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Set of completed cards, registers and reports: a companion for the exercise booklet of the three interlinked patient monitoring system

May 29, 2013 World Health Organization

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HIV/AIDS Programme

WHO/HIV/2013.5.

SET OF COMPLETED CARDS, REGISTERS AND REPORTS A COMPANION FOR THE EXERCISE BOOKLET OF THE THREE INTERLINKED PATIENT MONITORING SYSTEM

2012 GENEVA

WHO/HIV/2013.5.

© World Health Organization 2013 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

Layout L’IV Com Sàrl, Villars-sous-Yens, Switzerland. Printed by the WHO Document Production Services, Geneva, Switzerland. ii

Set of completed cards, registers and reports A companion for the Exercise booklet of the three interlinked patient monitoring system

Completed for Ex. A Status at enrolment: Unique No. DS000029 District: Markduk Health unit: Veld District clinician/team: Dr Sam Y()  Prior ART None PMTCT only Earlier ARV not transfer in / / / / Where Where ARVs ARVs Date



HIV exposed Infant  TB Rx



Pregnancy 

Postpartum  other Prior ARVs

Name: David B Sex M  F  Age: 27 yrs

Patient clinic No. 01590 DOB Marital status: Married

Address: Middle home in Kanut circle

Telephone (whose): 123.456.789 (David’s) ART Date / / / / ART transfer in from Start ART 1st -line initital regimen Wt Cl.stage CD4 Preg ARVs

Treatment supporter/medication pick-up if ill: Lydia Address: Middle home in Kanut circle Telephone (whose): 234.567.891 Home based care provided by

Cohort (month/year)

At start ART

1st - line

Substitute within 1st-line / / / / nd

Family status Name of family members and partners Lydia (wife) Age HIV P/N HIV care Y/N Unique No. Exposed Infant Name/ No. DOB

Exposed infant follow-up Infant feeding practice at 3 mos. CTX started by 2 mos. HIV test type/ result Final status (If confirm +) Unique ID

New regimen New regimen nd

Why Why

2nd - line

Switch to 2 -line (or substitution within 2 -line) / / / / New regimen New regimen Why Why

ART treatment interruption - Stop or missed drug pick-up Stop or Lost Date Stop Lost Stop Lost Stop Lost Stop Lost

HIV care Date Confirmed HIV + test HIV enrolled Medically eligible for ART 30.05.2007 20.06.2007 20.06.2007 HIV 1 2 Ab/virologic test Where  HIV care transfer in from

Why Date if restart

Status Date Dead Transferd out Lost to follow-up (drop) Where

Clinical stage 3 CD4  Presumptive clinical diagnosis of severe HIV infection in infants

Drug allergies

Relevant medical conditions

Exercise booklet

Unique No.         

HIV care/ART card Name

Date Check if scheduled. Write in alternate pick-up if ill

Followup date

Duration in months since first starting ART/since starting current regimen

Wt(kg) Ht(mt) at first visit If child record +/Oedema

Pregnancy/ RH-FP choices If child record MUAC Write age in mos. if ≤59 mos.

TB status (if TBRX record month/ year started and TB reg No.)

Potential side effects

New OI, Other problems If child, include nutritional problems

WHO clinical stage

Cotrimoxazole Adhere Dose/ days

INH No. pills dispensed

Other meds dispensed (including nutritional supplements)

ARV drugs(incl. prophylaxis) Adhere/ why Regimen/ Dose/ No. days dispensed

Investigations CD4 if <5, record CD4% Hgb,RPR, CXR, TB sputum. Infant Ab/HIV virologic test, other

Refer or consult or link/provide (including nutritional support and infant feeding) If hospitalized, No. of days

HIV transmission prevention for key population (Check) • Discordant couple • MSM • IDU • SW • Clients of SW –

 20.05.07                     

23.5.07

–

70 1.65

–

No signs

–

Thrush

–

960/32

–

Miconazol

–

Follow-up education, support and preparation for ARV therapy Date/comments Date/comments Date/comments Date/comments Basic HIV and TB education, transmission Prevention: abstinence, safer sex, condoms Prevention: household precautions, what is safe Post-test counselling: implications of results Positive living Testing partners Disclosure, to whom disclosed (list) Family/living situation Shared confidentiality Reproductive choices, prevention of MTCT Child's HIV test Progression of disease Available treatment/prophylaxis CTX, INH prophylaxis Malaria prevention, IPT, ITN Follow-up appointments, clinical team ART -- educate on essentials (locally adapted) Why complete adherence needed Adherence preparation, indicate visits Indicate when READY for ART: DATE/result clinical team discussion Explain dose, when to take What can occur, how to manage side effects What to do if one forgets dose What to do when travelling Adherence plan (schedule, aids, explain diary) Treatment supporter preparation Which doses, why missed ARV support group How to contact clinic 20.05.07 20.05.07 20.05.07 20.05.07 20.05.07 20.05.07 20.05.07

Home based care, support

ART preparation, initiation, support, monitor Rx

Progress-ion, Rx

Education on basics, prevention, disclosure

Symptom management/palliative care at home Caregiver booklet Home-based care -- specify Support groups Community support

Exercise booklet Completed for Ex. A Status at enrolment: Unique No. DS000132 District: Markduk Health unit: Veld District clinician/team: Dr Sam Y()  Prior ART None PMTCT only Earlier ARV not transfer in / / / / Where Where ARVs ARVs Date



HIV exposed Infant  TB Rx



Pregnancy  Postpartum  other Prior ARVs

Name: Mary Sima Patient clinic No. 01494 Sex M  F  Age: 35 DOB Marital status: Married Telephone (whose): 078.231.456(Mary)

Address: Nile road in the roundabout in Masaka Treatment supporter/medication pick-up if ill: Sam Address: Nile road in the roundabout in Masaka Telephone (whose): 078.231.323 (Sam’s)

ART Date / / / / ART transfer in from

Cohort (month/year)

ARVs

Start ART 1st -line initital regimen Wt Cl.stage CD4 Preg

Home based care provided by

At start ART

1st - line

Substitute within 1st-line / / / / nd

Family status Name of family members and partners Sam (Husband) Timothy Age HIV P/N HIV care Y/N Unique No. Exposed Infant Name/ No. DOB

Exposed infant follow-up Infant feeding practice at 3 mos. CTX started by 2 mos. HIV test type/ result Final status (If confirm +) Unique ID

New regimen New regimen nd

Why Why

2nd - line

Switch to 2 -line (or substitution within 2 -line) / / / / New regimen New regimen Why Why

40yrs.

4yrs

P Stop or Lost Date

ART treatment interruption - Stop or missed drug pick-up Stop Lost Stop Lost Stop Lost Stop Lost

HIV care Date Confirmed HIV + test HIV enrolled Medically eligible for ART 12.01.07 25.11.07 23.12.07 HIV 1 2 Ab/virologic test Where  HIV care transfer in from

Why Date if restart

Status Date Dead Transferd out Lost to follow-up (drop) Where

Clinical stage CD4  Presumptive clinical diagnosis of severe HIV infection in infants

Drug allergies

Relevant medical conditions

Unique No. DS000132

HIV care/ART card Name Mary Sima

Date Check if scheduled. Write in alternate pick-up if ill

Followup date

Duration in months since first starting ART/since starting current regimen

Wt(kg) Ht(mt) at first visit If child record +/Oedema

Pregnancy/ RH-FP choices If child record MUAC Write age in mos. if ≤59 mos.

TB status (if TBRX record month/ year started and TB reg No.)

Potential side effects

New OI, Other problems If child, include nutritional problems

WHO clinical stage

Cotrimoxazole Adhere Dose/ days

INH No. pills dispensed

Other meds dispensed (including nutritional supplements)

ARV drugs(incl. prophylaxis) Adhere/ why Regimen/ Dose/ No. days dispensed

Investigations CD4 if <5, record CD4% Hgb,RPR, CXR, TB sputum. Infant Ab/HIV virologic test, other

Refer or consult or link/provide (including nutritional support and infant feeding) If hospitalized, No. of days

HIV transmission prevention for key population (Check) • Discordant couple • MSM • IDU • SW • Clients of SW – –

 25.11.07  02.12.07

02.12.07 30.12.07

– –

54 1.55 54

P P, ANC No. 001234 EDD 02.07.08 P P

No signs No signs

– –

Z –

2 2

– G

960/8 960/8

– –

Acyclovir cream –

– –

 20.12.07  23.12.07                 07.01.08

– –

53 52

Suspects TB RX 12/07 #13967

– –

2 3

G G

– –

Sputum -, ++, ++

– –

Exercise booklet Follow-up education, support and preparation for ARV therapy Date/comments Date/comments Date/comments Date/comments Basic HIV and TB education, transmission Prevention: abstinence, safer sex, condoms Prevention: household precautions, what is safe Post-test counselling: implications of results Positive living Testing partners Disclosure, to whom disclosed (list) Family/living situation Shared confidentiality Reproductive choices, prevention of MTCT Child's HIV test Progression of disease Available treatment/prophylaxis CTX, INH prophylaxis Malaria prevention, IPT, ITN Follow-up appointments, clinical team ART -- educate on essentials (locally adapted) Why complete adherence needed Adherence preparation, indicate visits Indicate when READY for ART: DATE/result clinical team discussion Explain dose, when to take What can occur, how to manage side effects What to do if one forgets dose What to do when travelling Adherence plan (schedule, aids, explain diary) Treatment supporter preparation Which doses, why missed ARV support group How to contact clinic 13.12.07 13.12.07 13.12.07 15.11.07 15.11.07 15.11.07 15.11.07 15.11.07 15.11.07

Home based care, support

ART preparation, initiation, support, monitor Rx

Progress-ion, Rx

Education on basics, prevention, disclosure

Symptom management/palliative care at home Caregiver booklet Home-based care -- specify Support groups Community support

Completed for Ex. A Status at enrolment: Unique No. DS000147 District: Markduk Health unit: Veld District clinician/team: Dr Sam Y()  Prior ART None PMTCT only Earlier ARV not transfer in / / / / Where Where ARVs ARVs Date



HIV exposed Infant  TB Rx



Pregnancy 

Postpartum  other Prior ARVs

Name: Sadiki John Patient clinic No. 01651 Sex M  F  Age: 39yrs DOB Marital status: Single

Address: Kigogo, Ilala district

Telephone (whose): 077.888.999 ART Date / / ART transfer in from Start ART 1st -line initital regimen AZT-3TC-NVP Wt 50 Cl.stage 4 CD4 Preg ARVs

Treatment supporter/medication pick-up if ill: Salim John Address: Telephone (whose): 077.444.666 Home based care provided by

Cohort (month/year) December/2007

26 / 12 / 07 At start ART

1st - line

Substitute within 1st-line / / / / nd

Family status Name of family members and partners Age HIV P/N HIV care Y/N Unique No. Exposed Infant Name/ No. DOB

Exposed infant follow-up Infant feeding practice at 3 mos. CTX started by 2 mos. HIV test type/ result Final status (If confirm +) Unique ID

New regimen New regimen nd

Why Why

2nd - line

Switch to 2 -line (or substitution within 2 -line) / / / / New regimen New regimen Why Why

ART treatment interruption - Stop or missed drug pick-up Stop or Lost Date Stop Lost Stop Lost Stop Lost Stop Lost

HIV care Date Confirmed HIV + test HIV enrolled Medically eligible for ART 24.09.05 23.12.07 23.12.07 HIV 1 2 Ab/virologic test Where  HIV care transfer in from

Why Date if restart

Status Date Dead Transferd out Lost to follow-up (drop) Where

Clinical stage 4 CD4  Presumptive clinical diagnosis of severe HIV infection in infants

Drug allergies

Relevant medical conditions

Exercise booklet Unique No. DS000147 HIV care/ART card Name Sadiki John

Date Check if scheduled. Write in alternate pick-up if ill

Followup date

Duration in months since first starting ART/since starting current regimen

Wt(kg) Ht(mt) at first visit If child record +/Oedema

Pregnancy/ RH-FP choices If child record MUAC Write age in mos. if ≤59 mos.

TB status (if TBRX record month/ year started and TB reg No.)

