2020 MIPS Measure #475: HIV Screening

Quality ID 475
eMeasure ID CMS349v2
High Priority Measure No
Specifications EHR
Measure Type Process
Specialty Family Medicine Infectious Disease Internal Medicine Obstetrics/Gynecology Preventive Medicine

Measure Description

Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for HIV



Human immunodeficiency virus (HIV) is a communicable infection that leads to a progressive disease with a long asymptomatic period. There were an estimated 38,500 new HIV infections in the United States in 2015 (Centers for Disease Control and Prevention, 2018a). Without treatment, most persons develop acquired immunodeficiency syndrome (AIDS) within 10 years of HIV infection. Antiretroviral therapy (ART) delays this progression and increases the length of survival, but it is most effective when initiated during the asymptomatic phase. Persons living with HIV who use ART and achieve viral suppression can have a nearly normal life expectancy (Samji et al., 2013).  DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents recommends antiretroviral therapy for all HIV-infected individuals to reduce the risk of disease progression (regardless of CD4 cell count at diagnosis) (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2017).

CDC estimates that almost 15% of the 1.1 million adults and adolescents living with HIV infection in the United States are unaware of their infection (Centers for Disease Control and Prevention, 2018b). Among persons diagnosed with HIV in 2011, one quarter were diagnosed with Stage 3 HIV (AIDS) at the time of HIV diagnosis (Centers for Disease Control and Prevention, 2018c), which is when the median CD4 count at diagnosis is less than 200 cells/mm3 for persons aged greater than or equal to 6 years (Centers for Disease Control and Prevention, 2018a). HIV screening identifies infected persons who were previously unaware of their infection, which enables them to seek medical and social services that can improve their health and the quality and length of their lives. Additionally, using ART with high levels of medication adherence has been shown to substantially reduce risk for HIV transmission (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2017).

Based on the National Health Interview Survey, fewer than half of persons 18 and older reported ever having been tested for HIV as of 2017 (Blackwell et al., 2019).

Clinical Recommendation Statements

The US Preventive Services Task Force recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened (A Recommendation) (Moyer, 2013). 

Since 2006, the CDC has recommended routine opt-out HIV screening (i.e., patient is notified that testing will be performed unless the patient declines) in healthcare facilities of adolescents and adults 13-64 years of age and HIV diagnostic testing of adolescents and adults with clinical signs or symptoms consistent with HIV infection (Centers for Disease Control and Prevention, 2006).

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