Title: HIV ScreeningFHIR Id: HIVScreeningFHIR Download cql: HIVScreeningFHIR.cql Version: 0.0.001 Url: HIV ScreeningFHIR short-name identifier: CMS349FHIR version-independent identifier: urn:uuid:40b617bf-3054-4663-bf9c-a15417c9a7dc version-specific identifier: urn:uuid:2c928085806c39a2018085c0e0570593 publisher (CMS) identifier: 349FHIR Effective Period: 2024-01-01 ..2024-12-31 Status: draft Date: 2023-10-27 08:12:32+0000 Approval Date: 2023-08-14 Last Review Date: 2023-08-14 Name: HIVScreeningFHIR Publisher: Centers for Disease Control and Prevention (CDC) Author: Mathematica: https://www.mathematica.org/ Description: Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for Human immunodeficiency virus (HIV) Use Context: code value program Purpose: UNKNOWN Copyright: Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2022 World Health Organization. All Rights Reserved. Disclaimer: The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]. Rationale: Human immunodeficiency virus (HIV) is a communicable infection that leads to a progressive disease with a long asymptomatic period. There were an estimated 34,800 new HIV infections in the United States in 2019 (Centers for Disease Control and Prevention, 2021a). Without treatment, most persons develop acquired immunodeficiency syndrome (AIDS) within 10 years of HIV infection. Antiretroviral therapy (ART) delays this progression and increases the length of survival, but it is most effective when initiated during the asymptomatic phase. Persons living with HIV who use ART and achieve viral suppression can have a nearly normal life expectancy (Samji et al., 2013). DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents recommends immediate antiretroviral therapy for all HIV-infected individuals, regardless of CD4 count at diagnosis, to reduce the risk of disease progression (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2019). CDC estimates that, at the end of 2016, approximately 14% of the 1.1 million adults and adolescents living with HIV infection in the United States were unaware of their infection (Centers for Disease Control and Prevention, 2018b). Among persons diagnosed with HIV in 2017, approximately 21% were diagnosed with Stage 3 HIV (AIDS) at the time of HIV diagnosis (Centers for Disease Control and Prevention, 2019c), which is when the median CD4 count at diagnosis is less than 200 cells/mm3 for persons aged greater than or equal to 6 years (Centers for Disease Control and Prevention, 2019a). HIV screening identifies infected persons who were previously unaware of their infection, which enables them to seek medical and social services that can improve their health and the quality and length of their lives. Additionally, using ART with high levels of medication adherence has been shown to substantially reduce risk for HIV transmission (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2019). Based on the Behavioral Risk Factor Surveillance System (BRFSS), the percentage of ever tested for HIV increased from 42.9% in 2011 to 45.9% in 2017. Despite this increase, less than half of US adults have ever been tested for HIV over ten years after CDC’s recommendations (Patel et al., 2019). Clinical recommendation statement: The US Preventive Services Task Force recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened (A Recommendation) (Owens, et al., 2019). Since 2006, the CDC has recommended routine opt-out HIV screening (i.e., patient is notified that testing will be performed unless the patient declines) in healthcare facilities of adolescents and adults 13-64 years of age and HIV diagnostic testing of adolescents and adults with clinical signs or symptoms consistent with HIV infection (Centers for Disease Control and Prevention, 2006). Guidance (Usage): This measure evaluates the proportion of patients aged 15 to 65 at the start of the measurement period who have documentation of having received an HIV test at least once on or after their 15th birthday and before their 66th birthday. In order to satisfy the measure, the reporting provider must have documentation of the administration of the laboratory test present in the patient's medical record. In cases where the HIV test was performed elsewhere, providers cannot rely on patient attestation or self-report to meet the measure requirements, as previous research has shown that patient self-report is an unreliable indicator of previous HIV testing history. Rather, providers must request documentation of those test results. If such documentation is not available, the patient should be considered still eligible for HIV screening. If such documentation is available, but cannot be provided in a standardized, structured format (such that the lab test and results can be readily incorporated as structured data within the EHR), providers should enter the information into their EHR as a laboratory test in a manner consistent with the EHR in use. If the specific Human Immunodeficiency Virus (HIV) Laboratory Test LOINC code of the test is not known, the entry should use the more generic code LOINC panel code [75622-1]. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS349v6. