Toxoplasma Screening

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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 [ 1 ] with HIV infection for whom Toxoplasma screening [ 2 ] was performed at least once since the diagnosis of HIV infection [ 3 ]

Number of HIV-infected clients who have documented Toxoplasma status in health record

Number of HIV-infected clients who had a medical visit with a provider with prescribing privileges [ 4 ] at least once in the measurement period

Patients with known toxoplasmic disease, e.g. Toxoplasma gondii encephalitis

1. Is the client HIV-infected? (Y/N)
   1. If yes, is there documentation of the client's Toxoplasma status in the health record? (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
• Billing records

None available at this time

• Toxoplasmosis-related mortality rates in the clinic population
• Incidence of Toxoplasmosis in the clinic population

Toxoplasmic disease appears to occur almost exclusively because of reactivation of latent tissue cysts. Clinical disease is rare among patients with CD4 counts >200 cells/ u L. The greatest risk is among patients with a CD4 cell count < 50/ u L. HIV-infected patients with Toxoplasma gondii encephalitis (TE) are almost uniformly seropositive for anti-toxoplasma IgG antibodies. [ 5 ]

The measure was placed in Group 3 because it overlaps and focuses on similar aspects of care (prophylaxis) previously captured in measures included in Group 1. Certain geographic regions have lower rates of toxoplasmic disease.

"HIV-infected persons should be tested for immunoglobulin G (IgG) antibody to Toxoplasma soon after the diagnosis of HIV infection to deter latent infection with T. gondii (strength of recommendation: BIII)." [ 6 ]

"Toxoplasma -seronegative persons who are not taking a PCP prophylactic regimen known to be active against TE should be retested for IgG antibody to Toxoplasma when their CD4 counts decline to <100/ u L to determine whether they have seroconverted and are therefore at risk for TE (strength of recommendation: CIII) )." [ 7 ]

[1] "Clients" includes all clients aged 13 years or older.

[2] Toxoplasma screening refers to testing for the presence of anti-toxoplasma immunoglobulin G (IgG) antibodies to detect latent infection with Toxoplasma gondii.

[3] Unless there is concern about ongoing exposure, annual re-screening is not generally recommended.

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

[5] Centers for Disease Control and Prevention. Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. June 18, 2008; 1-134. (http://aidsinfo.nih.gov/contentfiles/Adult_OI.pdf)

[6] Ibid.

[7] Ibid.