The advent of highly active antiretroviral therapy (HAART) has significantly reduced the incidence of Pneumocystis carinii pneumonia (PCP) among those infected with HIV.

If a patient’s CD4 cell count falls below 200 cells/mm³, signaling a very weak immune system, drug prophylaxis — such as TMP/SMX, atovaquone, or dapsone — can prevent HIV-related opportunistic infections, including PCP. Due to the toxicity of these drugs, treatment regimens may require frequent modification. Continuous monitoring is recommended.

Formula: The number of patients/clients with at least one HIV primary care visit in the past 12 months and a CD4 count <200 cells/mm³ who received PCP prophylaxis (such as TMP/SMX, atovaquone, dapsone) during the past 12 months, divided by the total number of patients/clients with at least one HIV primary care visit in the past 12 months and a CD4 count below 200 cells/mm³, including patients who refuse prophylaxis or are intolerant. Multiply by 100 to calculate percent.

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

Increase the percentage of patients/clients with CD4 counts <200 who are on PCP prophylaxis to above 95 percent within six months.

Assess a random number of patient records monthly or at the frequency established by your quality improvement effort. Count the number of patients/clients with at least one HIV primary care visit in the past 12 months and a CD4 cell count <200 cells/mm³ who received PCP prophylaxis (such as TMP/SMX, atovaquone, or dapsone) during the past month. Divide by the total number of patients/clients with at least one HIV primary care visit in the past 12 months and a CD4 count <200 cells/mm³ , including patients who refuse prophylaxis or are intolerant. Multiply by 100 to calculate percent.

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