WHO SMART Guidelines - HIV
0.4.4 - ci-build

WHO SMART Guidelines - HIV, published by WHO. This guide is not an authorized publication; it is the continuous build for version 0.4.4 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/WorldHealthOrganization/smart-hiv/tree/main and changes regularly. See the Directory of published versions

Measure: HIV.IND.33 Early viral load testing (at six months) (Experimental)

Official URL: http://smart.who.int/hiv/Measure/HIVIND33 Version: 0.4.4
Draft as of 2024-08-18 Computable Name: HIVIND33

Number and % of people living with HIV on ART who had a viral load result reviewed by six months after initiation of ART

Knowledge Artifact Metadata
Name (machine-readable) HIVIND33
Title (human-readable) HIV.IND.33 Early viral load testing (at six months)
Status Draft
Experimental true
Description

Number and % of people living with HIV on ART who had a viral load result reviewed by six months after initiation of ART

Measure Steward WHO
Steward Contact Details WHO: http://who.int
Measure Metadata
Version Number 0.4.4
Measure Scoring Proportion
Improvement Notation Increased score indicates improvement
Population Basis boolean
Measure Population Criteria
Initial Population ID: HIV.IND.33.IP
Description:

Initial Population

Logic Definition: Initial Population
Denominator ID: HIV.IND.33.DEN
Description:

Number of people living with HIV on ART eligible for VL monitoring at six months after initiation of ART during the reporting period

Logic Definition: Denominator
Numerator ID: HIV.IND.33.NUM
Description:

Number of people living with HIV on ART who were eligible for VL monitoring at six months after initiation of ART during the reporting period and who had a VL test performed and result reviewed by six months after ART initiation