Potential side effects

New OI, Other problems If child, include nutritional problems

WHO clinical stage

Cotrimoxazole Adhere Dose/ days

INH No. pills dispensed

Other meds dispensed (including nutritional supplements)

ARV drugs(incl. prophylaxis) Adhere/ why Regimen/ Dose/ No. days dispensed

Investigations CD4 if <5, record CD4% Hgb,RPR, CXR, TB sputum. Infant Ab/HIV virologic test, other

Refer or consult or link/provide (including nutritional support and infant feeding) If hospitalized, No. of days

HIV transmission prevention for key population (Check) • Discordant couple • MSM • IDU • SW • Clients of SW –

 23.12.07  06.12.07

– 0

50 1.70 50

– –

No signs No signs

– –

Kaposi’s sarcoma –

4 4

960/32 –

– –

–

– AZT3TCNVP 32

–

Hgb11g/dl

–

                  

Follow-up education, support and preparation for ARV therapy Date/comments Date/comments Date/comments Date/comments Basic HIV and TB education, transmission Prevention: abstinence, safer sex, condoms Prevention: household precautions, what is safe Post-test counselling: implications of results Positive living Testing partners Disclosure, to whom disclosed (list) Family/living situation Shared confidentiality Reproductive choices, prevention of MTCT Child's HIV test Progression of disease Available treatment/prophylaxis CTX, INH prophylaxis Malaria prevention, IPT, ITN Follow-up appointments, clinical team ART -- educate on essentials (locally adapted) Why complete adherence needed Adherence preparation, indicate visits Indicate when READY for ART: DATE/result clinical team discussion Explain dose, when to take What can occur, how to manage side effects What to do if one forgets dose What to do when travelling Adherence plan (schedule, aids, explain diary) Treatment supporter preparation Which doses, why missed ARV support group How to contact clinic 26.11.07 26.11.07 23.11.07 24.11.07 23.11.07(1st Visit) 25.11.07 26.11.07 26.11.07 24.11.07(2nd visit) 25.11.07(3rd visit) 23.11.07

Home based care, support

ART preparation, initiation, support, monitor Rx

Progress-ion, Rx

Education on basics, prevention, disclosure

Symptom management/palliative care at home Caregiver booklet Home-based care -- specify Support groups Community support 26.11.07/booklet provided

Exercise booklet sample completed for Ex. F- 1 Status at enrolment: Unique No. DS01042343 District: Markduk Health unit: Veld District clinician/team: Dr Sam Y()  Prior ART None PMTCT only Earlier ARV not transfer in / / / / Where Where ARVs ARVs Date



HIV exposed Infant  TB Rx



Pregnancy 

Postpartum  other Prior ARVs

Name: Timothy M. Patient clinic No. 03576 Sex M  F  Age: 58yrs DOB Marital status: Married

Address: St 58 # 11

Telephone (whose): 011.354.546(home) ART Date / / ART transfer in from Start ART 1st -line initital regimen AZT-3TC-EFV Wt 74 Cl.stage 2 CD4 120 Preg ARVs

Treatment supporter/medication pick-up if ill: Address: Telephone (whose): Home based care provided by

Cohort (month/year) October/2008

12 / 10 / 08 At start ART

1st - line

Substitute within 1st-line / / / / nd

Family status Name of family members and partners Sara(wife) Age HIV P/N HIV care Y/N Unique No. Exposed Infant Name/ No. DOB

Exposed infant follow-up Infant feeding practice at 3 mos. CTX started by 2 mos. HIV test type/ result Final status (If confirm +) Unique ID

New regimen New regimen nd

Why Why

2nd - line

Switch to 2 -line (or substitution within 2 -line) / / / / New regimen New regimen Why Why

ART treatment interruption - Stop or missed drug pick-up Stop or Lost Date Stop Lost Stop Lost Stop Lost Stop Lost

HIV care Date Confirmed HIV + test HIV enrolled Medically eligible for ART 29.09.08 05.10.08 05.10.08 HIV 1 2 Ab/virologic test Where  HIV care transfer in from

Why Date if restart

Status Date Dead Transferd out Lost to follow-up (drop) 05.12.08 Where

Clinical stage 2 CD4 120  Presumptive clinical diagnosis of severe HIV infection in infants

Drug allergies

Relevant medical conditions

Unique No. DS01042343

HIV care/ART card Name Timothy M.

Date Check if scheduled. Write in alternate pick-up if ill

Followup date

Duration in months since first starting ART/since starting current regimen

Wt(kg) Ht(mt) at first visit If child record +/Oedema

Pregnancy/ RH-FP choices If child record MUAC Write age in mos. if ≤59 mos.

TB status (if TBRX record month/ year started and TB reg No.)

Potential side effects

New OI, Other problems If child, include nutritional problems

WHO clinical stage

Cotrimoxazole Adhere Dose/ days

INH No. pills dispensed

Other meds dispensed (including nutritional supplements)

ARV drugs(incl. prophylaxis) Adhere/ why Regimen/ Dose/ No. days dispensed

Investigations CD4 if <5, record CD4% Hgb,RPR, CXR, TB sputum. Infant Ab/HIV virologic test, other

Refer or consult or link/provide (including nutritional support and infant feeding) If hospitalized, No. of days

HIV transmission prevention for key population (Check) • Discordant couple • MSM • IDU • SW • Clients of SW – –

 05.10.08  12.10.08  26.10.08  12.11.08  26.11.08  02.12.08  05.12.08          

12.02.09 26.02.09

– 0

75 1.85 74

– –

No sign No sign

– –

Z –

2 2

– G

960/30 –

– –

– AZT-3TCEFV 15 AZT-3TCEFV 15 AZT-3TCEFV 30 –

120 –

– Hgb-11

– –

12.03.09

2wks

–

No sign

–

960/30

–

9.04.09

4wks

–

No sign

–

Hgb- 10

–

6wks

–

Suspe-ct

Fever Cough >2wks Fever Cough

F/5

–

F/5

–

Sputum

–

7wks

–

Suspe-ct

F/5

–

F/5

–

Sputum --,--, -CX-ray

Notified patient death

Exercise booklet Follow-up education, support and preparation for ARV therapy Date/comments Date/comments Date/comments Date/comments Basic HIV and TB education, transmission Prevention: abstinence, safer sex, condoms Prevention: household precautions, what is safe Post-test counselling: implications of results Positive living Testing partners Disclosure, to whom disclosed (list) Family/living situation Shared confidentiality Reproductive choices, prevention of MTCT Child's HIV test Progression of disease Available treatment/prophylaxis CTX, INH prophylaxis Malaria prevention, IPT, ITN Follow-up appointments, clinical team ART -- educate on essentials (locally adapted) Why complete adherence needed Adherence preparation, indicate visits Indicate when READY for ART: DATE/result clinical team discussion Explain dose, when to take What can occur, how to manage side effects What to do if one forgets dose What to do when travelling Adherence plan (schedule, aids, explain diary) Treatment supporter preparation Which doses, why missed ARV support group How to contact clinic 05.10.08(1st Visit) 11.10.08 07.10.08(2nd visit) 11.10.08(3rd visit) 05.10.08 05.10.08 05.10.08 05.10.08 05.10.08 05.10.08

Home based care, support

ART preparation, initiation, support, monitor Rx

Progress-ion, Rx

Education on basics, prevention, disclosure

Symptom management/palliative care at home Caregiver booklet Home-based care -- specify Support groups Community support

Sample completed for Ex. F- 2 Status at enrolment: Unique No. DS01042344 District: Markduk Health unit: Veld District clinician/team: Dr Sam Y()  Prior ART None PMTCT only Earlier ARV not transfer in / / / / Where Where ARVs ARVs Date



HIV exposed Infant  TB Rx



Pregnancy 

Postpartum  other Prior ARVs

Name: Mike K Sex M  F  Age: 44yrs

Patient clinic No. 03761 DOB Marital status: Single

Address: St 10, #73

Telephone (whose): 092.134.555(self) ART Date / / ART transfer in from Start ART 1st -line initital regimen AZT-3TC-NVP Wt 49 Cl.stage 4 CD4 Preg ARVs

Treatment supporter/medication pick-up if ill: Address: Telephone (whose): Home based care provided by

Cohort (month/year) October/2008

23 / 10 / 08 At start ART

1st - line

Substitute within 1st-line 18 / 12 / 08 / / New regimen TDF -3TC-NVP New regimen Why Why 1

Family status Name of family members and partners Age HIV P/N HIV care Y/N Unique No. Exposed Infant Name/ No. DOB

Exposed infant follow-up Infant feeding practice at 3 mos. CTX started by 2 mos. HIV test type/ result Final status (If confirm +) Unique ID

2nd - line

Switch to 2nd-line (or substitution within 2nd-line) / / / / New regimen New regimen Why Why

ART treatment interruption - Stop or missed drug pick-up Stop or Lost Date Stop Lost Stop Lost Stop Lost Stop Lost

HIV care Date Confirmed HIV + test HIV enrolled Medically eligible for ART 11.09.08 09.10.08 09.10.08 HIV 1 2 Ab/virologic test Where  HIV care transfer in from

Why Date if restart

Status Date Dead Transferd out Lost to follow-up (drop) 12.03.09 Where MIH Health centre

Clinical stage 4 CD4  Presumptive clinical diagnosis of severe HIV infection in infants

Drug allergies

Relevant medical conditions

Exercise booklet Unique No. DS01042344 HIV care/ART card Name Mike K.

Date Check if scheduled. Write in alternate pick-up if ill

Followup date

Duration in months since first starting ART/since starting current regimen

Wt(kg) Ht(mt) at first visit If child record +/Oedema

Pregnancy/ RH-FP choices If child record MUAC Write age in mos. if ≤59 mos.

TB status (if TBRX record month/ year started and TB reg No.)

Potential side effects

New OI, Other problems If child, include nutritional problems

WHO clinical stage

Cotrimoxazole Adhere Dose/ days

INH No. pills dispensed

Other meds dispensed (including nutritional supplements)

ARV drugs(incl. prophylaxis) Adhere/ why Regimen/ Dose/ No. days dispensed

Investigations CD4 if <5, record CD4% Hgb,RPR, CXR, TB sputum. Infant Ab/HIV virologic test, other

Refer or consult or link/provide (including nutritional support and infant feeding) If hospitalized, No. of days

HIV transmission prevention for key population (Check) • Discordant couple • MSM • IDU • SW • Clients of SW –

 09.10.08  23.10.08  06.11.08  20.11.08  18.12.08  15.01.09  12.03.09         

23.10.08

–

49 1.75 49

–

No sign

–

ThrushOesophageal –

–

960/30

–

Fluconazol

–

6.11.08

–

No sign

–

AZT-3TCNVP 15 AZT-3TCNVP 15 AZT-3TCNVP 30 TDF-3TCNVP 30 TDF-3TCNVP 64 TDF-3TCNVP 30

–

Hgb.10

–

20.11.08

2wks

–

No sign

H and R

–

960/60

–

18.12.08

4wks

–

No sign

H and F

–

F/1

–

F/1

–

Hgb. 9

–

15.01.09

8wks

–

No sign

–

P/1

960/60

–

F/1

–

Hgb. 7

–

12.03.09

12wks

–

No sign

–

Hgb. 8

–

TO MIH HC

20wks

–

No sign

–

960/60

–

Hgb. 9

–

Follow-up education, support and preparation for ARV therapy Date/comments Date/comments Date/comments Date/comments Basic HIV and TB education, transmission Prevention: abstinence, safer sex, condoms Prevention: household precautions, what is safe Post-test counselling: implications of results Positive living Testing partners Disclosure, to whom disclosed (list) Family/living situation Shared confidentiality Reproductive choices, prevention of MTCT Child's HIV test Progression of disease Available treatment/prophylaxis CTX, INH prophylaxis Malaria prevention, IPT, ITN Follow-up appointments, clinical team ART -- educate on essentials (locally adapted) Why complete adherence needed Adherence preparation, indicate visits Indicate when READY for ART: DATE/result clinical team discussion Explain dose, when to take What can occur, how to manage side effects What to do if one forgets dose What to do when travelling Adherence plan (schedule, aids, explain diary) Treatment supporter preparation Which doses, why missed ARV support group How to contact clinic 09.10.08(1st Visit) 14.10.08(2nd visit) 20.10.08(3rd visit) 09.10.08 09.10.08 09.10.08 09.10.08 09.10.08 09.10.08

Home based care, support

ART preparation, initiation, support, monitor Rx

Progress-ion, Rx

Education on basics, prevention, disclosure

Symptom management/palliative care at home Caregiver booklet Home-based care -- specify Support groups Community support

Exercise booklet sample completed for Ex. F- 3 Status at enrolment: Unique No. DS01042345 District: Markduk Health unit: Veld District clinician/team: Dr Sam Y()  Prior ART None PMTCT only Earlier ARV not transfer in / / / / Where Where ARVs ARVs Date



HIV exposed Infant  TB Rx



Pregnancy 

Postpartum  other Prior ARVs

Name: Lily S Sex M  F  Age: 27yrs

Patient clinic No. 02344 DOB Marital status: Married

Address: St.22 # 76

Telephone (whose): 011.244.777(home) ART Date / / ART transfer in from Start ART 1st -line initital regimen AZT-3TC-NVP Wt 55 Cl.stage 3 CD4 Preg ARVs

Treatment supporter/medication pick-up if ill: Samson W Address: St 22 #76 Telephone (whose): 011.244.777(home) Home based care provided by

Cohort (month/year) October/2008

29 / 10 / 08 At start ART

1st - line

Substitute within 1st-line 28 / 01 / 09 / / New regimen AZT-3TC-EFV New regimen Why Why 1

Family status Name of family members and partners Samson (Husband) Age HIV P/N HIV care Y/N Unique No. Exposed Infant Name/ No. DOB

Exposed infant follow-up Infant feeding practice at 3 mos. CTX started by 2 mos. HIV test type/ result Final status (If confirm +) Unique ID

2nd - line

Switch to 2nd-line (or substitution within 2nd-line) / / / / New regimen New regimen Why Why

ART treatment interruption - Stop or missed drug pick-up Stop or Lost Date Stop Lost 31.12.08 Stop Lost Stop Lost Stop Lost

HIV care Date Confirmed HIV + test HIV enrolled Medically eligible for ART 13.06.08 15.10.08 15.10.08 HIV 1 2 Ab/virologic test Where  HIV care transfer in from

Why Date if restart

Status Date Dead Transferd out Lost to follow-up (drop) 28.12.08 Where BL hospital

Clinical stage 3 CD4  Presumptive clinical diagnosis of severe HIV infection in infants

Drug allergies

Relevant medical conditions

Unique No. DS01042345

HIV care/ART card Name Lily S

Date Check if scheduled. Write in alternate pick-up if ill

Followup date

Duration in months since first starting ART/since starting current regimen

Wt(kg) Ht(mt) at first visit If child record +/Oedema

Pregnancy/ RH-FP choices If child record MUAC Write age in mos. if ≤59 mos.

TB status (if TBRX record month/ year started and TB reg No.)