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html). Population Criteria: 6385057e4ba3d47c885c02cc Initial Population: Patients 15 to 65 years of age at the start of the measurement period AND who had at least one outpatient visit during the measurement period Denominator: Equals Initial Population Denominator Exclusion: Patients diagnosed with HIV prior to the start of the measurement period Denominator Exception: None Numerator: Patients with documentation of an HIV test performed on or after their 15th birthday and before their 66th birthday Numerator Exclusion: None Supplemental Data Guidance : Supplemental Data Elements: SDE Ethnicity SDE Payer SDE Race SDE Sex Libraries: HIVScreeningFHIR Related Artifact Dependencies: SupplementalDataElements version: 3.4.000 QICoreCommon version: 1.5.000 FHIRHelpers version: 4.3.000 http://hl7.org/fhir/v3/AdministrativeGender LOINC ActCode ConditionVerificationStatus Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag) Preventive Care Services, Initial Office Visit, 0 to 17 Preventive Care Services-Initial Office Visit, 18 and Up Preventive Care, Established Office Visit, 0 to 17 Preventive Care Services - Established Office Visit, 18 and Up Office Visit Payer HIV Parameters: name use min max type Measurement Period In 0 1 Period SDE Sex Out 0 1 Coding Numerator Out 0 1 boolean Denominator Out 0 1 boolean SDE Payer Out 0 * Resource Initial Population Out 0 1 boolean SDE Ethnicity Out 0 1 Resource Denominator Exclusions Out 0 1 boolean SDE Race Out 0 1 Resource DataRequirements: Type Elements Valueset Name Valueset Patient(QICorePatient) ethnicity race Observation(QICoreObservation) code effective status status.value Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag) Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag) Observation(QICoreObservation) code effective status status.value Encounter(QICoreEncounter) type period class status status.value Preventive Care Services, Initial Office Visit, 0 to 17 Preventive Care Services, Initial Office Visit, 0 to 17 Encounter(QICoreEncounter) type period class status status.value Preventive Care Services-Initial Office Visit, 18 and Up Preventive Care Services-Initial Office Visit, 18 and Up Encounter(QICoreEncounter) type period class status status.value Preventive Care, Established Office Visit, 0 to 17 Preventive Care, Established Office Visit, 0 to 17 Encounter(QICoreEncounter) type period class status status.value Preventive Care Services - Established Office Visit, 18 and Up Preventive Care Services - Established Office Visit, 18 and Up Encounter(QICoreEncounter) type period class status status.value Office Visit Office Visit Coverage(QICoreCoverage) type period Payer Type Payer Condition(QICoreCondition) code verificationStatus HIV HIV Direct Reference Codes: display code system Male M http://hl7.org/fhir/v3/AdministrativeGender Female F http://hl7.org/fhir/v3/AdministrativeGender HIV 1 and 2 tests - Meaningful Use set 75622-1 http://loinc.org Ambulatory AMB http://terminology.hl7.org/CodeSystem/v3-ActCode refuted http://terminology.hl7.org/CodeSystem/condition-ver-status Logic Definitions: Group Scoring Population Criteria Expression 6385057e4ba3d47c885c02cc Group scoring: proportion Initial Population define "Initial Population": AgeInYearsAt(date from start of "Measurement Period") in Interval[15, 65] and exists "Qualifying Encounters" Denominator define "Denominator": "Initial Population" Denominator Exclusion define "Denominator Exclusions": exists ( ["Condition": "HIV"] HIV where QICoreCommon."ToPrevalenceInterval" ( HIV Indicators ) starts before start of "Measurement Period" and HIV.verificationStatus !~ "refuted" ) Denominator Exception None Numerator define "Numerator": ( "Has HIV Test Performed" ) Numerator Exclusion None Library Name Name SupplementalDataElements SDE Sex define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end Library Name Name HIVScreeningFHIR SDE Sex define "SDE Sex": SDE."SDE Sex" Library Name Name HIVScreeningFHIR Has HIV Test Performed define "Has HIV Test Performed": exists ( ["Observation": "Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)"] union ["Observation": "HIV 1 and 2 tests - Meaningful Use set"] ) HIVTest where AgeInYearsAt(date from start of QICoreCommon."ToInterval"(HIVTest.effective)) in Interval[15, 65] and QICoreCommon."ToInterval" ( HIVTest.effective ) starts before end of "Measurement Period" and ( HIVTest.status = 'final' or HIVTest.status = 'amended' or HIVTest.status = 'corrected' ) Library Name Name HIVScreeningFHIR Numerator define "Numerator": ( "Has HIV Test Performed" ) Library Name Name HIVScreeningFHIR Qualifying Encounters define "Qualifying Encounters": ( ["Encounter": "Preventive Care Services, Initial Office Visit, 0 to 17"] union ["Encounter": "Preventive Care Services-Initial Office Visit, 18 and Up"] union ["Encounter": "Preventive Care, Established Office Visit, 0 to 17"] union ["Encounter": "Preventive Care Services - Established Office Visit, 18 and Up"] union ["Encounter": "Office Visit"] ) Encounter where Encounter.period during "Measurement Period" and Encounter.class ~ "AMB" and Encounter.status = 'finished' Library Name Name HIVScreeningFHIR Initial Population define "Initial Population": AgeInYearsAt(date from start of "Measurement Period") in Interval[15, 65] and exists "Qualifying Encounters" Library Name Name HIVScreeningFHIR Denominator define "Denominator": "Initial Population" Library Name Name SupplementalDataElements SDE Payer define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period } Library Name Name HIVScreeningFHIR SDE Payer define "SDE Payer": SDE."SDE Payer" Library Name Name SupplementalDataElements SDE Ethnicity define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text } Library Name Name HIVScreeningFHIR SDE Ethnicity define "SDE Ethnicity": SDE."SDE Ethnicity" Library Name Name HIVScreeningFHIR Denominator Exclusions define "Denominator Exclusions": exists ( ["Condition": "HIV"] HIV where QICoreCommon."ToPrevalenceInterval" ( HIV Indicators ) starts before start of "Measurement Period" and HIV.verificationStatus !