Logic Definition: Numerator
Stratifier ID: HIV.IND.33.S
Measure Logic
Primary Library HIV.IND.33 Logic
Dependency Description: FHIR model information
Resource: http://fhir.org/guides/cqf/common/Library/FHIR-ModelInfo|4.0.1
Canonical URL: http://fhir.org/guides/cqf/common/Library/FHIR-ModelInfo|4.0.1
Dependency Description: Library HIE
Resource: HIVIndicatorElements
Canonical URL: http://smart.who.int/hiv/Library/HIVIndicatorElements
Dependency Description: Library Elements
Resource: HIVElements
Canonical URL: http://smart.who.int/hiv/Library/HIVElements
Dependency Description: Library Concepts
Resource: http://smart.who.int/hiv/Library/HIVConcepts|0.0.2
Canonical URL: http://smart.who.int/hiv/Library/HIVConcepts|0.0.2
Dependency Description: Library FHIRHelpers
Resource: http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1
Canonical URL: http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1
Dependency Description: Library ConceptsCustom
Resource: http://smart.who.int/hiv/Library/HIVConceptsCustom|0.0.1
Canonical URL: http://smart.who.int/hiv/Library/HIVConceptsCustom|0.0.1
Dependency Description: Library WC
Resource: WHOCommon
Canonical URL: http://smart.who.int/hiv/Library/WHOCommon
Dependency Description: Code system HIVConcepts
Resource: WHO SMART HIV Concepts CodeSystem
Canonical URL: http://smart.who.int/hiv/CodeSystem/HIVConcepts
Dependency Description: Code system ConditionClinicalStatusCodes
Resource: Condition Clinical Status Codes
Canonical URL: http://terminology.hl7.org/CodeSystem/condition-clinical
Dependency Description: Code system ConditionCategoryCodes
Resource: Condition Category Codes
Canonical URL: http://terminology.hl7.org/CodeSystem/condition-category
Dependency Description: Code system ObservationCategoryCodes
Resource: Observation Category Codes
Canonical URL: http://terminology.hl7.org/CodeSystem/observation-category
Direct Reference Code Display: HIV-positive
Code: HIV.B.DE116
System: http://smart.who.int/hiv/CodeSystem/HIVConcepts
Direct Reference Code Code: active
System: http://terminology.hl7.org/CodeSystem/condition-clinical
Direct Reference Code Display: Encounter Diagnosis
Code: encounter-diagnosis
System: http://terminology.hl7.org/CodeSystem/condition-category
Direct Reference Code Display: HIV status
Code: HIV.B.DE115
System: http://smart.who.int/hiv/CodeSystem/HIVConcepts
Direct Reference Code Display: On ART
Code: HIV.H.DE47
System: http://smart.who.int/hiv/CodeSystem/HIVConcepts
Direct Reference Code Display: On ART
Code: HIV.D.DE38
System: http://smart.who.int/hiv/CodeSystem/HIVConcepts
Direct Reference Code Display: Viral load test result
Code: HIV.D.DE387
System: http://smart.who.int/hiv/CodeSystem/HIVConcepts
Direct Reference Code Display: Male
Code: HIV.A.DE20
System: http://smart.who.int/hiv/CodeSystem/HIVConcepts
Direct Reference Code Display: Female
Code: HIV.A.DE19
System: http://smart.who.int/hiv/CodeSystem/HIVConcepts
Direct Reference Code Display: Transgender female
Code: HIV.A.DE22
System: http://smart.who.int/hiv/CodeSystem/HIVConcepts
Direct Reference Code Display: Transgender male
Code: HIV.A.DE21
System: http://smart.who.int/hiv/CodeSystem/HIVConcepts
Direct Reference Code Display: Other
Code: HIV.A.DE23
System: http://smart.who.int/hiv/CodeSystem/HIVConcepts
Direct Reference Code Display: Key population member*
Code: HIV.B.DE49
System: http://smart.who.int/hiv/CodeSystem/HIVConcepts
Direct Reference Code Display: Social History
Code: social-history
System: http://terminology.hl7.org/CodeSystem/observation-category
Parameter Name: Measurement Period
Use: In
Min Cardinality: 0
Max Cardinality: 1
Type: Period
Parameter Name: Numerator
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Parameter Name: Denominator
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Parameter Name: Initial Population
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Parameter Name: Stratification
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: string
Measure Logic Data Requirements
Data Requirement Type: Condition
Profile(s): Condition
Must Support Elements: code, clinicalStatus, category, onset
Code Filter(s):
Path: code
Code:
Data Requirement Type: Observation
Profile(s): Observation
Must Support Elements: code, status, value, issued, effective
Code Filter(s):
Path: code
Code:
Data Requirement Type: Observation
Profile(s): Observation
Must Support Elements: code, status, issued
Code Filter(s):
Path: code
Code:
Data Requirement Type: Observation
Profile(s): Observation
Must Support Elements: code, status, category, effective, issued, code.coding
Code Filter(s):
Path: code
Code:
Data Requirement Type: MedicationStatement
Profile(s): MedicationStatement
Must Support Elements: reasonCode, effective
Data Requirement Type: Patient
Profile(s): Patient
Must Support Elements: use
Measure Logic Definitions
Logic Definition Library Name: HIVElements
define "HIV Status Positive Condition":
  [Condition: Concepts."HIV-positive - HIV.B.DE116"] C
    where C.clinicalStatus ~ ConceptsCustom."active"
      and exists(C.category CC where CC ~ ConceptsCustom."encounter-diagnosis")
    sort by start of onset.toInterval()
Logic Definition Library Name: HIVIndicatorElements
define "HIV Status Positive Condition":
  Elements."HIV Status Positive Condition" C
  where C.onset before end of "Measurement Period"
Logic Definition Library Name: HIVElements
/* End of HIV-inconclusive */

/*
@dataElement: HIV.B.DE115 - HIV status
@activity: HIV.B7 Test for HIV using testing algorithm
@description: HIV status reported after applying the national HIV testing algorithm. No single HIV test can provide an HIV-positive diagnosis.
*/
define "HIV Status Observation":
  [Observation: Concepts."HIV status"] O
    where O.status in { 'final', 'amended', 'corrected' }
Logic Definition Library Name: HIVElements
define "HIV Status Positive Observation":
"HIV Status Observation" O
    where O.value ~ Concepts."HIV-positive - HIV.B.DE116"
      sort by start of effective.toInterval()
Logic Definition Library Name: HIVIndicatorElements
define "HIV Status Positive Observation":
  Elements."HIV Status Positive Observation" O
  where O.issued before end of "Measurement Period"
  or O.effective.toInterval() starts before end of "Measurement Period"
Logic Definition Library Name: HIVIndicatorElements
define "Has HIV-positive Status":
  exists "HIV Status Positive Condition"
  or exists "HIV Status Positive Observation"
Logic Definition Library Name: HIVElements
/* End of Refused stopped treatment */

/*
@dataElement: HIV.H.DE47 - On ART
@activity: HIV.H3 Record outreach and result
@description: Client is currently taking ART 
*/

define "On ART H.DE47":
    [MedicationStatement] MS
    where exists(MS.reasonCode C where C ~ Concepts."On ART - HIV.H.DE47")
    sort by start of effective.toInterval()
Logic Definition Library Name: HIVIndicatorElements
/* End of Refused stopped treatment */