Potential side effects

New OI, Other problems If child, include nutritional problems

WHO clinical stage

Cotrimoxazole Adhere Dose/ days

INH No. pills dispensed

Other meds dispensed (including nutritional supplements)

ARV drugs(incl. prophylaxis) Adhere/ why Regimen/ Dose/ No. days dispensed

Investigations CD4 if <5, record CD4% Hgb,RPR, CXR, TB sputum. Infant Ab/HIV virologic test, other

Refer or consult or link/provide (including nutritional support and infant feeding) If hospitalized, No. of days

HIV transmission prevention for key population (Check) • Discordant couple • MSM • IDU • SW • Clients of SW – –

 15.10.08  29.10.08  12.11.08  26.11.08  24.12.08  28.12.08            

29.10.08 12.11.08

– 0

55 1.65 55

Wants FP Wants FP

No sign No sign

– –

3 3

– G

960/30 –

– –

– AZT-3TCNVP 15 AZT-3TCNVP 15 AZT-3TCNVP 30 STOP STOP

– –

– Hgb.10

– –

26.11.08

2wks

Has FP/C & OC Has FP/C & OC Has FP/C & OC –

No sign

–

960/60

–

24.12.08

4wks

No sign

–

Hgb. 9

–

21.01.09 TO BL HO

8wks 9wks

56 56

No sign No sign

N&F J

– –

3 3

F/1 P/5

960/60 STOP

– –

F/1 P/5

– –

ALT/AST sent ALT 10 x

– –

Exercise booklet Follow-up education, support and preparation for ARV therapy Date/comments Date/comments Date/comments Date/comments Basic HIV and TB education, transmission Prevention: abstinence, safer sex, condoms Prevention: household precautions, what is safe Post-test counselling: implications of results Positive living Testing partners Disclosure, to whom disclosed (list) Family/living situation Shared confidentiality Reproductive choices, prevention of MTCT Child's HIV test Progression of disease Available treatment/prophylaxis CTX, INH prophylaxis Malaria prevention, IPT, ITN Follow-up appointments, clinical team ART -- educate on essentials (locally adapted) Why complete adherence needed Adherence preparation, indicate visits Indicate when READY for ART: DATE/result clinical team discussion Explain dose, when to take What can occur, how to manage side effects What to do if one forgets dose What to do when travelling Adherence plan (schedule, aids, explain diary) Treatment supporter preparation Which doses, why missed ARV support group How to contact clinic 15.10.08(1st Visit) 20.10.08(2nd visit) 27.10.08(3rd visit) 15.10.08 15.10.08 15.10.08 15.10.08 15.10.08 15.10.08

Home based care, support

ART preparation, initiation, support, monitor Rx

Progress-ion, Rx

Education on basics, prevention, disclosure

Symptom management/palliative care at home Caregiver booklet Home-based care -- specify Support groups Community support

Sample completed for Ex. F- 4 Status at enrolment: Unique No. DS01042355 District: Markduk Health unit: Veld District clinician/team: Dr Sam Y()  Prior ART None PMTCT only Earlier ARV not transfer in / / / / Where Where ARVs ARVs Date

Ex.4



HIV exposed Infant  TB Rx



Pregnancy  Postpartum  other Prior ARVs

Name: Martha N. Patient clinic No. 05544 Sex M  F  Age: 29yrs DOB Marital status: Married

Address: St 33, #67

Telephone (whose): 091.113.287(self) ART Date / / ART transfer in from Start ART 1st -line initital regimen AZT-3TC-NVP Wt 50 Cl.stage 2 CD4 150 Preg  ARVs

Treatment supporter/medication pick-up if ill: Address: Telephone (whose): Home based care provided by

Cohort (month/year) November/2008

08 / 11 / 08 At start ART

Family status Name of family members and partners Steven (husband) John (son) Sara (daughter) Age HIV P/N HIV care Y/N Unique No. Exposed Infant Name/ No. DOB

Exposed infant follow-up Infant feeding practice at 3 mos. CTX started by 2 mos. HIV test type/ result Final status (If confirm +) Unique ID

1st - line

Substitute within 1st-line / / / / nd

New regimen New regimen nd

Why Why

2nd - line

Switch to 2 -line (or substitution within 2 -line) / / / / New regimen New regimen Why Why

36 12 6

ART treatment interruption - Stop or missed drug pick-up Stop or Lost Date Stop Lost 31.12.08 Stop Lost Stop Lost Stop Lost

HIV care Date Confirmed HIV + test HIV enrolled Medically eligible for ART 24.10.08 29.10.08 29.10.08 HIV 1 2 Ab/virologic test Where  HIV care transfer in from

Why Date if restart

Status Date Dead Transferd out Lost to follow-up (drop) Where

Clinical stage 2 CD4 150  Presumptive clinical diagnosis of severe HIV infection in infants

Drug allergies

Relevant medical conditions

Exercise booklet

Unique No. DS01042355

HIV care/ART card Name Martha N

Date Check if scheduled. Write in alternate pick-up if ill

Followup date

Duration in months since first starting ART/since starting current regimen

Wt(kg) Ht(mt) at first visit If child record +/Oedema

Pregnancy/ RH-FP choices If child record MUAC Write age in mos. if ≤59 mos.

TB status (if TBRX record month/ year started and TB reg No.)

Potential side effects

New OI, Other problems If child, include nutritional problems

WHO clinical stage

Cotrimoxazole Adhere Dose/ days

INH No. pills dispensed

Other meds dispensed (including nutritional supplements)

ARV drugs(incl. prophylaxis) Adhere/ why Regimen/ Dose/ No. days dispensed

Investigations CD4 if <5, record CD4% Hgb,RPR, CXR, TB sputum. Infant Ab/HIV virologic test, other

Refer or consult or link/provide (including nutritional support and infant feeding) If hospitalized, No. of days

HIV transmission prevention for key population (Check) • Discordant couple • MSM • IDU • SW • Clients of SW –

 29.10.08

08.11.08

–

P. EDD6.08.09 ANC No. 00345 P

No sign

–

960/30

–

 08.11.08  22.11.08  05.12.08  05.01.09  04.03.09          

22.11.08

No sign

–

AZT-3TCNVP 15 AZT-3TCNVP 15 AZT-3TCNVP 30 AZT-3TCNVP 64 AZT-3TCNVP 64

–

Hgb.10

–

05.12.08

2wks

No sign

–

F/1

960/30

–

F/1

–

05.01.09

1mo.

No sign

–

Hgb-11

–

02.03.09

2mo.

No sign

–

960/64

–

Hgb-10

–

05.05.09

–

960/64

–

Hgb-10

–

Sample completed for Ex. F- 5 Status at enrolment: Unique No. DS01042356 District: Markduk Health unit: Veld District clinician/team: Dr Sam Y()  Prior ART None PMTCT only Earlier ARV not transfer in / / / / Where Where ARVs ARVs Date



HIV exposed Infant  TB Rx



Pregnancy 

Postpartum  other Prior ARVs

Name: Ann B. Sex M  F  Age: 27yrs

Patient clinic No. 02458 DOB Marital status: Married

Address: 12 St. #12

Telephone (whose): 091. 302.408(Ann) David K. ART Date / / ART transfer in from Start ART 1st -line initital regimen AZT-3TC-NVP Wt 52kg Cl.stage 3 CD4 Preg ARVs

Treatment supporter/medication pick-up if ill: Address: 12 St. #12 Telephone (whose): 091.786.443(David)

Cohort (month/year) November/2008

24 / 11 / 08 At start ART

Home based care provided by

Family status Name of family members and partners David (Husband) TR (Son) MM (Son) Age HIV P/N HIV care Y/N Unique No. Exposed Infant Name/ No. DOB

Exposed infant follow-up Infant feeding practice at 3 mos. CTX started by 2 mos. HIV test type/ result Final status (If confirm +) Unique ID

1st - line

Substitute within 1st-line 20 / 02 / 09 / / New regimen AZT-3TC-EFV New regimen Why Why 4

2nd - line

Switch to 2nd-line (or substitution within 2nd-line) / / / / New regimen New regimen Why Why

40 5 3

P N N

Y – – – –

ART treatment interruption - Stop or missed drug pick-up Stop or Lost Date Stop Lost 13.04.09 Stop Lost Stop Lost Stop Lost

HIV care Date Confirmed HIV + test HIV enrolled Medically eligible for ART 19.05.08 10.11.08 10.11.08 HIV 1 2 Ab/virologic test Where  HIV care transfer in from

Why Date if restart

Status Date Dead Transferd out Lost to follow-up (drop) Where

Clinical stage 3 CD4  Presumptive clinical diagnosis of severe HIV infection in infants

Drug allergies

Relevant medical conditions

Exercise booklet

Unique No. DS01042356

HIV care/ART card Name Ann B

Date Check if scheduled. Write in alternate pick-up if ill

Followup date

Duration in months since first starting ART/since starting current regimen

Wt(kg) Ht(mt) at first visit If child record +/Oedema

Pregnancy/ RH-FP choices If child record MUAC Write age in mos. if ≤59 mos.

TB status (if TBRX record month/ year started and TB reg No.)

Potential side effects

New OI, Other problems If child, include nutritional problems

WHO clinical stage

Cotrimoxazole Adhere Dose/ days

INH No. pills dispensed

Other meds dispensed (including nutritional supplements)

ARV drugs(incl. prophylaxis) Adhere/ why Regimen/ Dose/ No. days dispensed

Investigations CD4 if <5, record CD4% Hgb,RPR, CXR, TB sputum. Infant Ab/HIV virologic test, other

Refer or consult or link/provide (including nutritional support and infant feeding) If hospitalized, No. of days

HIV transmission prevention for key population (Check) • Discordant couple • MSM • IDU • SW • Clients of SW

 10.11.08  24.11.08  08.12.08  15.12.08  22.12.08  19.01.09  16.02.09

24.11.08

–

52 1.62 52

Has FP/ IMP Has FP/ IMP Has FP/C & IMP Has FP/C & IMP Has FP/C & IMP Has FP/C & IMP Has FP/ IMP

No sign

–

960/30

–

8.12.08

No sign

–

AZT-3TCNVP 15 days AZT-3TCNVP 15 days – AZT-3TCNVP 32 days AZT-3TCNVP 30 days AZT-3TCNVP 30 days AZT-3TCEFV 30 days AZT-3TCEFV 30 days

–

Hgb.11

15.12.08

2wks

No sign

–

P/1

960/60

–

F/1

–

22.12.08 19.01.09

3wks 4Wks

52 53

No sign No sign

– –

3 3

G G

– –

G G

– –

– Hgb 11

16.02.09

8wks

No sign

–

960/60

–

Hgb 10

–

12wks

Suspect

–

Cough>3 wks

–

Hgb9 Sputum for AFB sent Sputum -+–

 20.02.09  16.03.09  13.04.09    

16.03.09

13wks

Has FP/ IMP Has FP/ IMP

TBRX 02/2009 Reg. # 0156 TBRX

–

F/13

–

F/13

–

13.04.09

16wks

CNS

–

F/13

960/60

–

F/13

–

Lost

Follow-up education, support and preparation for ARV therapy Date/comments Date/comments Date/comments Date/comments Basic HIV and TB education, transmission Prevention: abstinence, safer sex, condoms Prevention: household precautions, what is safe Post-test counselling: implications of results Positive living Testing partners Disclosure, to whom disclosed (list) Family/living situation Shared confidentiality Reproductive choices, prevention of MTCT Child's HIV test Progression of disease Available treatment/prophylaxis CTX, INH prophylaxis Malaria prevention, IPT, ITN Follow-up appointments, clinical team ART -- educate on essentials (locally adapted) Why complete adherence needed Adherence preparation, indicate visits Indicate when READY for ART: DATE/result clinical team discussion Explain dose, when to take What can occur, how to manage side effects What to do if one forgets dose What to do when travelling Adherence plan (schedule, aids, explain diary) Treatment supporter preparation Which doses, why missed ARV support group How to contact clinic 14.11.08 14.11.08 10.11.08(1st Visit) 20.11.08 24.11.08 24.11.08 24.11.08 24.11.08 24.11.08 24.11.08 14.11.08(2nd visit) 20.11.08(3rd visit) 10.11.08 10.11.08 10.11.08 10.11.08 10.11.08 10.11.08

Home based care, support

ART preparation, initiation, support, monitor Rx

Progress-ion, Rx

Education on basics, prevention, disclosure

Symptom management/palliative care at home Caregiver booklet Home-based care -- specify Support groups Community support 24.11.08

Exercise booklet Pre-ART register Page 1 Health Facility: Veld Health Center

Completed for Ex. D

Registration Date enrolled In chronic HIV care Unique ID No. Patient clinic ID No. Name in full Upper space: surname Lower space: given name David B 25.11.07 DS000132 01494 Mary Sima 23.12.07 DS000147 01651 Sadiki John M 39 12/07 F 35 Preg 11/07 Sex Age Status at enrolment (record TI if transfer in) CTX Start month/ year

Fill when applicable INH start month/ year TBRX Start month/ year and TB reg No. 1

Clinical stage 2 3 4

PMTCT For each pregnancy, record EDD, ANC No. and HIV -exposed infant No. Preg 1 Preg 2 Preg 3 Preg 4

ART Date medically eligible for ART Date ART Started (transfer to ART register)

20.06.07

DS000029

01590

05/07



20.06.07

12/07 #13967



EDD 2.07.08 ANC#001234 

23.12.07

26.12.07

Pre-ART register Page 2

Quarterly follow - up status Year 2007 Q1 Q2 Jan-Mar Apr-Jun – Y Q3 Jul-Sep Q4 Oct-Dec

