rr4608.pdf

36. Mycobacterium avium Complex (MAC) % of clients with HIV infection with CD4 count <50 cells/mm3 who were prescribed MAC prophylaxis within the measurement year

37. MAC • Mycobacterium avium complex = comprising M. avium and M.intracellulare. • In HIV infected persons, manifestations are of multi-organ infection: night sweats, weight loss, abdominal pain, fatigue, diarrhea, and anemia. • Most likely environmentally acquired through inhalation or ingestion. • Risk Groups: HIV-infected persons. • Rarely in children or nonimmuno-compromised persons. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/mycobacteriumavium_t.htm

38. http://aidsinfo.nih.gov

39. MAC • In the absence of ART or prophylaxis for those with AIDS-associated immunosuppression, incidence of disseminated MAC disease is 20-40% • For those with CD4 count <100cells who are receiving effective prophylaxis or have responded to ART, incidence is 2 cases per 100-person years http://aidsinfo.nih.gov/contentfiles/Adult_OI_041009.pdf

40. MAC risk factors • CD4 counts <50 cells/mm3 • High plasma HIV RNA levels (>100,000 copies/ml) • Previous opportunistic infections • Previous colonization of the respiratory or gastrointestinal tract http://aidsinfo.nih.gov/contentfiles/Adult_OI_041009.pdf

41. http://aidsinfo.nih.gov/contentfiles/Adult_OI_041009.pdf

42. Adherence Tb Cervical Cancer Hepatitis B Hepatitis C Influenza Pneumococcal MAC prophylaxis Screening and Vaccination Measures: Summary