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Table 2 Clinical monitoring standard examined and performance

From: Routine monitoring and assessment of adults living with HIV: results of the British HIV Association (BHIVA) national audit 2015

Clinical Monitoring requirement audited Specified target in guidelines Proportion of cases with documentation of meeting audit standard % (n/N)
Whether a baseline HIV resistance test had been done or sample stored for later testing Patients with a genotypic resistance test performed within 3 months of first diagnosis (or with a stored sample available for later testing) (90%). 80.8% (6636/8258 tested, 40/8258 sample stored)
Whether HIV viral load measured within past 6 months Patients on ART with HIV viral load measured within the last 6 months (80%). 90.1% (6660/7395)
Whether adherence assessed within past 425 days Adherence documented within the first 3 months of starting ART (90%) and at least annually thereafter (70%). 93.4% (6908/7395)
Whether all medication recorded within past 425 days All medication taken by patients on ART should be reviewed annually (100%). 89.0% (6584/7395)
Whether vaccinated/immune to hepatitis A No target specified but serology recommended followed by vaccination for all non-immune at risk and/or co-infected with hepatitis B or C. 61.2% (5053/8258)
Whether hepatitis B serology recorded; whether anti-surface antibody measured within past 425 days for individuals with serology consistent with vaccination No target specified but surface antigen (HBsAg), anti-core total antibody (anti-HBc) and anti-surface antibody (anti-HBs) testing recommended. Vaccination recommended if non-immune. Annual surface antibody titre measurement recommended in vaccine responders. 82.1% (6781/8258)
Whether hepatitis C antibody status known No target specified but antibody testing recommended, followed by RNA testing if antibody positive. Annual re-testing recommended for antibody negative men who have sex with men (MSM) or injecting drug users (IDU). 96.6% (7979/8258)
Whether CVD risk assessed, within past 3 years if on ART, ever if not on ART 10-year cardiovascular disease (CVD) risk calculated within 1 year of first presentation (70%), and within the last 3 years if taking ART (70%). 44.9% (3318/7395) on ART
32.3% (279/863)
Whether smoking status recorded within past two years; if a smoker, whether offered a cessation service. Smoking history documented in the last 2 years (90%) and if a smoker offered referral to a cessation service (90%). 65.9% (5445/8258)
45.2% (862/1905) offered cessation
Whether blood pressure recorded within past 425 days Blood pressure (BP) recorded in the last year (90%). 85.5% (7058/8258)
Whether glucose measurement recorded within past 425 days No target specified but recommended yearly or 3–6-monthly if on ART. 77% (6359/8258)
Whether lipid profile recorded within past 425 days No target specified but recommended yearly or 6–12-monthly if on ART. 83.2% (6869/8258)
Whether liver function test (LFT) assessed within past 425 days No target specified but recommended yearly or 3–6 monthly if on ART. 97% (8013/8258)
Whether estimated glomerular filtration rate (eGFR) assessed within past 425 days No target specified but recommended yearly or 3–6 monthly if on ART. 95.5% (7887/8258)
Whether urinalysis or urine protein/creatinine (uP/C) checked within past 425 days, or 243 if receiving tenofovir No target specified but urinalysis and uP/C recommended annually, with 3–6-monthly urinalysis if receiving tenofovir. 73.7% (2050/2781)
74.8% (4098/5477) receiving tenofovir
Whether flu vaccination had been done or record made of advice to obtain this from general practitioner (GP) within past year: as audit was conducted in summer this fully covered the preceding season No target specified in monitoring guidelines but vaccination history recommended as part of regular clinical review. Vaccination guidelines specify: offer annual influenza vaccination to all HIV-infected persons (target 95%) [14]. 21.1% (1744/8258) vaccination given
36.2% (2993/8258) advice given
Whether sexual health screen offered within past 425 days No target specified but recommended to offer sexual health screen 12-monthly, or more frequently if identified risks. 65.7% (5424/8258)
Whether syphilis serology had been done within past 243 days No target specified but recommended 3–6-monthly at each routine visit for MSM and 12-monthly for others 63.0% (5201/8258)
Whether cervical cytology had been done or record made of advice to obtain elsewhere within past 425 days, females only No target specified but recommended 12-monthly. 53.2% (1471/2763)
Whether bone mineral density measured, individuals aged >70 and on ART only No target specified but recommended in all men aged 70 years and all women aged 65 years. 17.4% (29/167)
Whether fracture risk assessed within past 3 years, individuals aged >50 only No target specified but recommended 3-yearly if aged over 50 years. 16.7% (430/2568)
Outcome: whether vaccinated against pneumococcus, CD4 > 200 only No target specified in monitoring guidelines but vaccination history recommended as part of regular clinical review. Vaccination guidelines recommend pneumococcus vaccination if CD4 > 200, and consideration of vaccination at lower CD4. 26.4% (2082/7877)
  1. ART antiretroviral therapy