Year Q1 Q2 Jan-Mar Apr-Jun Q3 Jul-Sep Q4 Oct-Dec

Total TB staus Y Seen at least once in Y

Top row: record follow-up status at end of each quarter CD4 - record last CD4 in quarter - did not have visit scheduled for that quarter LOST- not seen in the last quarter, but scheduled for a visit TO- transferred out (record to where) DEAD - record date

Bottom row: Record TB status Yes/No - TB status completed at last visit in last quarter

Exercise booklet Pre-ART register Page 1 Health Facility:

Sample completed Ex. E 1-10

Registration Date enrolled In chronic HIV care Unique ID No. Patient clinic ID No. Name in full Upper space: surname Lower space: given name R P 02.01.07 BA0002 A S 02.01.07 BA0003 T M 05.01.07 BA0004 P P 07.01.07 BA0005 O M 33 TBRX M 48 01/07 M 50 TI F 22 01/07 Sex Age Status at enrolment (record TI if transfer in) CTX Start month/ year

Fill when applicable INH start month/ year TBRX Start month/year and TB reg No. 1

Clinical stage 2 3 4

PMTCT For each pregnancy, record EDD, ANC No. and HIV -exposed infant No. Preg 1 Preg 2 Preg 3 Preg 4

ART Date medically eligible for ART Date ART Started (transfer to ART register)

01.01.07

BA0001

01/07



02.01.07

01.02.07



02.01.07

02.02.07



10/06 TB # 1126 = 01/07 



07.01.07

12.01.07

BA0006

O R

17.01.07

BA0007

A D



17.01.07

20.01.07

BA0008

M P

Preg

01/07



20.7.07 ANC#2688 

25.01.07

BA0009

S P

25.01.07

05.02.07

BA0010

02/07



05.02.07

18.02.07

Pre-ART register Page 2

Ex. E 1-10

Quarterly follow - up status Year 2007 Q1 Q2 Jan-Mar Apr-Jun 370 Y 100 Y 150 Y 380 Y 300 Y 380 Y 300 Y 200 N 180 N 180 Y Total TB staus Y Seen at least once in Y Q3 Jul-Sep Q4 Oct-Dec

Year Q1 Q2 Jan-Mar Apr-Jun Q3 Jul-Sep Q4 Oct-Dec

Bottom row: Record TB status Yes/No - TB status completed at last visit in last quarter

Exercise booklet Pre-ART register Page 1 Health Facility:

Sample completed Ex. E 11-20

Registration Date enrolled In chronic HIV care Unique ID No. Patient clinic ID No. Name in full Upper space: surname Lower space: given name F R 12.02.07 BA0013 M S 15.02.07 BA0014 W T 18.02.07 BA0017 L T 24.02.07 BA0020 L A 25.03.07 BA0028 F M 25.03.07 BA0029 M L 26.03.07 BA0030 S S 27.03.07 BA0031 P J 28.03.07 BA0032 R S F 21 Preg 03/07 M 7 TI M 39 TBRX F 33 03/07 M 22 03/07 F 20 M 5 TI 02/07 F 22 02/07 F 26 Sex Age Status at enrolment (record TI if transfer in) TBRX CTX Start month/ year

Fill when applicable INH start month/ year TBRX Start month/ year and TB reg No. 12/06 1

Clinical stage 2 3 4

PMTCT For each pregnancy, record EDD, ANC No. and HIV -exposed infant No. Preg 1 Preg 2 Preg 3 Preg 4

ART Date medically eligible for ART Date ART Started (transfer to ART register)

07.02.07

BA0011



07.02.07

02/07



12.02.07



18.02.07

26.02.07

02/07



02/07



25.03.07



26.03.07



15.6.07

28.03.07

Pre-ART register Page 2

Ex. E 11-20

Quarterly follow - up status Year 2007 Q1 Q2 Jan-Mar Apr-Jun 300 N DEAD Q3 Jul-Sep Q4 Oct-Dec

Year Q1 Q2 Jan-Mar Apr-Jun Q3 Jul-Sep Q4 Oct-Dec

360 Y 100 Y TO (Veld)

200 Y 380 Y 80 Y 380 Y 200 Y Total TB staus Y Seen at least once in Y

Bottom row: Record TB status Yes/No - TB status completed at last visit in last quarter

Exercise booklet ART register page 1 Health Facility:

Completed for Ex. F

Cohort : Year 2007 Month December Registration ART start date Unique ID No. Patient clinic ID Name in full Upper space: surname Lower space: given name Sadiki John Sex Age weight

Status at start of ART WHO clinical TBRX Start month/ year and TB reg No.

Fill in when applicable CTX Start Month/ year INH Start Month/ year TBRX Start month/ year and TB reg No. Preg 1 Preg 2

PMTCT Preg 3 Preg 4 Original regimen

1st -line regimen Substitution 1st: reason/ date 2nd : Reason/ date

2nd -line regimen Switches, substitution 1st : Reason/ date 2nd : reason/ date

26.12.07

DS000147

01651

12/07

Reasons for regimen change 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify)

Reasons for switch to 2nd -line regimen: 8. Clinical treatment failure 9. Immunologic failure 10. Virologic failure

Adult 1st -line regimens 1a = AZT-3TC-EFV 1b = AZT-3TC-NVP 1C = TDF-FTC-EFV 1d = TDF-FTC-EFV 1e = TDF-3TC-EFV 1f = TDF-3TC-NVP 1g = other

Child 1st -line regimens 4a = d4T-3TC-NVP 4b = d4T-3TC-EFV 4c = AZT-3TC-NVP 4d = AZT-3TC-EFV 4e = …. 4f = …. 4g = other

Adult 2nd -line regimens 2a(250) = ABC - ddI(250) - LPV/r 2a(400) = ABC - ddI(400) - LPV/r 2b(250) = ABC - ddI(250) - SQV/r 2b(400) = ABC - ddI(400) - SQV/r 2c(250) = TDF - ddI(250) - LPV/r 2c(400) = TDF - ddI(400) - LPV/r 2d(250) = TDF - ddI(250) - SQV/r 2d(400) = TDF - ddI(400) - SQV/r 2e = other

Child 2nd -line regimen 5a = ABC - ddI - LPV/r 5b = ABC - ddI - NFV 5c = ABC - ddI - SQV/r 5d = …. 5e = other

Pre-ART register Page 2

Write in year and month Month 0 Dec 07 1b Y Month 1 2 3 4 5 6 CD4 7 8 9 10 11 12 CD4 13 14 15 16 17 18 CD4 19 20 21 22 23 24 CD4

Top row: Record follow-up status at end of each month On treatment (record current regimen code) DEAD STOPed ART (continued on other care) LOST (missed drug pick-up) DROP (lost to follow-up), not seen 3 months from last missed appointment RESTART Transferred out(TO)- if TO, transferred out to where

Bottom row: Record TB status at last visit during the month Yes/No - TB status completed at last visit in the month

If follow-up status is ‘’STOP’’, then add reason (and weeks of interruption if later restarted) 1. Toxicity/sides effect 2. Pregnancy 3. Treatment failure 4. Poor adherence 5. Illness, hospitalization 6. Drugs out of stock 7. Patient lack finances 8. Other patient decision 9. Planned treatment interruption 10. Other 11. Excluded HIV infection in infant

Exercise booklet ART register page 1 Health Facility:

Completed for Ex. F

Cohort : Year 2008 Month October Registration ART start date Unique ID No. Patient clinic ID Name in full Upper space: surname Lower space: given name Timothy M 23.10.08 DS01042344 03761 Mike K 29.10.08 DS010442345 02344 Lily S F 27 55 3 10/08 1b M 44 49 4 10/08 1b 1f ''1''/18.12.08 Sex Age weight

Status at start of ART WHO clinical TBRX Start month/ year and TB reg No. 120

Fill in when applicable CTX Start Month/ year INH Start Month/ year TBRX Start month/ year and TB reg No. Preg 1 Preg 2

PMTCT Preg 3 Preg 4 Original regimen

1st -line regimen Substitution 1st: reason/ date 2nd : Reason/ date

2nd -line regimen Switches, substitution 1st : Reason/ date 2nd : reason/ date

12.10.08

DS01042343

03576

10/08

Reasons for regimen change 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify)

Reasons for switch to 2nd -line regimen: 8. Clinical treatment failure 9. Immunologic failure 10. Virologic failure

Adult 1st -line regimens 1a = AZT-3TC-EFV 1b = AZT-3TC-NVP 1C = TDF-FTC-EFV 1d = TDF-FTC-EFV 1e = TDF-3TC-EFV 1f = TDF-3TC-NVP 1g = other

Child 1st -line regimens 4a = d4T-3TC-NVP 4b = d4T-3TC-EFV 4c = AZT-3TC-NVP 4d = AZT-3TC-EFV 4e = …. 4f = …. 4g = other

Child 2nd -line regimen 5a = ABC - ddI - LPV/r 5b = ABC - ddI - NFV 5c = ABC - ddI - SQV/r 5d = …. 5e = other

ART register page 2

Write in year and month Month 0 Oct 08 1a Y 1b Y 1b Y 1b Y 1b Y Month 1 Nov 08 1a Y 1f Y TO BL HO 1f Y  TO MIH HC 2 Dec 08 DEAD 3 Jan 09 4 Feb 09 5 Mar 09 6 CD4 7 8 9 10 11 12 CD4 13 14 15 16 17 18 CD4 19 20 21 22 23 24 CD4

Bottom row: Record TB status at last visit during the month Yes/No - TB status completed at last visit in the month

Exercise booklet ART register page 1

Completed for Ex. F

Cohort : Year 2008 Month November Registration and personal information ART start date Unique ID No. Patient clinic ID Name in full Upper space: surname Lower space: given name Martha N 24.11.08 DS01042356 02458 Ann B F 27 52 3 11/08 02/09 # 0156 Sex Age weight

Status at start of ART WHO clinical TBRX Start month/ year and TB reg No. 150

Fill in when applicable CTX Start Month/ year INH Start Month/ year TBRX Start month/ year and TB reg No. Preg 1 Preg 2

PMTCT Preg 3 Preg 4 Original regimen

1st -line regimen Substitution 1st: reason/ date 2nd : Reason/ date

2nd -line regimen Switches, substitution 1st : Reason/ date 2nd : reason/ date

08.11.08

DS01042355

05544

10/08

EDD 6.8.09 NC # 00345

1a''4'' /20.02.09

Reasons for regimen change 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify)

Reasons for switch to 2nd -line regimen: 8. Clinical treatment failure 9. Immunologic failure 10. Virologic failure

Adult 1st -line regimens 1a = AZT-3TC-EFV 1b = AZT-3TC-NVP 1C = TDF-FTC-EFV 1d = TDF-FTC-EFV 1e = TDF-3TC-EFV 1f = TDF-3TC-NVP 1g = other

Child 1st -line regimens 4a = d4T-3TC-NVP 4b = d4T-3TC-EFV 4c = AZT-3TC-NVP 4d = AZT-3TC-EFV 4e = …. 4f = …. 4g = other

Child 2nd -line regimen 5a = ABC - ddI - LPV/r 5b = ABC - ddI - NFV 5c = ABC - ddI - SQV/r 5d = …. 5e = other

ART register page 2

Write in year and month Month 0 Nov 08 1b Y 1b Y Month 1 Dec 08 1b Y 1b Y 2 3 Jan 08 Feb 09 1b Y 1b Y 1a Y  4 Mar 09 1b N LOST 5 Apr 09  6 CD4 7 8 9 10 11 12 CD4 13 14 15 16 17 18 CD4 19 20 21 22 23 24 CD4

Bottom row: Record TB status at last visit during the month Yes/No - TB status completed at last visit in the month

Exercise booklet ART register page 1 Cohort : Year 2007 Month June Registration and personal information ART start date Unique ID No. Patient clinic ID Name in full Upper space: surname Lower space: given name Wenda Sara 18833 Muwanga Constance 18889 Mbege Frances 18569 Wanre John 17001 G R 16220 B T 16990 D V 19001 Thanga Hope 18993 F B 19154 J D M 12 22 3 4a F 30 49 3 190 1a F 30 42 3 01/07 1a M 32 52 2 285 1a 1b''7''/ 28.04.08 F 22 43 3 1a M 45 52 3 250 1a M 50 55 3 1a F 32 50 3 F 45 45 4 04/07 TB 4034 Sex Age weight

Sample completed for Ex. G Status at start of ART WHO clinical TBRX Start month/ year and TB reg No.