~ "refuted" ) Library Name Name SupplementalDataElements SDE Race define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text } Library Name Name HIVScreeningFHIR SDE Race define "SDE Race": SDE."SDE Race" Library Name Name QICoreCommon ToInterval /* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in QICore, allowing this function to be used across any resource. The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime. If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age, and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later. If the input is a DateTime Interval, the result is the input. If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending immediately before one year later than the date the patient turned the age given as the end of the quantity interval. Any other input will reslt in a null DateTime Interval @deprecated: This function is deprecated. Use the fluent function `toInterval()` instead */ define function ToInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>>): case when choice is DateTime then Interval[choice as DateTime, choice as DateTime] when choice is Interval<DateTime> then choice as Interval<DateTime> when choice is Quantity then Interval[Patient.birthDate + (choice as Quantity), Patient.birthDate + (choice as Quantity) + 1 year) when choice is Interval<Quantity> then Interval[Patient.birthDate + (choice.low as Quantity), Patient.birthDate + (choice.high as Quantity) + 1 year) when choice is QICore.Timing then null as Interval<DateTime> else null as Interval<DateTime> end Library Name Name FHIRHelpers ToString define function ToString(value uri): value.value Library Name Name FHIRHelpers ToCode /* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value } Library Name Name QICoreCommon ToPrevalenceInterval /* @description: Returns an interval representing the normalized prevalence period of a given Condition. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. If the condition is active, the resulting interval will have a closed ending boundary. If the condition is not active, the resulting interval will have an open ending boundary. @deprecated: This function is deprecated. Use the `prevalenceInterval()` fluent function instead */ define function ToPrevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition)] else Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition))
define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end
define "Has HIV Test Performed": exists ( ["Observation": "Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)"] union ["Observation": "HIV 1 and 2 tests - Meaningful Use set"] ) HIVTest where AgeInYearsAt(date from start of QICoreCommon."ToInterval"(HIVTest.effective)) in Interval[15, 65] and QICoreCommon."ToInterval" ( HIVTest.effective ) starts before end of "Measurement Period" and ( HIVTest.status = 'final' or HIVTest.status = 'amended' or HIVTest.status = 'corrected' )
define "Numerator": ( "Has HIV Test Performed" )
define "Qualifying Encounters": ( ["Encounter": "Preventive Care Services, Initial Office Visit, 0 to 17"] union ["Encounter": "Preventive Care Services-Initial Office Visit, 18 and Up"] union ["Encounter": "Preventive Care, Established Office Visit, 0 to 17"] union ["Encounter": "Preventive Care Services - Established Office Visit, 18 and Up"] union ["Encounter": "Office Visit"] ) Encounter where Encounter.period during "Measurement Period" and Encounter.class ~ "AMB" and Encounter.status = 'finished'
define "Initial Population": AgeInYearsAt(date from start of "Measurement Period") in Interval[15, 65] and exists "Qualifying Encounters"
define "Denominator": "Initial Population"
define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }
define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }
define "SDE Ethnicity": SDE."SDE Ethnicity"
define "Denominator Exclusions": exists ( ["Condition": "HIV"] HIV where QICoreCommon."ToPrevalenceInterval" ( HIV Indicators ) starts before start of "Measurement Period" and HIV.verificationStatus !~ "refuted" )
define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }
/* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in QICore, allowing this function to be used across any resource. The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime. If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age, and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later. If the input is a DateTime Interval, the result is the input. If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending immediately before one year later than the date the patient turned the age given as the end of the quantity interval. Any other input will reslt in a null DateTime Interval @deprecated: This function is deprecated. Use the fluent function `toInterval()` instead */ define function ToInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>>): case when choice is DateTime then Interval[choice as DateTime, choice as DateTime] when choice is Interval<DateTime> then choice as Interval<DateTime> when choice is Quantity then Interval[Patient.birthDate + (choice as Quantity), Patient.birthDate + (choice as Quantity) + 1 year) when choice is Interval<Quantity> then Interval[Patient.birthDate + (choice.low as Quantity), Patient.birthDate + (choice.high as Quantity) + 1 year) when choice is QICore.Timing then null as Interval<DateTime> else null as Interval<DateTime> end
define function ToString(value uri): value.value
/* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
