Title: HIV.IND.37 Logic Id: HIVIND37Logic Version: 0.4.4 Url: HIV.IND.37 Logic Status: draft Experimental: true Type: system: http://terminology.hl7.org/CodeSystem/library-type code: logic-library Date: 2025-12-10 09:22:27+0000 Publisher: WHO Description: % of HIV-positive pregnant women who are virally suppressed at labour and delivery Related Artifacts: Dependencies http://smart.who.int/hiv/Library/HIVCommon|0.0.1 WHOCommon HIVIndicatorElements HIVElements Parameters: Name Type Min Max In/Out Measurement Period Period 0 1 In Patient Patient 0 1 Out Initial Population boolean 0 1 Out First Health facility Observation 0 1 Out Numerator boolean 0 1 Out Denominator boolean 0 1 Out Age Stratifier string 0 1 Out Geographic Region Stratifier string 0 1 Out Timing of ART initiation Coding 0 1 Out Stratification string 0 1 Out Content: text/cql /** * Library: HIV.IND.37 Logic * Ref No: VER.1 * Short Name: Viral suppression at labour and delivery * * Definition: % of HIV-positive pregnant women who are virally suppressed at labour and delivery * * Numerator: Number of HIV-positive pregnant women on ART during pregnancy and delivering at a facility during the reporting period who were virally suppressed (<1000 copies/mL) at delivery * Numerator Calculation: COUNT of clients with "HIV status"='HIV-positive' AND "Place of delivery" is a 'Health facility' AND "Delivery date" is in the reporting period AND "Date of viral load sample collection" is on "Delivery date" AND "Viral load test result" LESS THAN 1000 copies/mL * Numerator Exclusions: * * Denominator: Number of HIV-positive pregnant women on ART during pregnancy who deliver at a facility during the reporting period and had a viral load test during delivery, or the estimated total number of pregnant women living with HIV * Denominator Calculation: COUNT of clients with "HIV status"='HIV-positive' AND "Place of delivery" is a 'Health facility' AND "Delivery date" is in the reporting period AND "Date of viral load sample collection" is on "Delivery date" | | Alternatively: *Estimated total number of pregnant women living with HIV * Denominator Exclusions: * * Disaggregations: * • Age (<15, 15–19, 20–25, 25+ years) * • Timing of ART initiation (during pregnancy, on ART at first ANC visit) * • Cities and other administrative regions of epidemiologic importance * * Disaggregation Elements: Age | Timing of ART initiation * * Numerator and Denominator Elements: * Date of viral load sample collection * Delivery date * HIV status * Place of delivery * Viral load test result * * Reference: Consolidated guidelines on person-centred HIV strategic information: strengthening routine data for impact. Geneva: World Health Organization; 2022 * * Data Concepts: * HIV.A.DE17: Age | Calculated age (number of years) of the client based on date of birth * HIV.B.DE115: HIV status | HIV status reported after applying the national HIV testing algorithm. No single HIV test can provide an HIV-positive diagnosis. * HIV.B.DE116: HIV-positive | Client is HIV-positive * HIV.B.DE117: HIV-negative | Client is HIV-negative * HIV.B.DE118: Unknown | Client has unknown HIV status * HIV.D.DE194: Date of viral load sample collection | Date and time when the sample was collected to test the client's HIV viral load * HIV.D.DE387: Viral load test result | Result from the viral load test in number of copies/mL * HIV.E.DE41: Timing of ART initiation | When the pregnant woman or mother initiated ART, for women living with HIV. * HIV.E.DE42: Already on ART at first antenatal care visit | The pregnant woman was already on antiretroviral therapy (ART) at first antenatal care visit * HIV.E.DE43: Newly on ART during pregnancy | The pregnant woman started ART during her pregnancy * HIV.E.DE44: Newly on ART during labour and delivery | The woman started ART during labour and delivery * HIV.E.DE46: Delivery date | Date on which the woman delivered * HIV.E.DE67: Place of delivery | The type of place where the woman delivered * HIV.E.DE68: Health facility | The woman delivered at a health facility * HIV.E.DE69: Home | The woman delivered at home * HIV.E.DE70: Other | The woman delivered at another location that is not at home or at a health facility * HIV.G.DE8: Date of viral load sample collection | Date and time when the sample was collected to test the client's HIV viral load * HIV.G.DE12: Viral load test result | Result from the viral load test in number of copies/mL * HIV.SRV.DE12: Date of viral load sample