PCP Prophylaxis

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		Performance Measure
		Numerator
		Denominator
		Patient Exclusions
		Data Element
		Data Sources
		National Goals, Targets or Benchmarks for Comparison
		Outcome Measures for Consideration
		Basis for Selection and Placement in Group 2
		US Public Health Service Guidelines
		References/Notes

Percentage of clients with HIV infection and a CD4 T-cell count below 200 cells/mm³ who were prescribed PCP prophylaxis.

Number of HIV-infected clients with CD4 T-cell counts below 200 cells/mm³ who were prescribed PCP prophylaxis

Number of HIV-infected clients who:

• had a medical visit with a provider with prescribing privileges [ 1 ], i.e. MD, PA, NP at least once in the measurement year, and
• had a CD4 T-cell count below 200 cells/mm³

1. Patients with CD4 T-cell counts below 200 cells/mm³ repeated within 3 months rose above 200 cells/mm³
2. Patients newly enrolled in care during last three months of the measurement year

1. Is the client HIV-infected? (Y/N)
2. If yes, was the CD4 T-cell count <200 cells/mm³ ? (Y/N)
3. If yes, was PCP prophylaxis prescribed? (Y/N)
   1. If no, was the CD4 count repeated within 3 months? (Y/N)
   2. If yes, did it remain below 200 cells/mm³ ? (Y/N)
      1. If yes, was PCP prophylaxis prescribed? (Y/N)?

• 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

IHI Goal: 95% [ 2 ]

National HIVQUAL Data [ 3 ]

	2003	2004	2005	2006
Top 10%	100.0%	100.0%	100.0%	100.0%
Top 25%	100.0%	100.0%	100.0%	100.0%
Median*	93.3%	90.9%	92.3%	94.4%

*from HAB data base

• Rate of PCP in the measurement year
• Mortality rates
• Cost savings

Pneumocystis pneumonia (PCP) is the most common opportunistic infection in people with HIV. Without treatment, over 85% of people with HIV would eventually develop PCP. It is a major cause of mortality among persons with HIV infection, yet is almost entirely preventable and treatable. Pneumocystis almost always affects the lungs, causing a form of pneumonia. People with CD4 T-cell counts under 200 cells/mm³ are at greatest risk of developing PCP. The drugs now used to prevent and treat PCP include TMP/SMX, dapsone, pentamidine, and atovaquone. [ 4 ]

Before the widespread use of primary PCP prophylaxis and effective ART, PCP occurred in 70%-80% of patients with AIDS. The course of treated PCP was associated with a mortality rate of between 20% and 40% in persons with profound immunosuppression. Approximately 90% of cases occurred among patients with CD4 T-cell counts <200 cells/mm³. [ 5 ]

Measure reflects important aspect of care that significantly impacts survival and mortality. Data collection is currently feasible and measure has a strong evidence base supporting the use.

HIV-infected adults and adolescents, including pregnant women and those on HAART, should receive chemoprophylaxis against PCP if they have a CD4 T-cell count <200 cells/mm³. [ 6 ]

[1] A "provider with prescribing privileges" is a health care professional who is certified in their jurisdiction to prescribe ARV therapy.

[2] IHI Measure reads, "Percent of Patients with a CD4 Cell Count Below 200 cells/mm 3  Receiving Pneumocystis Carinii Pneumonia (PCP) Prophylaxis"

[3] http://www.hivguidelines.org/admin/files/qoc/hivqual/proj%20info/ HQNatlAggScrs3Yrs.pdf

[4] http://www.aidsinfonet.org/factsheet_detail.php?fsnumber=515

[5] Centers for Disease Control and Prevention. Treating opportunistic infections among HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. MMWR 2004;53(No. RR-15) (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5315a1.htm)

[6] Centers for Disease Control and Prevention. Guidelines for Preventing Opportunistic Infections Among HIV-Infected Persons - 2002 Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America . MMWR 2002;51 (No. RR-8) (http://www.cdc.gov/mmwr/PDF/rr/rr5108.pdf or http://aidsinfo.nih.gov/ContentFiles/OIpreventionGL.pdf)