Title: HIV.IND.29 Logic Id: HIVIND29Logic Version: 0.4.4 Url: HIV.IND.29 Logic Status: draft Experimental: true Type: system: http://terminology.hl7.org/CodeSystem/library-type code: logic-library Date: 2025-12-08 16:41:10+0000 Publisher: WHO Description: % of people living with HIV on ART (for at least six months) who have virological suppression Related Artifacts: Dependencies http://smart.who.int/hiv/Library/HIVCommon|0.0.1 WHOCommon HIVElements HIVIndicatorElements Parameters: Name Type Min Max In/Out Measurement Period Period 0 1 In Patient Patient 0 1 Out Initial Population boolean 0 1 Out Numerator boolean 0 1 Out Denominator boolean 0 1 Out Administrative Gender Stratifier Coding 0 1 Out Age Stratifier string 0 1 Out Geographic Region Stratifier string 0 1 Out patientGroups Stratifier string 0 * Out Stratification string 0 1 Out Content: text/cql /** * Library: HIV.IND.29 Logic * Ref No: ART.3 * Short Name: People living with HIV on ART who have suppressed viral load * * Definition: % of people living with HIV on ART (for at least six months) who have virological suppression * * Numerator: Number of people living with HIV on ART for at least six months and with at least one routine VL test result who have virological suppression (<1000 copies/mL*) during the reporting period. * Numerator Calculation: COUNT of clients with "HIV status"='HIV-positive' AND "On ART"=True and "ART start date" GREATER THAN 6 months before reporting period end date AND "Date of viral load sample collection" within reporting period AND "Reason for HIV viral load test"='Routine viral load test' AND "Viral load test result" LESS THAN 1000 copies/mL * Numerator Exclusions: * * Denominator: Number of people living with HIV on ART at least six months with at least one routine VL result in a medical or laboratory record during the reporting period, to monitor progress towards the third 95 target | | In addition, this can also be presented as the number with suppressed VL among all people living with HIV to calculate population-level viral suppression. * Denominator Calculation: COUNT of clients with "HIV status"='HIV-positive' AND "On ART"=True and "ART start date" GREATER THAN 6 months before reporting period end date AND "Date of viral load sample collection" within reporting period AND "Reason for HIV viral load test"='Routine viral load test' * Denominator Exclusions: * * Disaggregations: * • Gender (female, male, other**) * • Age (0–4, 5–9, 10–14, 15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50+ years)*** * • Key populations (men who have sex with men, people living in prisons and other closed settings, people who inject drugs, sex workers, trans and gender diverse people)**** * • Cities and other administrative regions of epidemiologic importance * * Disaggregation Elements: Gender | Age | Key population member type * * Numerator and Denominator Elements: * ART start date * Date of viral load sample collection * HIV status * On ART * Reason for HIV viral load test * Viral load test result * * Reference: Consolidated guidelines on person-centred HIV strategic information: strengthening routine data for impact. Geneva: World Health Organization; 2022 * * Data Concepts: * HIV.A.DE17: Age | Calculated age (number of years) of the client based on date of birth * HIV.A.DE18: Gender* | Gender of the client* * HIV.A.DE19: Female | Client identifies as female * HIV.A.DE20: Male | Client identifies as male * HIV.A.DE21: Transgender male | Client identifies as transgender male * HIV.A.DE22: Transgender female | Client identifies as transgender female * HIV.A.DE23: Other | Additional category * HIV.B.DE50: Key population member type* | The type of key population that the client is included in * HIV.B.DE51: Sex worker | Client is a sex worker * HIV.B.DE52: Men who have sex with men | Client is a man who has sex with men * HIV.B.DE53: Trans and gender-diverse people | Client identifies as trans and gender-diverse * HIV.B.DE54: People who inject drugs | Client is a person who injects drugs * HIV.B.DE55: People living in prisons and other closed settings | Client lives in a prison or another closed setting * HIV.B.DE72: ART start date | The date on which the client started or restarted antiretroviral therapy (ART) * HIV.B.DE115: HIV status | HIV status reported after applying the national HIV testing algorithm. No single HIV test can provide an HIV-positive diagnosis. * HIV.B.DE116: HIV-positive | Client is HIV-positive * HIV.B.DE117: HIV-negative | Client is HIV-negative * HIV.B.DE118: Unknown | Client has unknown HIV status * HIV.D.DE38: On ART | Client is currently taking ART * HIV.D.DE39: ART start date | The date on which the client started or restarted ART * HIV.D.DE194: Date of viral load sample collection | Date and time when the sample was collected to test the client's HIV viral load * HIV.D.DE387: Viral load test result | Result from the viral load test in number of copies/mL * HIV.D.DE391: Reason for HIV viral load test | Whether the viral load is being tested for routine monitoring on a set schedule or for targeted monitoring for suspected treatment failure * HIV.D.DE392: Routine viral load test | Routine refers to viral load tests obtained at standard intervals following ART initiation to monitor viral load response to ART * HIV.D.DE393: Targeted viral load monitoring | Targeted refers to viral load tests obtained based on a specific clinical indication (such as concern about disease progression or failure to respond to ART) * HIV.D.DE394: Initial viral load test | The first viral load test of the client * HIV.D.DE395: Follow-up viral load test after receiving enhanced adherence counselling | A follow-up viral load test