Antiretroviral (ARV) therapy controls immune suppression of the HIV virus and reduces viral replication. Appropriate ARV management decreases HIV-related morbidity and mortality, restores and/or preserves immune functions, improves quality of life, and limits the likelihood of viral resistance, thus preserving future treatment options.   

Criteria for appropriate management differ according to whether the patient is deemed clinically stable or unstable.

• If the patient is deemed clinically stable:
  • Appropriate management requires that the patient/client’s viral load be monitored during the 4-month review period.
  • Patients are deemed clinically stable if their case meets at least one of the following criteria:
    • Viral load is undetectable.
    • Viral load has dropped by at least one log since the last 4-month review period.
    • Note by treating physician indicates the patient is deemed clinically stable.

• If the patient is deemed clinically unstable:
  • One of three appropriate management options must be documented:
    • Regimen changed and viral load assay performed within 8 weeks of decision;
    • Justification provided not to change therapy along with a viral load assay within 8 weeks; or
    • A decision to discontinue therapy along with a clinical follow-up plan noted within 3 months.
  • Patients are deemed clinically unstable if their case meets at least one of the following criteria:
    • Viral load has increased by more than 1 log and absolute value is over 1,000;
    • CD4 has dropped by 50 percent since the last 4-month review period;
    • Opportunistic infection in the last four month review period; or 
    • Patient deemed unstable by physician, as per note.

Formula: The total number of patients/clients on ARV therapy who are identified as appropriately managed during a 4-month period, divided by the total number of patients who are on ARV therapy during that same 4-month period. Appropriately managed patients are divided into two categories: stable and unstable. Multiply the results for each category by 100.

For further explanation of this indicator and/or criteria for exclusions, please view indicator definitions on the National HIVQUAL Project’s website.

Increase the total percentage of patients/clients on ARV therapy who are appropriately managed (whether clinically stable or unstable) to above 90 percent within one year.

Assess a random number of patients monthly or at the frequency established by your quality improvement effort. Identify your sample (patients who are on ARV therapy), determine if each patient is clinically stable or unstable (the input of an experienced clinical practitioner is advised), and conduct clinical assessments of the patient's medical records to determine whether patients are appropriately managed.

Patients who are clinically stable:

Add the total number of patients who are clinically stable and managed appropriately during the past 4 months. Divide by the total number of patients who are clinically stable and were on ARV therapy during that same 4-month period. Multiply by 100 to calculate percent.

Patients who are clinically unstable:

Add the total number of patients who are clinically unstable and managed appropriately during the past 4 months. Divide by the total number of patients/clients who are clinically unstable and were on ARV therapy during that same 4-month period. Multiply by 100 to calculate percent.

Both groups (stable and unstable) combined:

Add the total number of patients (whether clinically stable or unstable) who were managed appropriately during the past 4 months. Divide by the total number of patients/clients who were on ARV therapy during the same 4-month period. Multiply by 100 to calculate percent.

Graph each category (stable, unstable, and both groups combined) as a separate data series on the same graph to provide the most detailed performance information (see sample graph below).

The National HIVQUAL Project’s Minimum Sample Table will help you determine the number of records in your sample. Research Randomizer can generate a random number series to help you select which records to review.