MAC Prophylaxis
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| Performance Measure: MAC Prophylaxis - OPR-Related Measure: No |
Percentage of clients [ 1 ] with HIV infection with CD4 count < 50 cells/mm3 who were prescribed Mycobacterium avium Complex (MAC) prophylaxis [ 2 ] within the measurement year
Number of HIV-infected clients with CD4 count < 50 cells/mm3 who were prescribed MAC prophylaxis
Number of HIV-infected clients who had a:
- CD4 count < 50 cells/mm3 of vaccination; and
- medical visit with a provider with prescribing privileges [ 3 ] at least once in the measurement period
Patients who have disseminated MAC
- Is the client HIV-infected? (Y/N)
- If yes, was the CD4 count < 50 cells/mm3? (Y/N)
- If yes, was MAC prophylaxis subsequently prescribed?
- Electronic Medical Record/Electronic Health Record
- CAREWare, Lab Tracker or other electronic data base
- HIVQUAL reports on this measure for grantee under review
- Medical record data abstraction by grantee of a sample of records
- Billing records
| TOP |
| National Goals, Targets, or Benchmarks for Comparison |
National HIVQUAL Data [ 4 ]
| |
2003 |
2004 |
2005 |
2006 |
2007 |
| Top 10% |
100.0% |
100.0% |
100.0% |
100.0% |
100.0% |
| Top 25% |
100.0% |
100.0% |
100.0% |
100.0% |
100.0% |
| Mean* |
86.5% |
84.7% |
85.7% |
83.1% |
84.6% |
*from HAB data base
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| Outcome Measures for Consideration |
- Incidence of MAC disease in the clinic population
- MAC-related mortality rates in the population assessed
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| Basis for Selection and Placement in Group 3 |
MAC disease is an opportunistic infection that can cause severe illness in people with advanced AIDS but rarely affects others. The risk of disseminated MAC (DMAC) is directly related to the severity of immunosuppression. DMAC typically occurs in persons with CD4 counts < 50 cells/mm3 and its frequency increases as the CD4 count declines. In the absence of antibiotic prophylaxis, DMAC occurs in up to 40% of AIDS patients with CD4 counts of < 50 cells/mm3. [ 5 ]
The measure was placed in Group 3 because it focuses on similar aspects of care (prophylaxis) previously captured in measures included in Groups 1 & 2.
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| US Public Health Service Guidelines |
"Adults and adolescents who have HIV infection should receive chemoprophylaxis against disseminated MAC disease if they have CD4 count < 50 cells/mm3." [ 6 ]
[1] "Clients" includes all clients aged 13 years or older.
[2] Current regimens for preventing MAC can be found at: 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 )
[3] A "provider with prescribing privileges" is a health care professional who is certified in their jurisdiction to prescribe medications.
[4] MAC Prophylaxis (http://www.hivguidelines.org/admin/files/qoc/hivqual/proj%20info/HQNatlAggScrs3Yrs.pdf )
[5] National AIDS Education & Training Centers (2006). Clinical Manual for Management of the HIV-Infected Adult.
[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 )
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