Fill in when applicable CTX Start Month/ year INH Start Month/ year TBRX Start month/ year and TB reg No. Preg 1 Preg 2

PMTCT Preg 3 Preg 4 Original regimen

1st -line regimen Substitution 1st: reason/ date 2nd : Reason/ date

2nd -line regimen Switches, substitution 1st : Reason/ date 2nd : reason/ date

08.06.07

BA 00523 BA 00524 BA 00525 BA 00526 BA 00527 BA 00528 BA 00529 AL 00124 AL 00087 RH 00032

18775

02/07

EDD 15.01.08 ANC 347

15.06.07

2b''8''/ 15.03.08 1b''1''/ 15.10.07

16.06.07

18.06.07

22.06.07

24.06.07

26.06.07

10.06.07

20.06.07

02.06.07

Reasons for regimen change 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify)

Reasons for switch to 2nd -line regimen: 8. Clinical treatment failure 9. Immunologic failure 10. Virologic failure

Adult 1st -line regimens 1a = AZT-3TC-EFV 1b = AZT-3TC-NVP 1C = TDF-FTC-EFV 1d = TDF-FTC-EFV 1e = TDF-3TC-EFV 1f = TDF-3TC-NVP 1g = other

Child 1st -line regimens 4a = d4T-3TC-NVP 4b = d4T-3TC-EFV 4c = AZT-3TC-NVP 4d = AZT-3TC-EFV 4e = …. 4f = …. 4g = other

Child 2nd -line regimen 5a = ABC - ddI - LPV/r 5b = ABC - ddI - NFV 5c = ABC - ddI - SQV/r 5d = …. 5e = other

ART register page 2

Write in year and month Month 0 June 07 1a Y 1b Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 225 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1b Y 1a Y 1a Y 1a Y 1a Y 1a 1b Y 1a Y 1a Y 1a Y 1a Y 1a 1a Y 1a Y 1a Y 1a Y STOP/8 Month 1 July 07 2 Aug 07 3 Sept 07 1a Y LOST 1b Y 1b Y 1a Y 1a Y LOST 1b Y 1b Y 1a Y 1a Y 1a Y 4 Oct 07 5 Nov 07 6 Dec 07 CD4 1a Y 1b Y 1b Y 1a Y 1a Y 1a Y RESTART1b Y 1a Y LOST 1b Y 1a Y 1a Y 4a Y 1b Y 1a Y 1a Y 4a Y 300 360 1b Y 1a Y 1a Y DEAD 1b Y 1a Y 1a Y 1b 1b 7 8 Jan 08 Feb 08 9 Mar 08 1a Y 2b Y 1b Y TO Kilemba 1a Y 1a Y 1a Y 1a Y 380 2b Y 1b Y 1b Y LOST 10 Apr 08 11 May 08 12 June 08 CD4 1a Y 2b Y 1b Y 13 14 Jul 08 Aug 08 15 Sept 08 16 Oct 08 17 Nov 08 18 Dec 08 CD4 19 20 21 22 23 24 CD4

Bottom row: Record TB status at last visit during the month Yes/No - TB status completed at last visit in the month

Exercise booklet ART register page 1 Sample ART register at March 2007 Cohort : Year 2007 Month February Registration and personal information ART start date Unique ID No. Patient clinic ID Name in full Upper space: surname Lower space: given name Sex Age weight

Sample ART Ex. H

Status at start of ART WHO clinical TBRX Start month/ year and TB reg No. 100

Fill in when applicable CTX Start Month/ year INH Start Month/ year TBRX Start month/ year and TB reg No. Preg 1 Preg 2

PMTCT Preg 3 Preg 4 Original regimen

1st -line regimen Substitution 1st: reason/ date 2nd : Reason/ date

2nd -line regimen Switches, substitution 1st : Reason/ date 2nd : reason/ date

01.02.07

BA0001

01/07

02.02.07

BA0002

150

01/07

08.02.07

BA0012

11/06

15.06.07 ANC 01223 01/07 TB 02346

15.02.07

BA0015

02/07

16.02.07

BA0016

18.02.07

BA0010

180

22.02.07

BA0018

150

24.02.07

BA0019

26.02.07

BA0017

185

Reasons for regimen change 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify)

Reasons for switch to 2nd -line regimen: 8. Clinical treatment failure 9. Immunologic failure 10. Virologic failure

Adult 1st -line regimens 1a = AZT-3TC-EFV 1b = AZT-3TC-NVP 1C = TDF-FTC-EFV 1d = TDF-FTC-EFV 1e = TDF-3TC-EFV 1f = TDF-3TC-NVP 1g = other

Child 1st -line regimens 4a = d4T-3TC-NVP 4b = d4T-3TC-EFV 4c = AZT-3TC-NVP 4d = AZT-3TC-EFV 4e = …. 4f = …. 4g = other

Adult 2nd -line regimens 2a = AZT+3TC+LPV7r 2a = AZT+3TC+ATV7r 2b = TDF+3TC+LPV7r 2b = TDF+3TC+ATV7r 2c =.... 2d =..... 2e= other

Child 2nd -line regimen 5a = ABC - ddI - LPV/r 5b = ABC - ddI - NFV 5c = ABC - ddI - SQV/r 5d = …. 5e = other

ART register page 2

Write in year and month Month 0 Feb 1a Y 1a Y 1b Month 1 Mar 1a Y 1a Y 2 3 4 5 6 CD4 7 8 9 10 11 12 CD4 13 14 15 16 17 18 CD4 19 20 21 22 23 24 CD4

Y 1a Y 1b Y 1a Y 1a 1a Y 1b N 1a Y

Y 1a Y 4a Y 1a N 4a Y

Bottom row: Record TB status at last visit during the month Yes/No - TB status completed at last visit in the month

Exercise booklet ART register page 1 Cohort : Year 2007 Month March Registration and personal information ART start date Unique ID No. Patient clinic ID Name in full Upper space: surname Lower space: given name Sex Age weight

Sample ART Ex. H

Status at start of ART WHO clinical TBRX Start month/ year and TB reg No.

Fill in when applicable CTX Start Month/ year INH Start Month/ year TBRX Start month/ year and TB reg No. Preg 1 Preg 2

PMTCT Preg 3 Preg 4 Original regimen

1st -line regimen Substitution 1st: reason/ date 2nd : Reason/ date

2nd -line regimen Switches, substitution 1st : Reason/ date 2nd : reason/ date

01.03.07

BA0021

02.03.07

BA0022

195

08.03.07

BA0023

190

15.03.07

BA0024

01/07

16.03.07

BA0025

185

18.03.07

BA0026

22.03.07

BA0027

03/07

Reasons for regimen change 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify)

Reasons for switch to 2nd -line regimen: 8. Clinical treatment failure 9. Immunologic failure 10. Virologic failure

Adult 1st -line regimens 1a = AZT-3TC-EFV 1b = AZT-3TC-NVP 1C = TDF-FTC-EFV 1d = TDF-FTC-EFV 1e = TDF-3TC-EFV 1f = TDF-3TC-NVP 1g = other

Child 1st -line regimens 4a = d4T-3TC-NVP 4b = d4T-3TC-EFV 4c = AZT-3TC-NVP 4d = AZT-3TC-EFV 4e = …. 4f = …. 4g = other

Adult 2nd -line regimens 2a = AZT+3TC+LPV7r 2a = AZT+3TC+ATV7r 2b = TDF+3TC+LPV7r 2b = TDF+3TC+ATV7r 2c =.... 2d =..... 2e= other

Child 2nd -line regimen 5a = ABC - ddI - LPV/r 5b = ABC - ddI - NFV 5c = ABC - ddI - SQV/r 5d = …. 5e = other

ART register page 2

Write in year and month Month 0 March 1a Y 1b Y 1a Y 1b Y 1b Y 1a Y 1a Y Month 1 2 3 4 5 6 CD4 7 8 9 10 11 12 CD4 13 14 15 16 17 18 CD4 19 20 21 22 23 24 CD4

Bottom row: Record TB status at last visit during the month Yes/No - TB status completed at last visit in the month

Exercise booklet Pre-ART register Page 1

Sample Pre-ART register for Exercise H

Registration Date enrolled In chronic HIV care Unique ID No. Patient clinic ID No. Name in full Upper space: surname Lower space: given name A A 02.04.07 M K 03.04.07 T H 04.04.07 C S 08.04.07 G F 11.04.07 A R 15.04.07 E P 02.05.07 H T 11.05.07 F N 11.05.07 G A M 37 05/ F 45 05/07 F 30 F 47 04/07 F 29 04/07 F 36 M 26 04/07 F 23 04/07 M 42 04/07 Sex Age Status at enrolment (record TI if transfer in) CTX Start month/ year

Fill when applicable INH start month/ year TBRX Start month/ year and TB reg No. 1

Clinical stage 2 3 4

PMTCT For each pregnancy, record EDD, ANC No. and HIV -exposed infant No. Preg 1 Preg 2 Preg 3 Preg 4

ART Date medically eligible for ART Date ART Started (transfer to ART register)

02.04.07

04/07



04.04.07

16.04.07



03.04.07

20.04.07



06.04.07

22.04.07



28.06.07



04.09.07 ANC.1676 



Pre-ART register Page 2

Quarterly follow - up status Year 2007 Q1 Q2 Jan-Mar Apr-Jun CD4400 Y CD4-195 Y Q3 Jul-Sep Q4 Oct-Dec

Year Q1 Q2 Jan-Mar Apr-Jun Q3 Jul-Sep Q4 Oct-Dec

Y CD4-180 Y

Y CD4450 Y CD4390 Y CD4-410 Y Total TB staus Y Seen at least once in Y Top row: record follow-up status at end of each quarter CD4 - record last CD4 in quarter - did not have visit scheduled for that quarter LOST- not seen in the last quarter, but scheduled for a visit TO- transferred out (record to where) DEAD - record date Bottom row: Record TB status Yes/No - TB status completed at last visit in last quarter

Exercise booklet Pre-ART register Page 1

Registration Date enrolled In chronic HIV care Unique ID No. Patient clinic ID No. Name in full Upper space: surname Lower space: given name C P 16.05.07 A H 18.05.07 T H 20.05.07 F B 20.05.07 R F 21.05.07 T T 29.05.07 S B 05.06.07 T M 10.06.07 S P 28.06.07 D M M 42 06/07 F 45 06/07 F 37 06/07 M 27 05/07 M 36 05/07 M 31 F 23 05/07 F 35 05/07 M 48 05/07 Sex Age Status at enrolment (record TI if transfer in) CTX Start month/ year

Fill when applicable INH start month/ year TBRX Start month/ year and TB reg No. 1

Clinical stage 2 3 4

PMTCT For each pregnancy, record EDD, ANC No. and HIV -exposed infant No. Preg 1 Preg 2 Preg 3 Preg 4

ART Date medically eligible for ART Date ART Started (transfer to ART register)

13.05.07



18.05.07

01.06.07



24.05.07

08.06.07



28.05.07

10.06.07



29.05.07

16.06.07



05.06.07

22.06.07



Pre-ART register Page 2

Quarterly follow - up status Year 2007 Q1 Q2 Jan-Mar Apr-Jun Q3 Jul-Sep Q4 Oct-Dec

Year Q1 Q2 Jan-Mar Apr-Jun Q3 Jul-Sep Q4 Oct-Dec

Y CD4-380 Y CD4-195 Y CD4-190 Y

Y CD4-195 Y

Y 410 N Total TB staus Y Seen at least once in Y

Bottom row: Record TB status Yes/No - TB status completed at last visit in last quarter

Exercise booklet ART register page 1 Cohort : Year 2007 Month February Registration and personal information ART start date Unique ID No. Patient clinic ID Name in full Upper space: surname Lower space: given name Sex Age weight

Sample ART register at June 2007 Status at start of ART WHO clinical TBRX Start month/ year and TB reg No. 195

Fill in when applicable CTX Start Month/ year INH Start Month/ year TBRX Start month/ year and TB reg No. Preg 1 Preg 2

PMTCT Preg 3 Preg 4 Original regimen

1st -line regimen Substitution 1st: reason/ date 2nd : Reason/ date

2nd -line regimen Switches, substitution 1st : Reason/ date 2nd : reason/ date

01.02.07

BA0001

12/06

2.02.07

BA0002

100

12/06

10/06 TB 02346 15.06.07 ANC 01223 01/07 TB 02346

08.02.07

BA0003

11/06

15.02.07

BA0005

02/07

16.02.07

BA0006

18.02.07

BA0007

22.02.07

BA0009

150

1c:1/ 26.05.07

24.02.07

BA0010

26.02.07

BA0011

185

04.02.07

GX0118

02/07

Reasons for regimen change 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify)

Reasons for switch to 2nd -line regimen: 8. Clinical treatment failure 9. Immunologic failure 10. Virologic failure

Adult 1st -line regimens 1a = AZT-3TC-EFV 1b = AZT-3TC-NVP 1C = TDF-FTC-EFV 1d = TDF-FTC-EFV 1e = TDF-3TC-EFV 1f = TDF-3TC-NVP 1g = other

Child 1st -line regimens 4a = d4T-3TC-NVP 4b = d4T-3TC-EFV 4c = AZT-3TC-NVP 4d = AZT-3TC-EFV 4e = …. 4f = …. 4g = other

Child 2nd -line regimen 5a = ABC - ddI - LPV/r 5b = ABC - ddI - NFV 5c = ABC - ddI - SQV/r 5d = …. 5e = other

ART register page 2

Write in year and month Month 0 Feb 07 1a Y 1b Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a N 1a Y 1a Y 1a Y 1a N 1a Y 1a Y 1a N 1a N 1a Y 1c Y 1a Y 1a N 1c Y 1a Y 1a Y 1a Y Month 1 Mar 07 1a Y 1b Y 1b Y 1a Y 1a N 1a Y 2 3 Apr 07 May 07 4 Jun 07 1a Y 5 6 CD4 7 8 9 10 11 12 CD4 13 14 15 16 17 18 CD4 19 20 21 22 23 24 CD4

Bottom row: Record TB status at last visit during the month Yes/No - TB status completed at last visit in the month

Sample ART register at June 2007 Status at start of ART WHO clinical TBRX Start month/ year and TB reg No.

