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.47 People living with HIV with active TB disease (Experimental)

Official URL: http://smart.who.int/hiv/Measure/HIVIND47 Version: 0.4.4
Draft as of 2024-08-18 Computable Name: HIVIND47

% of people living with HIV newly initiated on ART who have active TB disease

Knowledge Artifact Metadata
Name (machine-readable) HIVIND47
Title (human-readable) HIV.IND.47 People living with HIV with active TB disease
Status Draft
Experimental true
Description

% of people living with HIV newly initiated on ART who have active TB disease

Measure Steward WHO
Steward Contact Details WHO: http://who.int
Measure Metadata
Version Number 0.4.4
Measure Scoring Proportion
Improvement Notation Decreased score indicates improvement
Population Basis boolean
Measure Population Criteria
Initial Population ID: HIV.IND.47.IP
Description:

Initial Population

Logic Definition: Initial Population
Denominator ID: HIV.IND.47.DEN
Description:

Number of people living with HIV new on ART during the reporting period

Logic Definition: Denominator
Numerator ID: HIV.IND.47.NUM
Description:

Number of people living with HIV newly initiated on ART during the reporting period who have active TB disease. | 'Newly initiated on ART' is defined as the number of people living with HIV who start ART in accordance with national treatment guidelines during the reporting period.

Logic Definition: Numerator
Stratifier ID: HIV.IND.47.S
Measure Logic
Primary Library HIV.IND.47 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.D.DE38
System: http://smart.who.int/hiv/CodeSystem/HIVConcepts
Direct Reference Code Display: Diagnosed TB
Code: HIV.D.DE940
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
Direct Reference Code Display: Currently pregnant
Code: HIV.B.DE29
System: http://smart.who.int/hiv/CodeSystem/HIVConcepts
Direct Reference Code Code: recurrence
System: http://terminology.hl7.org/CodeSystem/condition-clinical
Direct Reference Code Code: relapse
System: http://terminology.hl7.org/CodeSystem/condition-clinical
Direct Reference Code Display: Breastfeeding
Code: HIV.B.DE32
System: http://smart.who.int/hiv/CodeSystem/HIVConcepts
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: Condition
Profile(s): Condition
Must Support Elements: code
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, effective
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: Observation
Profile(s): Observation
Must Support Elements: code, status, value, effective
Code Filter(s):
Path: code
Code:
Data Requirement Type: MedicationStatement
Profile(s): MedicationStatement
Must Support Elements: reasonCode
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 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 Presumptive TB D.DE945 */

/*
@dataElement: HIV.D.DE952 - Date of TB diagnosis
@activity: HIV.D8 Capture or update client history
@description: The date when the diagnosis was established
*/

define "Date of TB diagnosis":
  [Observation: Concepts."Diagnosed TB"] C
  return C.effective.toInterval()
Logic Definition Library Name: HIVIndicatorElements
/* End of Presumptive TB D.DE945 */

/*
@dataElement: HIV.D.DE952 - Date of TB diagnosis
@activity: HIV.D8 Capture or update client history
@description: The date when the diagnosis was established
*/

define "Date of TB diagnosis":
  exists(Elements."Date of TB diagnosis" C where C during "Measurement Period")
Logic Definition Library Name: HIVIND47Logic
/**
 * Numerator
 * 
 * Definition: Number of people living with HIV newly initiated on ART during the reporting period who have active TB disease. | "Newly initiated on ART" is defined as the number of people living with HIV who start ART in accordance with national treatment guidelines during the reporting period.
 * Calculation: COUNT of clients with "HIV status"='HIV-positive' AND "ART start date" in the reporting period AND "Date of TB diagnosis" in the reporting period
 */

define "Numerator":
  HIE."Has HIV-positive Status"
  and (start of HE."First On ART".effective.toInterval() during "Measurement Period")
  and HIE."Date of TB diagnosis"
Logic Definition Library Name: HIVIND47Logic
/**
 * Denominator
 *
 * Definition: Number of people living with HIV new on ART during the reporting period
 * Calculation: COUNT of clients with "HIV status"='HIV-positive' AND "ART start date" in reporting period
 */

