/**
* Library: HIV.IND.50 Logic
* Ref No: DFT.3
* Short Name: TB testing among those symptom-screened positive
*
* Definition: % of people living with HIV newly initiated on ART and screened positive for TB symptoms who then are tested for TB
*
* Numerator: Number of people living with HIV newly initiated on ART who are investigated for active TB disease with appropriate diagnostic testing*
* Numerator Calculation: COUNT of clients with "HIV status"='HIV-positive' AND with "ART start type"='First-time user of ART' AND with "ART start date" in the reporting period AND "TB screening date" in the reporting period AND "TB screening result"='Screen positive for TB' AND a "TB diagnostic test category" is NOT NULL AND with a "TB diagnostic test date" in the reporting period
* Numerator Exclusions:
*
* Denominator: Number of people living with HIV newly initiated on ART and screened positive for TB symptoms during the reporting period
* Denominator Calculation: COUNT of clients with "HIV status"='HIV-positive' AND with "ART start type"='First-time user of ART' AND with "ART start date" in the reporting period AND "TB screening date" in the reporting period AND "TB screening result"='Screen positive for TB'
* Denominator Exclusions:
*
* Disaggregations:
* • Gender (male, female, other**)
* • Age (0–4, 5–9, 10–14, 15–19, 20–24, 25–49, 50+ years)***
* • Cities and other administrative regions of epidemiologic importance
*
* Consider disaggregating the type of diagnostic testing, for example, GeneXpert testing, LF-LAM, sputum acid-fast bacilli (AFB) examination (alone) or other diagnostic testing.
*
* Disaggregation Elements: Gender | Age | TB diagnostic test category
*
* Numerator and Denominator Elements:
* ART start date
* ART start type
* HIV status
* TB diagnostic test category
* TB diagnostic test date
* TB screening date
* TB screening 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.A.DE18: Gender* | Gender of the client*
* HIV.A.DE19: Female | Client identifies as female
* HIV.A.DE20: Male | Client identifies as male
* HIV.A.DE21: Transgender male | Client identifies as transgender male
* HIV.A.DE22: Transgender female | Client identifies as transgender female
* HIV.A.DE23: Other | Additional category
* HIV.B.DE72: ART start date | The date on which the client started or restarted antiretroviral therapy (ART)
* 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.DE39: ART start date | The date on which the client started or restarted ART
* HIV.D.DE43: ART start type | Whether the client is ART naive or is restarting ART
* HIV.D.DE44: First-time user of ART | Client is ART naive, having never taken ART to treat HIV before
* HIV.D.DE45: Restarting ART | Client is restarting ART after stopping treatment for any reason
* HIV.D.DE986: TB screening result | Record the result of the tuberculosis (TB) screening
* HIV.D.DE987: Screen positive for TB | Screening result was positive for tuberculosis (TB)
* HIV.D.DE988: Screen negative for TB | Screening result was negative for tuberculosis (TB)
* HIV.D.DE989: Inconclusive | Screening result was inconclusive for tuberculosis (TB)
* HIV.D.DE990: TB screening date | Date the TB screening was conducted
* HIV.D.DE992: TB diagnostic test category | The type of diagnostic test performed to detect tuberculosis (TB) disease
* HIV.D.DE993: LF-LAM | Client tested for tuberculosis with a lateral flow urine lipoarabinomannan assay
* HIV.D.DE994: mWRD test for TB | Client tested with a WHO-recommended molecular diagnostic test to detect Mycobacterium tuberculosis (MTB)
* HIV.D.DE995: Microscopy - Sputum acid-fast bacilli (AFB) | Client tested for tuberculosis with a sputum acid-fast bacilli (AFB)
* HIV.D.DE996: TB Culture | Client tested for tuberculosis (TB) with a culture
* HIV.D.DE997: TB diagnostic test date | The date when TB diagnostic test was performed
* HIV.SRV.DE6: ART start date | The date on which the client started or restarted antiretroviral therapy (ART)
*
* Additional Context
* - what it measures: This indicator measures the percentage of people living with HIV newly initiated on ART and screened positive for TB symptoms who then had clinical evaluation and/or appropriate TB diagnostic testing.
* - rationale: • Appropriate TB diagnostic testing is essential for people living with HIV who symptom- screen positive for TB. | • It is important to understand the cascade from ART enrolment to treatment of active | TB disease; this indicator will shed light on any obstacles between positive screening for TB symptoms and proper diagnostic testing, based on national clinical guidelines. | • This is the third of five "screening cascade" indicators considered priority for high burden TB/HIV settings.
* - method: "Newly initiated" is defined as the number of people living with HIV who start ART in accordance with national treatment guidelines during the reporting period. | | For the numerator and denominator: Programme records (for example, ART registers, EMR)
*
* Suggested Scoring Method: proportion | http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm
*/
library HIVIND50Logic
// 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 HIVElements called HE
include HIVIndicatorElements called HIE
// 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 people living with HIV newly initiated on ART who are investigated for active TB disease with appropriate diagnostic testing*
* Calculation: COUNT of clients with "HIV status"='HIV-positive' AND with "ART start type"='First-time user of ART' AND with "ART start date" in the reporting period AND "TB screening date" in the reporting period AND "TB screening result"='Screen positive for TB' AND a "TB diagnostic test category" is NOT NULL AND with a "TB diagnostic test date" in the reporting period
*/
define "Numerator":
HIE."Has HIV-positive Status"
and (start of First(HE."First-time user of ART").effective.toInterval() during "Measurement Period")
//related the two since we want a positive observation from a specific diagnostic test.
and exists(
HE."TB diagnostic test category" P
with HE."Screen positive for TB" O
such that P.partOf.references(O)
where P.performed.toInterval() during "Measurement Period"
)
/**
* Denominator
*
* Definition: Number of people living with HIV newly initiated on ART and screened positive for TB symptoms during the reporting period
* Calculation: COUNT of clients with "HIV status"='HIV-positive' AND with "ART start type"='First-time user of ART' AND with "ART start date" in the reporting period AND "TB screening date" in the reporting period AND "TB screening result"='Screen positive for TB'
*/
define "Denominator":
HIE."Has HIV-positive Status"
and (start of First(HE."First-time user of ART").effective.toInterval() during "Measurement Period")
and HIE."Screen positive for TB"
/* end Populations */
/*
* Disaggregators
*/
define "Administrative Gender Stratifier":
HIE."By Administrative Gender Stratifier"
define "Age Stratifier":
HIE."By Age Stratifier"
define "Geographic Region Stratifier":
HIE."By Geographic Region Stratifier"
define "Stratification":
HIE."By Administrative Gender Stratifier".code
+ ':' + HIE."By Age Stratifier"
+ ':' + HIE."By Geographic Region Stratifier"
|