Improving The Detection of Osteopenia in Patients with HIV

HIV is a life-threatening disease that affects millions of people worldwide. Advancements in research have led to the discovery of Anti-Retroviral Therapy (ART). A number of treatment regimens can be used in ART including Tenofovir Disoproxil Fumarate (TDF). Both HIV and TDF containing agents can have a negative effect on a number of systems in the body including musculoskeletal system. The mechanism as to how this disease affects bone mineral density (BMD) is still poorly understood. A decrease in BMD can lead to the development of osteopenia and osteoporosis in these patients. Early detection of changes in BMD is vital to ensure that osteopenia does not develop. The aim of this Quality Improvement (QI) project was to improve the detection of osteopenia in patients with HIV. The QI framework used for this project was the DMAIC (Define, Measure, Analyse, Improve, Control) model. A variety of QI tools were utilised including Process Flow Maps, a Fishbone diagram and a Driver Diagram. For this QI project, the files of thirty patients were reviewed in order to determine if BMD changes were being detected. The results highlighted that there is currently no tool in place to determine if a patient requires formal BMD measurements. Current European AIDS Clinical Society (EACS) guidelines recommend the use of a fracture risk assessment tool (FRAX) to calculate a patients fracture risk in order to determine if formal BMD measurement is required. This QI project plan outline show an improvement in this process can be made through implementing the FRAX tool.