Fill in when applicable CTX Start Month/ year INH Start Month/ year TBRX Start month/ year and TB reg No. Preg 1 Preg 2

PMTCT Preg 3 Preg 4 Original regimen

1st -line regimen Substitution 1st: reason/ date 2nd : Reason/ date

2nd -line regimen Switches, substitution 1st : Reason/ date 2nd : reason/ date

01.03.07

BA0012

02.03.07

BA0013

195

08.03.07

BA0014

190

1c:1/ 02.06.07

15.03.07

BA0015

01/07

16.03.07

BA0016

185

18.03.07

BA0017

22.03.07

BA0018

03/07

Reasons for regimen change 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify)

Reasons for switch to 2nd -line regimen: 8. Clinical treatment failure 9. Immunologic failure 10. Virologic failure

Adult 1st -line regimens 1a = AZT-3TC-EFV 1b = AZT-3TC-NVP 1C = TDF-FTC-EFV 1d = TDF-FTC-EFV 1e = TDF-3TC-EFV 1f = TDF-3TC-NVP 1g = other

Child 1st -line regimens 4a = d4T-3TC-NVP 4b = d4T-3TC-EFV 4c = AZT-3TC-NVP 4d = AZT-3TC-EFV 4e = …. 4f = …. 4g = other

Child 2nd -line regimen 5a = ABC - ddI - LPV/r 5b = ABC - ddI - NFV 5c = ABC - ddI - SQV/r 5d = …. 5e = other

ART register page 2

Write in year and month Month 0 Mar 07 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1c Y LOST LOST LOST Month 1 Apr 07 1a Y 1a Y 1a Y 1a Y 1a Y TO Y 1c Y 2 May 07 1a Y 3 Jun 07 TO BHC 4 5 6 CD4 7 8 9 10 11 12 CD4 13 14 15 16 17 18 CD4 19 20 21 22 23 24 CD4

Bottom row: Record TB status at last visit during the month Yes/No - TB status completed at last visit in the month

Exercise booklet ART register page 1 Cohort : Year 2007 Month April Registration and personal information ART start date Unique ID No. Patient clinic ID Name in full Upper space: surname Lower space: given name Sex Age weight

Sample ART register at June 2007 Status at start of ART WHO clinical TBRX Start month/ year and TB reg No. 190

Fill in when applicable CTX Start Month/ year INH Start Month/ year TBRX Start month/ year and TB reg No. Preg 1 Preg 2

PMTCT Preg 3 Preg 4 Original regimen

1st -line regimen Substitution 1st: reason/ date 2nd : Reason/ date

2nd -line regimen Switches, substitution 1st : Reason/ date 2nd : reason/ date

01.04.07

BA0021

02.04.07

BA0022

01/07

08.04.07

BA0023

10.04.07

BA0024

03/07

16.04.07

BA0025

195

04/07

18.04.07

BA0026

20.04.07

BA0027

04/07

22.04.07

BA0028

180

04/07

15.04.07

FG0007

Reasons for regimen change 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify)

Reasons for switch to 2nd -line regimen: 8. Clinical treatment failure 9. Immunologic failure 10. Virologic failure

Adult 1st -line regimens 1a = AZT-3TC-EFV 1b = AZT-3TC-NVP 1C = TDF-FTC-EFV 1d = TDF-FTC-EFV 1e = TDF-3TC-EFV 1f = TDF-3TC-NVP 1g = other

Child 1st -line regimens 4a = d4T-3TC-NVP 4b = d4T-3TC-EFV 4c = AZT-3TC-NVP 4d = AZT-3TC-EFV 4e = …. 4f = …. 4g = other

Child 2nd -line regimen 5a = ABC - ddI - LPV/r 5b = ABC - ddI - NFV 5c = ABC - ddI - SQV/r 5d = …. 5e = other

ART register page 2

Write in year and month Month 0 April 07 1a Month 1 May 07 1a 2 Jun 07 1a 3 4 5 6 CD4 7 8 9 10 11 12 CD4 13 14 15 16 17 18 CD4 19 20 21 22 23 24 CD4

Bottom row: Record TB status at last visit during the month Yes/No - TB status completed at last visit in the month

Exercise booklet ART register page 1 Cohort : Year 2007 Month May Registration and personal information ART start date Unique ID No. Patient clinic ID Name in full Upper space: surname Lower space: given name Sex Age weight

Sample ART register at June 2007 Status at start of ART WHO clinical TBRX Start month/ year and TB reg No.

Fill in when applicable CTX Start Month/ year INH Start Month/ year TBRX Start month/ year and TB reg No. Preg 1 Preg 2

PMTCT Preg 3 Preg 4 Original regimen

1st -line regimen Substitution 1st: reason/ date 2nd : Reason/ date

2nd -line regimen Switches, substitution 1st : Reason/ date 2nd : reason/ date

01.05.07

BA0029

02.05.07

BA0030

08.05.07

BA0031

10.05.07

BA0032

190

15.05.07

BA0033

195

16.05.07

BA0034

18.05.07

BA0035

150

20.05.07

BA0036

22.05.07

FG0011

Reasons for regimen change 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify)

Reasons for switch to 2nd -line regimen: 8. Clinical treatment failure 9. Immunologic failure 10. Virologic failure

Adult 1st -line regimens 1a = AZT-3TC-EFV 1b = AZT-3TC-NVP 1C = TDF-FTC-EFV 1d = TDF-FTC-EFV 1e = TDF-3TC-EFV 1f = TDF-3TC-NVP 1g = other

Child 1st -line regimens 4a = d4T-3TC-NVP 4b = d4T-3TC-EFV 4c = AZT-3TC-NVP 4d = AZT-3TC-EFV 4e = …. 4f = …. 4g = other

Child 2nd -line regimen 5a = ABC - ddI - LPV/r 5b = ABC - ddI - NFV 5c = ABC - ddI - SQV/r 5d = …. 5e = other

ART register page 2

Write in year and month Month 0 May 07 1a Month 1 Jun 07 1a 2 3 4 5 6 CD4 7 8 9 10 11 12 CD4 13 14 15 16 17 18 CD4 19 20 21 22 23 24 CD4

DEAD

Bottom row: Record TB status at last visit during the month Yes/No - TB status completed at last visit in the month

Sample ART register at June 2007 Status at start of ART WHO clinical TBRX Start month/ year and TB reg No. 195

Fill in when applicable CTX Start Month/ year INH Start Month/ year TBRX Start month/ year and TB reg No. Preg 1 Preg 2

PMTCT Preg 3 Preg 4 Original regimen

1st -line regimen Substitution 1st: reason/ date 2nd : Reason/ date

2nd -line regimen Switches, substitution 1st : Reason/ date 2nd : reason/ date

01.06.07

BA0037

08.06.07

BA0039

F B

190

10.06.07

BA0040

T T

195

15.06.07

BA0041

16.06.07

BA0042

03/07

22.06.07

BA0043

Reasons for regimen change 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify)

Reasons for switch to 2nd -line regimen: 8. Clinical treatment failure 9. Immunologic failure 10. Virologic failure

Adult 1st -line regimens 1a = AZT-3TC-EFV 1b = AZT-3TC-NVP 1C = TDF-FTC-EFV 1d = TDF-FTC-EFV 1e = TDF-3TC-EFV 1f = TDF-3TC-NVP 1g = other

Child 1st -line regimens 4a = d4T-3TC-NVP 4b = d4T-3TC-EFV 4c = AZT-3TC-NVP 4d = AZT-3TC-EFV 4e = …. 4f = …. 4g = other

Child 2nd -line regimen 5a = ABC - ddI - LPV/r 5b = ABC - ddI - NFV 5c = ABC - ddI - SQV/r 5d = …. 5e = other

ART register page 2

Write in year and month Month 0 June 07 1a Month 1 2 3 4 5 6 CD4 7 8 9 10 11 12 CD4 13 14 15 16 17 18 CD4 19 20 21 22 23 24 CD4

Bottom row: Record TB status at last visit during the month Yes/No - TB status completed at last visit in the month

Ex. J Status at start of ART WHO clinical TBRX Start month/ year and TB reg No. 195

Fill in when applicable CTX Start Month/ year INH Start Month/ year TBRX Start month/ year and TB reg No. Preg 1 Preg 2

PMTCT Preg 3 Preg 4 Original regimen

1st -line regimen Substitution 1st: reason/ date 2nd : Reason/ date

2nd -line regimen Switches, substitution 1st : Reason/ date 2nd : reason/ date

01.02.07

12/06

02.02.07

100

12/06

10/06 TB-223 15.06.04 ANC-345 01/07 TB-456

08.02.07

11/06

15.02.07

02/07

1c:1/ 15.10.07

16.02.07

18.02.07

22.02.07

150

24.02.07

10.02.07

01/04

20.02.07

190

Reasons for regimen change 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify)

Reasons for switch to 2nd -line regimen: 8. Clinical treatment failure 9. Immunologic failure 10. Virologic failure

Adult 1st -line regimens 1a = AZT-3TC-EFV 1b = AZT-3TC-NVP 1C = TDF-FTC-EFV 1d = TDF-FTC-EFV 1e = TDF-3TC-EFV 1f = TDF-3TC-NVP 1g = other

Child 1st -line regimens 4a = d4T-3TC-NVP 4b = d4T-3TC-EFV 4c = AZT-3TC-NVP 4d = AZT-3TC-EFV 4e = …. 4f = …. 4g = other

Child 2nd -line regimen 5a = ABC - ddI - LPV/r 5b = ABC - ddI - NFV 5c = ABC - ddI - SQV/r 5d = …. 5e = other

ART register page 2

Write in year and month Month 0 Month 1 2 3 4 5 6 CD4 1a Y 1b Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a Y 1a 1a 1a 1a 1a 1a 225 1a 1a 1a 1a 1a 1a 265 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a TO 1a 1a 1a 180 1a 1a 210 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1a 1c 1c 1c 1c 1c 1a 1a 1a 1a 1b 1b 1b 1b 1b 1b 190 1b 1b 1b 1b 1b 1b 250 1a 1a 1a 1a 1a 1a 230 1a 1a 1a 1a 1a 1a 7 8 9 10 11 12 CD4 290 13 14 15 16 17 18 CD4 19 20 21 22 23 24 CD4

Bottom row: Record TB status at last visit during the month Yes/No - TB status completed at last visit in the month

Exercise booklet ART register page 1 Cohort : Year 2007 Month August Registration and personal information ART start date Unique ID No. Patient clinic ID Name in full Upper space: surname Lower space: given name Sex Age weight

Ex. J Status at start of ART WHO clinical TBRX Start month/ year and TB reg No.

Fill in when applicable CTX Start Month/ year INH Start Month/ year TBRX Start month/ year and TB reg No. Preg 1 Preg 2

PMTCT Preg 3 Preg 4 Original regimen

1st -line regimen Substitution 1st: reason/ date 2nd : Reason/ date

2nd -line regimen Switches, substitution 1st : Reason/ date 2nd : reason/ date

08.08.07

10.08.07

15.08.07

06/07

16.08.07

185

18.08.07

20.08.07

180

22.08.07

190

01.08.07

02.08.07

Reasons for regimen change 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify)

Reasons for switch to 2nd -line regimen: 8. Clinical treatment failure 9. Immunologic failure 10. Virologic failure

Adult 1st -line regimens 1a = AZT-3TC-EFV 1b = AZT-3TC-NVP 1C = TDF-FTC-EFV 1d = TDF-FTC-EFV 1e = TDF-3TC-EFV 1f = TDF-3TC-NVP 1g = other

Child 1st -line regimens 4a = d4T-3TC-NVP 4b = d4T-3TC-EFV 4c = AZT-3TC-NVP 4d = AZT-3TC-EFV 4e = …. 4f = …. 4g = other

Child 2nd -line regimen 5a = ABC - ddI - LPV/r 5b = ABC - ddI - NFV 5c = ABC - ddI - SQV/r 5d = …. 5e = other

ART register page 2

Write in year and month Month 0 Month 1 2 3 4 5 6 CD4 1b 1b LOST 1b LOST 1b 1b 7 8 9 10 11 12 CD4 13 14 15 16 17 18 CD4 19 20 21 22 23 24 CD4

LOST

220

240

Bottom row: Record TB status at last visit during the month Yes/No - TB status completed at last visit in the month

Ex. J Status at start of ART WHO clinical TBRX Start month/ year and TB reg No.

Fill in when applicable CTX Start Month/ year INH Start Month/ year TBRX Start month/ year and TB reg No. Preg 1 Preg 2

PMTCT Preg 3 Preg 4 Original regimen

1st -line regimen Substitution 1st: reason/ date 2nd : Reason/ date

2nd -line regimen Switches, substitution 1st : Reason/ date 2nd : reason/ date

01.02.08

02.02.08

08.02.08

185

10.02.08

180

15.02.08

190

16.02.08

12/07

22.02.08

Reasons for regimen change 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify)

Reasons for switch to 2nd -line regimen: 8. Clinical treatment failure 9. Immunologic failure 10. Virologic failure

Adult 1st -line regimens 1a = AZT-3TC-EFV 1b = AZT-3TC-NVP 1C = TDF-FTC-EFV 1d = TDF-FTC-EFV 1e = TDF-3TC-EFV 1f = TDF-3TC-NVP 1g = other

Child 1st -line regimens 4a = d4T-3TC-NVP 4b = d4T-3TC-EFV 4c = AZT-3TC-NVP 4d = AZT-3TC-EFV 4e = …. 4f = …. 4g = other

Child 2nd -line regimen 5a = ABC - ddI - LPV/r 5b = ABC - ddI - NFV 5c = ABC - ddI - SQV/r 5d = …. 5e = other

ART register page 2

Write in year and month Month 0 Month 1 2 3 4 5 6 CD4 1a 7 8 9 10 11 12 CD4 13 14 15 16 17 18 CD4 19 20 21 22 23 24 CD4

Bottom row: Record TB status at last visit during the month Yes/No - TB status completed at last visit in the month

Exercise booklet Ex. 1 Status at enrolment: Unique No. DS000029 District: Markduk Name: Timothy M. Sex M  F  Health unit: Veld DOB District clinician/team: Dr Sam Y()  Prior ART None PMTCT only Earlier ARV not transfer in / / / / Where Where ARVs ARVs Date



HIV exposed Infant  TB Rx



Pregnancy 

Postpartum  other Prior ARVs

Patient clinic No. 03576 Marital status: Married

Age: 58 yrs

Address: St 58 # 11

Telephone (whose): 011.354.546(home) ART Date / / ART transfer in from Start ART 1st -line initital regimen AZT-3TC-EFV Wt 74 Cl.stage 2 CD4 120 Preg ARVs

Treatment supporter/medication pick-up if ill: Address: Telephone (whose): Home based care provided by

Cohort (month/year)

12 / 10 / 08 At start ART

1st - line

Substitute within 1st-line / / / / nd

Family status Name of family members and partners Sara (wife) Age HIV P/N HIV care Y/N Unique No. Exposed Infant Name/ No. DOB

Exposed infant follow-up Infant feeding practice at 3 mos. CTX started by 2 mos. HIV test type/ result Final status (If confirm +) Unique ID

New regimen New regimen nd

Why Why

2nd - line

Switch to 2 -line (or substitution within 2 -line) / / / / New regimen New regimen Why Why

ART treatment interruption - Stop or missed drug pick-up Stop or Lost Date Stop Lost Stop Lost Stop Lost Stop Lost

HIV care Date Confirmed HIV + test HIV enrolled Medically eligible for ART 29.09.08 05.10.08 05.10.08 HIV 1 2 Ab/virologic test Where  HIV care transfer in from

Why Date if restart

Status Date Dead Transferd out Lost to follow-up (drop) 05.12.08 Where

Clinical stage 2 CD4 120  Presumptive clinical diagnosis of severe HIV infection in infants

Drug allergies

Relevant medical conditions

Unique No. DS01042343

HIV care/ART card Name Timothy M.