define "Denominator":
  HIE."Has HIV-positive Status"
  and (start of HE."First On ART".effective.toInterval() during "Measurement Period")
Logic Definition Library Name: HIVIND47Logic
/* 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
 * (0–4, 5–9, 10–14, 15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50+ years)
 * 
 */
define "By Age Stratifier":
  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" <= 29 then '25–29'
      when "Age In Years" <= 34 then '30–34'
      when "Age In Years" <= 39 then '35–39'
      when "Age In Years" <= 44 then '40–44'
      when "Age In Years" <= 49 then '45–49'
      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: HIVElements
/* End of Facility-level testing */

/*
@dataElement: HIV.B.DE29 - Currently pregnant
@activity: HIV.B6 Capture or update client history
@description: Client is currently pregnant
*/

define "Currently pregnant B.DE29":
  [Condition: Concepts."Currently pregnant - HIV.B.DE29"] C
  sort by start of prevalenceInterval()
Logic Definition Library Name: HIVIndicatorElements
/* End of Facility-level testing */

/*
@dataElement: HIV.B.DE29 - Currently pregnant
@activity: HIV.B6 Capture or update client history
@description: Client is currently pregnant
*/

define "Currently pregnant B.DE29":
  Elements."Currently pregnant B.DE29" C
    where C.prevalenceInterval() during "Measurement Period"
Logic Definition Library Name: HIVElements
/* End of Currently pregnant B.DE29 */

/*
@dataElement: HIV.B.DE32 - Breastfeeding
@activity: HIV.B6 Capture or update client history
@description: Infant is being breastfed by mother
*/

define "Breastfeeding B.DE32":
  [Observation: Concepts."Breastfeeding - HIV.B.DE32"] O
    where O.status in { 'final', 'amended', 'corrected' }
      and O.value is true
Logic Definition Library Name: HIVIndicatorElements
/* End of Currently pregnant B.DE29 */

/*
@dataElement: HIV.B.DE32 - Breastfeeding
@activity: HIV.B6 Capture or update client history
@description: Infant is being breastfed by mother
*/

define "Breastfeeding B.DE32":
  Elements."Breastfeeding B.DE32" O
    where O.effective.toInterval() during "Measurement Period"
Logic Definition Library Name: HIVIndicatorElements
define "pregnancy stratifier":
  case
    when exists("Currently pregnant B.DE29") then Concepts."Currently pregnant - HIV.B.DE29"
    when exists("Breastfeeding B.DE32") then Concepts."Breastfeeding - HIV.B.DE32"
    else null
  end
Logic Definition Library Name: HIVIND47Logic
define "Stratification":
 HIE."By Administrative Gender Stratifier".code 
  + ':' + HIE."By Age Stratifier"
+ ':' + HIE."By Geographic Region Stratifier"
+ Combine(HIE.patientGroups, ':')
+ HIE."pregnancy stratifier".code
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: 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
Logic Definition Library Name: WHOCommon
/*
@description: Returns an interval representing the normalized prevalence period of a given Condition resource.
@comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
  (end of condition.abatementInterval()) abatementDate
    return 
	  if abatementDate is null then
        Interval[start of condition.onset.toInterval(), abatementDate)
      else
        Interval[start of condition.onset.toInterval(), abatementDate]
Logic Definition Library Name: WHOCommon
/*
@description: Returns an interval representing the normalized Abatement of a given Condition resource.
@comment: NOTE: Due to the complexity of determining an interval from a String, this function will throw
a run-time exception if used with a Condition instance that has a String as the abatement value.
*/
define fluent function abatementInterval(condition Condition):
  if condition.abatement is FHIR.dateTime then
    Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]
  else if condition.abatement is FHIR.Period then
    FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)
  else if condition.abatement 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 if condition.abatement is FHIR.Age then
    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),
      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)
  else if condition.abatement is FHIR.Range then
    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),
      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)
  else if condition.abatement is FHIR.boolean then
    Interval[end of condition.onset.toInterval(), condition.recordedDate)
  else 
    null
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 ToBoolean(value boolean): value.value
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