/*
@dataElement: HIV.H.DE47 - On ART
@activity: HIV.H3 Record outreach and result
@description: Client is currently taking ART 
*/
define "On ART H.DE47":
  exists(Elements."On ART H.DE47" ART
   where ART.effective.toInterval() during "Measurement Period"
   )
Logic Definition Library Name: HIVElements
/* End of Serodiscordant partner D.DE37 */

/*
@dataElement: HIV.D.DE38 - On ART
@activity: HIV.D8 Capture or update client history
@description: Client is currently taking ART
*/

define "On ART D.DE38":
    [MedicationStatement] MS
    where exists(MS.reasonCode C where C ~ Concepts."On ART - HIV.D.DE38")
    sort by start of effective.toInterval()
Logic Definition Library Name: HIVElements
define "First On ART":
  (First("On ART D.DE38"))
Logic Definition Library Name: HIVElements
/* End of Time to start ART */

/*
@dataElement: HIV.D.DE387 - Viral load test result
@activity: HIV.D20 Diagnostics
@description: Result from the viral load test in number of copies/mL
*/

define "Viral load test result D.DE387":
  [Observation: Concepts."Viral load test result - HIV.D.DE387"] O
    where O.status in { 'final', 'amended', 'corrected' }
Logic Definition Library Name: HIVElements
define "Viral load tests received after ART intitiation":
  "Viral load test result D.DE387" O
  where start of O.issued.toInterval() after start of "First On ART".effective.toInterval()
  sort by start of issued.toInterval()
Logic Definition Library Name: HIVIND33Logic
/**
 * Numerator
 * 
 * Definition: Number of people living with HIV on ART who were eligible for VL monitoring at six months after initiation of ART during the reporting period and who had a VL test performed and result reviewed by six months after ART initiation
 * Calculation: COUNT of clients with "HIV status"='HIV-positive' AND "On ART"=True AND "ART start date" is within reporting period AND "Date viral load test results received by client" within 6 months of "ART start date"
 */

define "Numerator":
  HIE."Has HIV-positive Status"
  and HIE."On ART H.DE47"
   and (date from start of HE."First On ART".effective.toInterval() during "Measurement Period")
   and (months between (start of First(HE."Viral load tests received after ART intitiation").issued.toInterval()) and (date from start of HE."First On ART".effective.toInterval()) < 6 months)
Logic Definition Library Name: HIVIND33Logic
/**
 * Denominator
 *
 * Definition: Number of people living with HIV on ART eligible for VL monitoring at six months after initiation of ART during the reporting period
 * Calculation: COUNT of clients with "HIV status"='HIV-positive' AND "On ART"=True AND "ART start date" is within reporting period
 */

define "Denominator":
  HIE."Has HIV-positive Status"
  and HIE."On ART H.DE47"
   and (date from start of HE."First On ART".effective.toInterval() during "Measurement Period")
Logic Definition Library Name: HIVIND33Logic
/* Populations */

/*
 *Initial Population
 */

define "Initial Population":
  true
Logic Definition Library Name: HIVIndicatorElements
/*
@dataElement: HIV.A.DE18 - Gender
@activity: HIV.A6.1 Review sociodemographic data with client | HIV.A5 Create new client record
@description: Gender of the client
*/

/*
 * By Administrative Gender of Patient Stratifier
 * Need to expand codes
 */

define "By Administrative Gender Stratifier":
  case 
      when Patient.gender = 'male' then Concepts."Male"
      when Patient.gender = 'female' then Concepts."Female"
      when Patient.gender = 'transgender female' then Concepts."Transgender female"
      when Patient.gender = 'transgender male' then Concepts."Transgender male"
      else Concepts."Other - HIV.A.DE23"
  end
Logic Definition Library Name: HIVIndicatorElements
/* End of Visit date A.DE3 */