Date Check if scheduled. Write in alternate pick-up if ill

Followup date

Duration in months since first starting ART/since starting current regimen

Wt(kg) Ht(mt) at first visit If child record +/Oedema

Pregnancy/ RH-FP choices If child record MUAC Write age in mos. if ≤59 mos.

TB status (if TBRX record month/ year started and TB reg No.)

Potential side effects

New OI, Other problems If child, include nutritional problems

WHO clinical stage

Cotrimoxazole Adhere Dose/ days

INH No. pills dispensed

Other meds dispensed (including nutritional supplements)

ARV drugs(incl. prophylaxis) Adhere/ why Regimen/ Dose/ No. days dispensed

Investigations CD4 if <5, record CD4% Hgb,RPR, CXR, TB sputum. Infant Ab/HIV virologic test, other

Refer or consult or link/provide (including nutritional support and infant feeding) If hospitalized, No. of days

HIV transmission prevention for key population (Check) • Discordant couple • MSM • IDU • SW • Clients of SW – –

 05.10.08  12.10.08  26.10.08  12.11.08  26.11.08  02.12.08  05.12.08         

12.02.09 26.02.09

– 0

75 1.85 740

– –

No sign No sign

– –

Z –

2 2

– G

960/30 –

– –

– AZT-3TCEFV AZT-3TCEFV 15 AZT-3TCEFV 30 –

120 –

– Hgb-11

– –

12.03.09

2wks

–

No sign

–

960/30

–

9.04.09

4wks

–

No sign

–

Hgb- 10

–

6wks

–

Sputum

–

Fever Cough >2wks Fever Cough

F/5

–

F/5

–

– Notified patient death

7wks

–

C Xray

–

F/5

–

F/5

–

Exercise booklet

Codes for pregnancy/RH-FP choices P= pregnant. List EDD and ANC No.. If referred for PMTCT, note in last column. AB= recent induced abortion. Note when. MC= recent miscarriage. Note when Wants P= wants to become pregnant now or considering; not using FP Has FP= already using condoms/other FP. Note method(s) Wants FP= note method(s) provided or referred for. Record referral in last column. Unable P= thinks she cannot get pregnant No sex= not sexually active no

Why SUBSTITUTE or SWITCH codes 1. Toxicity/side effects 2. Pregnancy 3. Risk of pregnancy 4. Due to new TB 5. New drug available 6. Drug out of stock 7. Other reason (specify) Reasons for SWITCH to 2nd-line regimen only: 8. Clinical treatment failure 9.Immunologic failure 10. Virologic failure

Codes for HIV -exposed infant final status DEAD if dead (write in date of death if known) P if positive N if negative and no longer breast feeding N/BF if negative and still breast feeding U if status unknown

Codes for FP methods C = condoms OC = oral contraceptive pills IMP = implant LAM = Lactational Amenorrhea Method FA = fertility awareness method/periodic abstinence V = vasectomy (partner’s) ECP = emergency contraceptive pills dispensed INJ = Injectable IUD = intrauterine device D = diaphragm/cervical cap TL = tubal ligation/female sterilization UND = undecided

Codes for HIV prevention interventions for key population CC- couple counselling RR- targeted risk reduction C- Condom promotion/provision NSP- Needle and syringe programmes NSP code is checked for all with access to NSP or have access to sterile injection equipment. OST- Opioid Substitution Therapy

Codes for TB status (check on each visit) No signs = no signs or symptoms of TB Suspect = TB refer or sputums sent (Record sputum sent & results in lab column; record referral in Refer col) Not done (ND) = not assessed for whatever reason TB Rx = currently on TB treatment. Record month/year started and TB reg No. (Record INH in INH col. and TB treatment regimen in Other meds col)

Why STOP codes 1 Toxicity/side effects 2 Pregnancy 3 Treatment failure 4 Poor adherence 5 Illness, hospitalization

OST is checked for Opioid substitution therapy or other drug dependence treatment.

Codes for potential side effects or other problems Nausea Diarrhoea Fatigue BN burning/numb/tingling CNS: dizzy, anxiety, nightmare, depression Rash Anaemia ABdominal pain Headache Jaundice FAT changes

6 Drugs out of stock 7 Patient lacks finances 8 Other patient decision 9 Planned Rx interruption 10 Other (specify) 11 Excluded HIV infection in infant

Codes for new OI or other problems Zoster COUGH* FEVER* Weight loss* UD urethral discharge PID pelvic inflammatory disease Ulcers - mouth or other ___ IRIS Immune reconstitution inflammatory syndrome GUD genital ulcer disease Severe Complicated Malnutrition Poor Weight Gain Thrush- oral/vaginal DB difficult breathing DEmentia/Enceph Pneumonia G(Good) F(Fair) P(Poor) Adherence

Codes for CTX/ART adherence % Missed doses per month 1x daily dosing ≥ 95% 85-94% < 85% <2 doses 2-4 doses ≥ 5 doses 2x daily dosing ≤ 3 doses 4-8 doses ≥ 9 doses

Codes for why poor/ fair adherence 1. Toxicity/side effects 2. Share with others 3. Forgot 4. Felt better 5. Too ill 6. Stigma, disclosure or privacy issues 7. Drug stock out— dispensary 8. Patient lost/ran out of pills 9. Delivery/travel problems 10. Inability to pay 11. Alcohol 12. Depression 13. Pill burden 14. Other (specify)

Symptoms with * are suggestive of TB

Exercise booklet Follow-up education, support and preparation for ARV therapy Date/comments Date/comments Date/comments Date/comments Basic HIV and TB education, transmission Prevention: abstinence, safer sex, condoms Prevention: household precautions, what is safe Post-test counselling: implications of results Positive living Testing partners Disclosure, to whom disclosed (list) Family/living situation Shared confidentiality Reproductive choices, prevention of MTCT Child's HIV test Progression of disease Available treatment/prophylaxis CTX, INH prophylaxis Malaria prevention, IPT, ITN Follow-up appointments, clinical team ART -- educate on essentials (locally adapted) Why complete adherence needed Adherence preparation, indicate visits Indicate when READY for ART: DATE/result clinical team discussion Explain dose, when to take What can occur, how to manage side effects What to do if one forgets dose What to do when travelling Adherence plan (schedule, aids, explain diary) Treatment supporter preparation Which doses, why missed ARV support group How to contact clinic 05.10.08(1st visit) 11.10.08 07.10.08(2nd visit) 11.10.08(3rd visit) 05.10.08 05.10.08 05.10.08 05.10.08 05.10.08 05.10.08

Home based care, support

ART preparation, initiation, support, monitor Rx

Progress-ion, Rx

Education on basics, prevention, disclosure

Symptom management/palliative care at home Caregiver booklet Home-based care -- specify Support groups Community support

Reporting period: 01/01 -31/03

Year:

MOH or Project or Grantee: MOH Facility: Nikobo Location: Masaka Country: Uganda

Table 1 Pre-ART - new and cumulative number of persons enrolled in HIV care Cumulative number of persons ever enrolled in HIV care at this facility at end of the previous reporting period Males (>14 years) Females (>14 years) Boys (0-14 years) Girls (0-14 years) Total a. 45 d. 23 g. 8 j. 5 m. 81 New persons enrolled in HIV care at this facility during the reporting period b. 50 e. 59 h. 10 k. 6 n. 125 Cumulative number of persons ever enrolled in HIV care at this facility at end of the current reporting period c. f. 82 i. 18 l. 11 o. 206 Percentage (%)

c/o x 100 f/o x 100 i/o x 100 l/o x 100 82/206 = 40% 18/206 = 9% 11/206 = 5%

Subset of those newly enrolled in HIV care Pregnant Started INH prophylaxis during the reporting period Already enrolled in HIV care who transferred in from another facility during the reporting period p. 3 q. 12 r. 3

Subset of those cumulatively enrolled in HIV care Total number of persons who are enrolled and eligible for ART but have not been started on ART s

Table 2 Pre-ART - seen for HIV care during the reporting period Pre-ART persons seen for HIV care during the reporting period (total) a.1900 Percentage (%) b/a x 100 c/a x 100

Subset of those seen during the reporting period TB status assessed at last visit TB treatment started during the reporting period b. 162 c. 12

Exercise booklet Table 3 ART - new and cumulative number of persons started on ART Cumulative number of persons ever started on ART at this facility at the end of the previous reporting period Males (>14 years) Females (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total a. 20 d. 14 g. 4 j. 1 New persons started on ART at this facility during the reporting period b. 12 e. 22 h. 1 k. 0 n. 0 q. 45 Cumulative number of persons ever started on ART at this facility at end of the current reporting period c. 32 f. 36 i. 5 l. 0 o. 0 r. 73 Percentage (%)

c/r x 100 f/r x 100 i/r x 100 l/r x 100 o/r x 100 100

32/73 = 44% 36/73 = 49% 5/73 = 7% 0/73 = 0 0/73 = 0

m. 0 p. 39

Table 4 ART - current on ART - based on age at start ART ARV regimen at end of reporting period Male Female Total Percentage (%)

On 1st-line ARV regimen Adults (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total Adults and children on 1st-line regimens Percentage (%) a. 35 d. 2 g. 1 j. m. m/ag x 100 0 b. 25 e. 3 h. 0 k. 0 n. n/ag X 100 c. 60 f. i. l. o. o/ag x 100 5 1 0 c/ag x 100 f/ag x 100 i/ag x 100 l/ag x 100 o/ag x 100 60/126 = 50% 5/126 = 4% 1/126 = 1% 0/126 = 0%

On 2nd-line ARV regimen Adults (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total Adults and children on 2nd-line regimens Percentage (%) Adults and children on 1st & 2nd-line regimens (Total current on ART) Percentage (%) p. s. v. y. ab. 38 ab/ag x 100 ae. 73 ae/ag x 100 73/126 = 58% q. t. w. z. ac. 28 ac/ag x 100 af. 53 af/ag X 100 53/126 = 42% Subset of those current on ART TB status assessed at last visit during the reporting period TB treatment started during the reporting period ah. 125 ai. 20 ah/ag x 100 125/126 = 99% ai/ag x 100 20/126 = 16% r. u. x. aa. ad. 66 ad/ag x 100 ag. 126 100 100 r/ag x 100 u/ag x 100 x/ag x 100 aa/ag x 100 ad/ag x 100 66/126 = 52%

ART cohort analysis report

Exercise M

For cohort starting ART by month/year: at baseline, then results at 6 months on ART, 12 months on ART, 24 months on ART G TI TO N H I J Started on ART at this clinic - original cohort Transfers in Transfers out Add + Subtract -

24 mos.Jul 08

24 mos.Aug 08

12 mos.Sep 08

24 mos.Sep 08

24 mos.Oct 08

24 mos.Nov 08

9 x x x x 9 9 0 0

9 2 0 11 10 0 0

7 x x 7 7 0 0

7 2 0 9 7 0 0

8 x x 8 8 0 0

8 1 0 9 8 0 1

8 x x 8 8 0 0

8 1 0 9 7 0 1

7 x x 7 7 0 0

7 2 0 9 9 0 0

Net current cohort On original appropriate 1st-line regimen On original non-appropriate 1st-line regimen On alternate appropriate 1st-line regimen (Substituted) On alternate nonappropriate 1st-line regimen (Substituted) On 2nd-line regimen (Switched) Stopped Died Lost **Lost to Follow-up (DROP) Percent of cohort alive and on ART [ (H + I + J +k + L) / N * 100 ] Total on appropriate 1st-line regimen (H +J) Fraction CD4 < 100 (of adults with available CD4 at baseline) x x x

0 0 0 0 0 0 9/ 9 9 0/5

0 0 1 0 0 0 10/ 11 10 x x x

0 0 0 0 0 0 7/ 7 7 0/3

0 1 0 0 0 0 8/ 9 7 x x x

0 0 0 0 0 0 8/ 8 8 0/3

0 0 0 0 0 0 9/ 9 9 x x x

0 0 0 0 0 0 8/ 8 8 0/3

0 0 0 1 0 0 8/ 9 9 x x x

0 0 0 0 0 0 7/ 7 7 0/4

0 0 0 0 0 0 9/ 9 9 x x x

Child <5

Fraction with CD4% < 15% (of children <5 with available CD4 at baseline) CD4 median or fraction ≥200 (of adults with available CD4 - optional)

