Hepatitis/HIV Alcohol Counseling
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| Performance Measure: Hepatits/HIV Alcohol Counseling - OPR-Related Measure: No |
Percentage of clients [ 1 ] with HIV and Hepatitis B (HBV) or Hepatitis C (HCV) infection who received alcohol counseling [ 2 ] within the measurement year
Number of HIV-infected clients who received alcohol counseling
Number of HIV-infected clients who:
- were co-infected with HBV [ 3 ] or HCV; and
- had a medical visit with a provider with prescribing privileges [ 4 ] at least once in the measurement year
None
- Is the client HIV-infected? (Y/N)
- If yes, is the client HBV or HCV-positive? (Y/N)
- If yes, did the client receive alcohol counseling during the measurement year? (Y/N)
- Electronic Medical Record/Electronic Health Record
- CAREWare, Lab Tracker or other electronic data base
- Medical record data abstraction by grantee of a sample of records
- Billing records
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| National Goals, Targets, or Benchmarks for Comparison |
None available at this time
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| Outcome Measures for Consideration |
Hepatitis-related mortality rates in the clinic population
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| Basis for Selection and Placement in Group 3 |
Discussion of substance use allows the clinician to either provide counseling or make referrals to substance and alcohol treatment centers. A study of HIV-positive veterans showed that hazardous drinking and alcohol diagnoses were associated with HIV disease progression and/or hepatic co-morbidity and anemia. It also concluded that alcohol problems are often missed by providers thus increasing the need for routine screening. [ 5 ]
Long-term studies of patients with chronic HCV infection show that between 2%-20% develop cirrhosis in 20 years. This rate of progression increases with older age, alcoholism and HIV infection. [ 6 ]
The measure is placed in Group 3 because the definition of "counseling" varies considerably across grantees. The variation in definition impacts the feasibility of data collection.
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| US Public Health Service Guidelines |
"All patients with HIV/HCV infection should be advised to avoid or limit alcohol consumption." [ 7 ]
[1] "Clients" includes all clients aged 13 years or older.
[2] For the purposes of this measure, alcohol counseling refers to counseling provided by the primary care team that emphasizes the need to avoid or limit alcohol intake due to the impact on the liver.
[3] Markers of Hepatitis B infection include Hep B Surface Antigen, Hep B e Antigen, Hep B e Antibody or Hep B DNA.
[4] A "provider with prescribing privileges" is a health care professional who is certified in their jurisdiction to prescribe medications.
[5] Joseph Conigliaro, Adam J. Gordon, Kathleen A. McGinnis, Linda Rabeneck, and Amy C.; How Harmful Is Hazardous Alcohol Use and Abuse in HIV Infection: Do Health Care Providers Know Who Is at Risk?; Journal of Acquired Immune Deficiency Syndromes 33:521-525.
[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 )
[7] Ibid.
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