/*
@dataElement: HIV.A.DE17 - Age
@activity: HIV.A6.1 Review sociodemographic data with client | HIV.A5 Create new client record
@description: Calculated age (number of years) of the client based on date of birth
*/
define "Age In Years":
  AgeInYearsAt(start of "Measurement Period")
Logic Definition Library Name: HIVIndicatorElements
/*
 * By Age Stratifiers
 * Age (0–4, 5–9, 10–14, 15–19, 20–24, 25–49, 50+ years)
 * 
 */
define "By Age Stratifier 2":
  case 
      when "Age In Years" <= 4 then '0-4'
      when "Age In Years" <= 9 then '5-9'
      when "Age In Years" <= 14 then '10–14'
      when "Age In Years" <= 19 then '15–19'
      when "Age In Years" <= 24 then '20–24'
      when "Age In Years" <= 49 then '25–49'
      when "Age In Years" >= 50 then '50+'
      else null
  end
Logic Definition Library Name: HIVIndicatorElements
// Geographic Region
define "By Geographic Region Stratifier":
    First(Patient.address A where A.use in { 'home' }).state
Logic Definition Library Name: HIVElements
/* End of Key population member B.DE49 */

/*
@dataElement: HIV.B.DE50 - Key population member type
@activity: HIV.B6 Capture or update client history
@description: The type of key population that the client is included in
*/
define "Key population member type Observation":
  [Observation: Concepts."Key population member - HIV.B.DE49"] O
    where O.status in { 'final', 'amended', 'corrected' }
    and exists(O.category OC where OC ~ ConceptsCustom."social-history")
Logic Definition Library Name: HIVIndicatorElements
define "Key population member type Observation":
  Elements."Key population member type Observation" O
    where O.effective.toInterval() before end of "Measurement Period"
    or O.issued before end of "Measurement Period"
Logic Definition Library Name: HIVIndicatorElements
// Stratifier
define patientGroups:
  "Key population member type Observation" O
  return Combine(O.code.coding.code, ':')
Logic Definition Library Name: HIVIND33Logic
define "Stratification":
 HIE."By Administrative Gender Stratifier".code 
  + ':' + HIE."By Age Stratifier 2"
+ ':' + HIE."By Geographic Region Stratifier"
+ Combine(HIE.patientGroups, ':')
Logic Definition Library Name: FHIRHelpers
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }
Logic Definition Library Name: FHIRHelpers
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }
Logic Definition Library Name: FHIRHelpers
define function ToDateTime(value dateTime): value.value
Logic Definition Library Name: FHIRHelpers
define function ToString(value ObservationStatus): value.value
Logic Definition Library Name: FHIRHelpers
define function ToDateTime(value instant): value.value
Logic Definition Library Name: WHOCommon
/*
From FHIRCommon 4.1.0:
*/

/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in FHIR, allowing this function to be used across any resource.

The input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.
If the input is a Period, the result is a DateTime Interval.
If the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.
If the input is an instant, the result is a DateTime Interval beginning and ending on that instant.
If the input is a string, an error is raised indicating a single interval cannot be computed from a string.
If the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,
and ending immediately prior to when the patient was the given Age plus one year.
If the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given
by the low end of the Range, and ending immediately prior to when the patient was the Age given by the
high end of the Range plus one year.

NOTE: Due to the
complexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used
with a Timing or String.
*/
define fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):
  case
    when choice is FHIR.dateTime then
      Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]
    when choice is FHIR.Period then
      FHIRHelpers.ToInterval(choice as FHIR.Period)
    when choice is FHIR.instant then
      Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]
    when choice is FHIR.Age then
      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),
        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)
    when choice is FHIR.Range then
      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),
        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)
    when choice is FHIR.Timing then
      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported')
    when choice is FHIR.string then
      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')
    else
      null as Interval<DateTime>
  end
Logic Definition Library Name: FHIRHelpers
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]
Logic Definition Library Name: FHIRHelpers
define function ToDate(value date): value.value
Logic Definition Library Name: FHIRHelpers
define function ToQuantity(quantity FHIR.Quantity):
    case
        when quantity is null then null
        when quantity.value is null then null
        when quantity.comparator is not null then
            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')
        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'
              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then
            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }
        else
            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')
    end
Logic Definition Library Name: FHIRHelpers
define function ToCalendarUnit(unit System.String):
    case unit
        when 'ms' then 'millisecond'
        when 's' then 'second'
        when 'min' then 'minute'
        when 'h' then 'hour'
        when 'd' then 'day'
        when 'wk' then 'week'
        when 'mo' then 'month'
        when 'a' then 'year'
        else unit
    end
Logic Definition Library Name: FHIRHelpers
define function ToString(value AdministrativeGender): value.value
Logic Definition Library Name: FHIRHelpers
define function ToString(value string): value.value
Logic Definition Library Name: FHIRHelpers
define function ToString(value AddressUse): value.value
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