/* @description: Returns an interval representing the normalized prevalence period of a given Condition. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. If the condition is active, the resulting interval will have a closed ending boundary. If the condition is not active, the resulting interval will have an open ending boundary. @deprecated: This function is deprecated. Use the `prevalenceInterval()` fluent function instead */ define function ToPrevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition)] else Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition))
Value set Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)
Value set Preventive Care Services, Initial Office Visit, 0 to 17
Value set Preventive Care Services-Initial Office Visit, 18 and Up
Value set Preventive Care, Established Office Visit, 0 to 17
Value set Preventive Care Services - Established Office Visit, 18 and Up
Centers for Disease Control and Prevention (CDC)
Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for Human immunodeficiency virus (HIV)
This measure evaluates the proportion of patients aged 15 to 65 at the start of the measurement period who have documentation of having received an HIV test at least once on or after their 15th birthday and before their 66th birthday. In order to satisfy the measure, the reporting provider must have documentation of the administration of the laboratory test present in the patient's medical record. In cases where the HIV test was performed elsewhere, providers cannot rely on patient attestation or self-report to meet the measure requirements, as previous research has shown that patient self-report is an unreliable indicator of previous HIV testing history. Rather, providers must request documentation of those test results. If such documentation is not available, the patient should be considered still eligible for HIV screening. If such documentation is available, but cannot be provided in a standardized, structured format (such that the lab test and results can be readily incorporated as structured data within the EHR), providers should enter the information into their EHR as a laboratory test in a manner consistent with the EHR in use. If the specific Human Immunodeficiency Virus (HIV) Laboratory Test LOINC code of the test is not known, the entry should use the more generic code LOINC panel code [75622-1]. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS349v6. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html).
Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2022 World Health Organization. All Rights Reserved.
The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Human immunodeficiency virus (HIV) is a communicable infection that leads to a progressive disease with a long asymptomatic period. There were an estimated 34,800 new HIV infections in the United States in 2019 (Centers for Disease Control and Prevention, 2021a). Without treatment, most persons develop acquired immunodeficiency syndrome (AIDS) within 10 years of HIV infection. Antiretroviral therapy (ART) delays this progression and increases the length of survival, but it is most effective when initiated during the asymptomatic phase. Persons living with HIV who use ART and achieve viral suppression can have a nearly normal life expectancy (Samji et al., 2013). DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents recommends immediate antiretroviral therapy for all HIV-infected individuals, regardless of CD4 count at diagnosis, to reduce the risk of disease progression (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2019). CDC estimates that, at the end of 2016, approximately 14% of the 1.1 million adults and adolescents living with HIV infection in the United States were unaware of their infection (Centers for Disease Control and Prevention, 2018b). Among persons diagnosed with HIV in 2017, approximately 21% were diagnosed with Stage 3 HIV (AIDS) at the time of HIV diagnosis (Centers for Disease Control and Prevention, 2019c), which is when the median CD4 count at diagnosis is less than 200 cells/mm3 for persons aged greater than or equal to 6 years (Centers for Disease Control and Prevention, 2019a). HIV screening identifies infected persons who were previously unaware of their infection, which enables them to seek medical and social services that can improve their health and the quality and length of their lives. Additionally, using ART with high levels of medication adherence has been shown to substantially reduce risk for HIV transmission (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2019). Based on the Behavioral Risk Factor Surveillance System (BRFSS), the percentage of ever tested for HIV increased from 42.9% in 2011 to 45.9% in 2017. Despite this increase, less than half of US adults have ever been tested for HIV over ten years after CDC’s recommendations (Patel et al., 2019).
The US Preventive Services Task Force recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened (A Recommendation) (Owens, et al., 2019). Since 2006, the CDC has recommended routine opt-out HIV screening (i.e., patient is notified that testing will be performed unless the patient declines) in healthcare facilities of adolescents and adults 13-64 years of age and HIV diagnostic testing of adolescents and adults with clinical signs or symptoms consistent with HIV infection (Centers for Disease Control and Prevention, 2006).
Patients 15 to 65 years of age at the start of the measurement period AND who had at least one outpatient visit during the measurement period
Patients diagnosed with HIV prior to the start of the measurement period
Patients with documentation of an HIV test performed on or after their 15th birthday and before their 66th birthday