collection | Date and time when the sample was collected to test the client's HIV viral load * HIV.SRV.DE13: Viral load test result | Result from the viral load test in number of copies/mL * * Additional Context * - what it measures: This indicator measures viral suppression at the time of delivery among HIV-positive pregnant women. * - rationale: • Viral suppression at the time of delivery is a service quality measure at a critical point in the vertical transmission risk period. | • Two different denominators give indicators similar to general measures of viral suppression among people living with HIV: The programme-based/service delivery denominator, that is, those on ART, delivering in a facility and having a viral load test, measures the third "95" target. The population-based denominator, that is, viral load among all estimated pregnant women living with HIV, regardless of ART status or ANC/facility attendance, measures population viral load suppression (of pregnant women living with HIV). * - method: For the numerator: | Patient monitoring tools/EMRs (for example, PMTCT registers, patient records) | | For the denominator: | • Population-based denominator: modelling-based estimates (for example, Spectrum AIM) | • Programme-based/service delivery denominator: programme records, labour and delivery registers/EMRs | Note: This indicator should be interpreted with consideration of the VL testing coverage of pregnant women living with HIV at delivery. | | The recommended reporting period is 12 months. * * Suggested Scoring Method: proportion | http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm */ library HIVIND37Logic // Included Libraries using FHIR version '4.0.1' include HIVCommon version '0.0.1' called HIC include FHIRHelpers version '4.0.1' include WHOCommon called WCom include HIVIndicatorElements called HIE include HIVElements called HE // Indicator Definition parameter "Measurement Period" Interval<Date> default Interval[@2023-01-01, @2023-01-30] context Patient /* Populations */ /* *Initial Population */ define "Initial Population": true /** * Numerator * * Definition: Number of HIV-positive pregnant women on ART during pregnancy and delivering at a facility during the reporting period who were virally suppressed (<1000 copies/mL) at delivery * Calculation: COUNT of clients with "HIV status"='HIV-positive' AND "Place of delivery" is a 'Health facility' AND "Delivery date" is in the reporting period AND "Date of viral load sample collection" is on "Delivery date" AND "Viral load test result" LESS THAN 1000 copies/mL */ //health facility birth define "First Health facility": (First(HE."Health facility")) define "Numerator": HIE."Has HIV-positive Status" and HIE."On ART D.DE38" and HIE."Health facility" and exists( HIE."Viral load test result D.DE387" VL with HE."viral load sample collection" P such that VL.partOf.references(P) and start of P.performed.toInterval() = start of "First Health facility".effective.toInterval() where VL.value < 1000 ) /** * Denominator * * Definition: Number of HIV-positive pregnant women on ART during pregnancy who deliver at a facility during the reporting period and had a viral load test during delivery, or the estimated total number of pregnant women living with HIV * Calculation: COUNT of clients with "HIV status"='HIV-positive' AND "Place of delivery" is a 'Health facility' AND "Delivery date" is in the reporting period AND "Date of viral load sample collection" is on "Delivery date" | | Alternatively: *Estimated total number of pregnant women living with HIV */ define "Denominator": HIE."Has HIV-positive Status" and HIE."On ART D.DE38" and HIE."Health facility" and exists( HIE."Viral load test result D.DE387" VL with HE."viral load sample collection" P such that VL.partOf.references(P) and start of P.performed.toInterval() = start of "First Health facility".effective.toInterval() ) /* end Populations */ /* * Disaggregators */ define "Age Stratifier": HIE."By Age Stratifier 3" define "Geographic Region Stratifier": HIE."By Geographic Region Stratifier" define "Timing of ART initiation": HIE."Timing of ART initiation" define "Stratification": HIE."By Age Stratifier 3" + ':' + HIE."By Geographic Region Stratifier" + HIE."Timing of ART initiation".code Content: application/elm+xml Encoded data (55376 characters) Content: application/elm+json Encoded data (94376 characters)
% of HIV-positive pregnant women who are virally suppressed at labour and delivery