within 3-6 months after enhanced adherence counselling after client received a high viral load test result * HIV.E.DE114: Key population member type* | The type of key population that the infant's mother is included in * HIV.E.DE115: Sex worker | Infant's mother is a sex worker * HIV.E.DE116: People who inject drugs | Infant's mother is a person who injects drugs * HIV.E.DE117: Trans and gender-diverse people | Infant's mother identifies as trans and gender-diverse * HIV.E.DE118: People living in prisons and other closed setting | Infant's mother is in a prison or closed setting * HIV.G.DE8: Date of viral load sample collection | Date and time when the sample was collected to test the client's HIV viral load * HIV.G.DE12: Viral load test result | Result from the viral load test in number of copies/mL * HIV.H.DE47: On ART | Client is currently taking ART * HIV.SRV.DE6: ART start date | The date on which the client started or restarted antiretroviral therapy (ART) * HIV.SRV.DE12: Date of viral load sample collection | Date and time when the sample was collected to test the client's HIV viral load * HIV.SRV.DE13: Viral load test result | Result from the viral load test in number of copies/mL * * Additional Context * - what it measures: Measures clinical outcomes, specifically viral suppression of patients on ART regardless of ART initiation date. * - rationale: • Viral load suppression (VLS) represents the expected outcome of ART programme services that is, the third 95 target. | • VLS is also the best available measure of adherence to ART * - method: For the numerator and denominator: Patient monitoring tools (for example, ART register, patient records, EMRs, laboratory records) or acquired HIVDR surveillance, population-based surveys (such as, the Population-Based HIV Impact Assessment) that collects data on ART coverage and viral suppression | | This indicator must be interpreted along with VL testing coverage to assess the potential for bias, that is, whether VL testing occurs in only a particular subset of people receiving ART. | | Note: First routine VL testing is recommended at six months after ART initiation. As per ART.7, the time window for early VL monitoring can include a margin of +/– one month, that is, for reporting purposes a routine VL test can take place any time from five to seven months after initiation of ART. * * Suggested Scoring Method: proportion | http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm */ library HIVIND29Logic // Included Libraries using FHIR version '4.0.1' include HIVCommon version '0.0.1' called HIC include FHIRHelpers version '4.0.1' include WHOCommon called WCom include HIVElements called HE include HIVIndicatorElements called HIE // Indicator Definition parameter "Measurement Period" Interval<Date> default Interval[@2023-01-01, @2023-01-30] context Patient /* Populations */ /* *Initial Population */ define "Initial Population": true /** * Numerator * * Definition: Number of people living with HIV on ART for at least six months and with at least one routine VL test result who have virological suppression (<1000 copies/mL*) during the reporting period. * Calculation: COUNT of clients with "HIV status"='HIV-positive' AND "On ART"=True and "ART start date" GREATER THAN 6 months before reporting period end date AND "Date of viral load sample collection" within reporting period AND "Reason for HIV viral load test"='Routine viral load test' AND "Viral load test result" LESS THAN 1000 copies/mL */ define "Numerator": HIE."Has HIV-positive Status" and HIE."On ART H.DE47" and (months between (end of "Measurement Period") and (date from start of HE."First On ART".effective.toInterval()) > 6 months) and exists( HIE."Viral load test result D.DE387" VL with HE."routine viral load sample collection" P such that VL.partOf.references(P) and P.performed.toInterval() during "Measurement Period" where VL.value < 1000 ) /** * Denominator * * Definition: Number of people living with HIV on ART at least six months with at least one routine VL result in a medical or laboratory record during the reporting period, to monitor progress towards the third 95 target | | In addition, this can also be presented as the number with suppressed VL among all people living with HIV to calculate population-level viral suppression. * Calculation: COUNT of clients with "HIV status"='HIV-positive' AND "On ART"=True and "ART start date" GREATER THAN 6 months before reporting period end date AND "Date of viral load sample collection" within reporting period AND "Reason for HIV viral load test"='Routine viral load test' */ define "Denominator": HIE."Has HIV-positive Status" and HIE."On ART H.DE47" and (months between (end of "Measurement Period") and (date from start of HE."First On ART".effective.toInterval()) > 6 months) and exists( HIE."Viral load test result D.DE387" VL with HE."routine viral load sample collection" P such that VL.partOf.references(P) and P.performed.toInterval() during "Measurement Period" ) /* end Populations */ /* * Disaggregators */ define "Administrative Gender Stratifier": HIE."By Administrative Gender Stratifier" define "Age Stratifier": HIE."By Age Stratifier" define "Geographic Region Stratifier": HIE."By Geographic Region Stratifier" define "patientGroups Stratifier": HIE."patientGroups" define "Stratification": HIE."By Administrative Gender Stratifier".code + ':' + HIE."By Age Stratifier" + ':' + HIE."By Geographic Region Stratifier" + Combine(HIE.patientGroups, ':') Content: application/elm+xml Encoded data (70832 characters) Content: application/elm+json Encoded data (122908 characters)
% of people living with HIV on ART (for at least six months) who have virological suppression