0/5

2/4

0/3

0/4

24 mos.Dec 08 7

12 mos. Jul 08

12 mos. Aug 08

12 mos. Oct 08

12 mos. Nov 08

12 mos. Dec 08

6 mo-s. May 08

6 mo-s. Jun 08

6 mos.Feb 08

6 mos.Mar 08

Cohort Aug 07

Cohort Nov 07

Cohort Dec 07

Cohort Jul 07

Cohort Sep 07

Cohort Oct 07

6 moJan 08

6 moApr 08

Exercise booklet

24 mos.Jul 08

24 mos.Aug 08

12 mos.Sep 08

24 mos.Sep 08

24 mos.Oct 08

24 mos.Nov 08

8 x x 8 8 0 0

8 1 0 7 8 0 0

7 x x 7 7 0 0

7 0 0 7 7 0 0

8 x x 8 8 0 0

7 x x 7 7 0 0

8 x x 8 8 0 0

0 0 0 0 0 0 8/ 8 8 0/3

0 0 1 0 0 0 8/ 7 8 x x x

0 0 0 0 0 0 7/ 7 7 0/3

0 0 0 0 0 0 7/ 7 7 x x x

0 0 0 0 0 0 8/ 8 8 x x x

0 0 0 0 0 0 7/ 7 7 x x x

0 0 0 0 0 0 8/ 8 8 x x x

Child <5

Fraction with CD4% < 15% (of children <5 with available CD4 at baseline) CD4 median or fraction ≥200 (of adults with available CD4 - optional) 0/3

0/3

24 mos.Dec 08 8

12 mos. Jul 08

12 mos. Aug 08

12 mos. Oct 08

12 mos. Nov 08

12 mos. Dec 08

6 mo-s. May 08

6 mo-s. Jun 08

6 mos.Feb 08

6 mos.Mar 08

Cohort Aug 07

Cohort Nov 07

Cohort Dec 07

Cohort Jul 07

Cohort Sep 07

Cohort Oct 07

6 moJan 08

6 moApr 08

Reporting period: 1/1/2004- 31/3/2004 MOH or Project or Grantee:

Year: Facility: Kitanda

Kitanda Q 1

Location: Bukomansimbi, Masaka Country: Uganda

Table 1 Pre-ART - new and cumulative number of persons enrolled in HIV care Cumulative number of persons ever enrolled in HIV care at this facility at end of the previous reporting period Males (>14 years) Females (>14 years) Boys (0-14 years) Girls (0-14 years) Total a. 0 d. 0 g. 0 j. 0 m. 0 New persons enrolled in HIV care at this facility during the reporting period b. 45 e. 23 h. 8 k. 5 n. 81 Cumulative number of persons ever enrolled in HIV Percentage (%) care at this facility at end of the current reporting period c. 45 f. 23 i. 8 l. 5 o. 81 c/o x 100 45/81= 56% f/o x 100 23/81= 28% i/o x 100 l/o x 100 100% 8/81= 10% 5/81= 6%

Subset of those cumulatively enrolled in HIV care Total number of persons who are enrolled and eligible for ART but have not been started on ART s. 0

Table 2 Pre-ART - seen for HIV care during the reporting period Pre-ART persons seen for HIV care during the reporting period (total) a. 130 Percentage (%) b/a x 100 130/130= 100% c/a x 100 15/130= 12%

Subset of those seen during the reporting period TB status assessed at last visit TB treatment started during the reporting period b. 130 c. 15

Exercise booklet Table 3 ART - new and cumulative number of persons started on ART Cumulative number of persons ever started on ART at this facility at the end of the previous reporting period Males (>14 years) Females (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total a. 0 d. 0 g. 0 j. 0 m. 0 p. 0 New persons started on ART at this facility during the reporting period b. 20 e. 14 h. 2 k. 0 n. 0 q. 36 Cumulative number of persons ever started on ART at this facility at end of the current reporting period c. 20 f. 14 i. 2 l. 0 o. 0 r. 36 Percentage (%)

c/r x 100 20/36= 56% f/r x 100 14/36= 39% i/r x 100 l/r x 100 o/r x 100 100% 2/36= 5% 0/36= 0% 0/36= 0%

Table 4 ART - current on ART - based on age at start ART ARV regimen at end of reporting period Male Female Total Percentage (%)

On 1st-line ARV regimen Adults (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total Adults and children on 1st-line regimens Percentage (%) a. 20 d. 1 g. 1 j. 0 m. 22 m/ag x 100 b. 14 e. 0 h. 0 k. 0 n. 14 n/ag X 100 c. 34 f. 1 i. 1 l. 0 o. 36 o/ag x 100 c/ag x 100 34/36= 94% f/ag x 100 i/ag x 100 l/ag x 100 1/36= 3% 1/36= 3% 0/36= 0%

o/ag x 100 36/36= 100%

On 2nd-line ARV regimen Adults (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total Adults and children on 2nd-line regimens Percentage (%) Adults and children on 1st & 2nd-line regimens (Total current on ART) Percentage (%) p. s. v. y. ab ab/ag x 100 ae ae/ag x 100 q. t. w. z. ac ac/ag x 100 af af/ag X 100 Subset of those current on ART TB status assessed at last visit during the reporting period TB treatment started during the reporting period ah. 36 ai. 5 ah/ag x 100 36/36= 100% ai/ag x 100 5/36=14% r. u. x. aa ad ad/ag x 100 ag 100 100 r/ag x 100 u/ag x 100 x/ag x 100 aa/ag x 100 ad/ag x 100

Reporting period: 1/4/2004- 30/6/2004 MOH or Project or Grantee:

Year: Facility: Kitanda

Kitanda Q 2

Location: Bukomansimbi, Masaka Country: Uganda

Table 1 Pre-ART - new and cumulative number of persons enrolled in HIV care Cumulative number of persons ever enrolled in HIV care at this facility at end of the previous reporting period Males (>14 years) Females (>14 years) Boys (0-14 years) Girls (0-14 years) Total a. 45 d. 23 g. 8 j. 5 m. 81 New persons enrolled in HIV care at this facility during the reporting period b. 50 e. 59 h. 10 k. 17 n. 136 Cumulative number of persons ever enrolled in HIV care at this facility at end of the current reporting period c. 95 f. 82 i. 18 l. 22 o. 217 Percentage (%)

c/o x 100 95/217= 44% f/o x 100 82/217= 38% i/o x 100 l/o x 100 100% 18/217= 8% 22/217= 10%

Subset of those cumulatively enrolled in HIV care Total number of persons who are enrolled and eligible for ART but have not been started on ART s

Table 2 Pre-ART - seen for HIV care during the reporting period Pre-ART persons seen for HIV care during the reporting period (total) a. 166 Percentage (%) b/a x 100 166/166= 100% c/a x 100 1/166= 1%

Subset of those seen during the reporting period TB status assessed at last visit TB treatment started during the reporting period b. 166 c. 1

Exercise booklet Table 3 ART - new and cumulative number of persons started on ART Cumulative number of persons ever started on ART at this facility at the end of the previous reporting period Males (>14 years) Females (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total a. 20 d. 14 g. 2 j. 0 m. 0 p. 36 New persons started on ART at this facility during the reporting period b. 12 e. 22 h. 3 k. 0 n. 0 q. 37 Cumulative number of persons ever started on ART at this facility at end of the current reporting period c. 32 f. 36 i. 5 l. 0 o. 0 r. 73 Percentage (%)

c/r x 100 32/73= 44% f/r x 100 36/73= 49% i/r x 100 l/r x 100 o/r x 100 100% 5/73= 7% 0/73= 0% 0/73= 0%

Table 4 ART - current on ART - based on age at start ART ARV regimen at end of reporting period Male Female Total Percentage (%)

On 1st-line ARV regimen Adults (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total Adults and children on 1st-line regimens Percentage (%) a. 32 d. 2 g. 2 j. 0 m. 36 m/ag x 100 36/62= 58% b. 25 e. 1 h. 0 k. 0 n. 26 n/ag X 100 26/62= 42% c. 57 f. 3 i. 2 l. 0 o. 62 o/ag x 100 62/62= 100% c/ag x 100 57/62= 92% f/ag x 100 i/ag x 100 l/ag x 100 3/62= 5% 2/62= 3% 0/62= 0%

o/ag x 100 62/62= 100%

On 2nd-line ARV regimen Adults (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total Adults and children on 2nd-line regimens Percentage (%) Adults and children on 1st & 2nd-line regimens (Total current on ART) Percentage (%) p. 0 s. 0 v. 0 y. 0 ab. 0 ab/ag x 100 0/62= 0% ae. 36 ae/ag x 100 36/62= 58% q. 0 t. 0 w. 0 z. 0 ac. 0 ac/ag x 100 0/62= 0% af. 26 af/ag X 100 26/62= 42% Subset of those current on ART TB status assessed at last visit during the reporting period TB treatment started during the reporting period ah. 62 ai. 4 ah/ag x 100 62/62= 100% ai/ag x 100 4/62= 6% r. 0 u. 0 x. 0 aa.0 ad. 0 ad/ag x 100 0/62= 0% ag. 62 100% 100% r/ag x 100 0/62= 0% u/ag x 100 0/62= 0% x/ag x 100 0/62= 0% aa/ag x 100 0/62= 0% ad/ag x 100 0/62= 0%

Reporting period: 1/1/2004- 31/3/2004 MOH or Project or Grantee:

Year: 15/4/2004 Facility: Mirambi

Mirambi Q1

Location: Bukomansimbi, Masaka Country: Uganda

Table 1 Pre-ART - new and cumulative number of persons enrolled in HIV care Cumulative number of persons ever enrolled in HIV care at this facility at end of the previous reporting period Males (>14 years) Females (>14 years) Boys (0-14 years) Girls (0-14 years) Total a. 34 d. 23 g. 0 j. 1 m. 58 New persons enrolled in HIV care at this facility during the reporting period b. 57 e. 33 h. 15 k. 13 n. 118 Cumulative number of persons ever enrolled in HIV care at this facility at end of the current reporting period c. 91 f. 56 i. 15 l. 14 o. 176 Percentage (%)

c/o x 100 91/176= 52% f/o x 100 56/176= 32% i/o x 100 l/o x 100 100% 15/176= 8% 14/176= 8%

Subset of those cumulatively enrolled in HIV care Total number of persons who are enrolled and eligible for ART but have not been started on ART s. 12

Table 2 Pre-ART - seen for HIV care during the reporting period Pre-ART persons seen for HIV care during the reporting period (total) a. 150 Percentage (%) b/a x 100 150/150= 100% c/a x 100 1/150= 1%

Subset of those seen during the reporting period TB status assessed at last visit TB treatment started during the reporting period b. 150 c. 1

Exercise booklet Table 3 ART - new and cumulative number of persons started on ART Cumulative number of persons ever started on ART at this facility at the end of the previous reporting period Males (>14 years) Females (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total a. 12 d. 4 g. 0 j. 0 m. 0 p. 16 New persons started on ART at this facility during the reporting period b. 35 e. 14 h. 9 k. 0 n. 0 q. 58 Cumulative number of persons ever started on ART at this facility at end of the current reporting period c. 47 f. 18 i. 9 l. 0 o. 0 r. 74 Percentage (%)

c/r x 100 47/74= 64% f/r x 100 18/74= 24% i/r x 100 l/r x 100 o/r x 100 100% 9/74= 12% 0/74= 0% 0/74= 0%

Table 4 ART - current on ART - based on age at start ART ARV regimen at end of reporting period Male Female Total Percentage (%)

On 1st-line ARV regimen Adults (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total Adults and children on 1st-line regimens Percentage (%) a. 45 d. 5 g. 0 j. 0 m. 50 m/ag x 100 50/67= 75% b. 14 e. 3 h. 0 k. 0 n. 17 n/ag X 100 17/67=25% c. 59 f. 8 i. 0 l. 0 o. 67 o/ag x 100 67/67= 100% c/ag x 100 59/67 = 88% f/ag x 100 8/67 = 12% i/ag x 100 l/ag x 100 0/67= 0% 0/67= 0%

o/ag x 100 67/67= 100%

On 2nd-line ARV regimen Adults (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total Adults and children on 2nd-line regimens Percentage (%) Adults and children on 1st & 2nd-line regimens (Total current on ART) Percentage (%) p. 0 s. 0 v. 0 y. 0 ab. 0 ab/ag x 100 0/67= 0% ae. 50 ae/ag x 100 50/67= 75% q. 0 t. 0 w. 0 z. 0 ac. 0 ac/ag x 100 0/67= 0% af. 17 af/ag X 100 17/67=25% Subset of those current on ART TB status assessed at last visit during the reporting period TB treatment started during the reporting period ah. 67 ai. 3 ah/ag x 100 67/67= 100% ai/ag x 100 3/67= 4% r. 0 u. 0 x. 0 aa.0 ad. 0 ad/ag x 100 0/67= 0% ag. 67 100% 100% r/ag x 100 0/67= 0% u/ag x 100 0/67= 0% x/ag x 100 0/67= 0% aa/ag x 100 067= 0% ad/ag x 100 0/67= 0%

Reporting period: 1/4/2004- 30/6/2004 MOH or Project or Grantee:

Year: 15/7/2004 Facility: Mirambi

Mirambi Q 2

Location: Bukomansimbi, Masaka Country: Uganda

Table 1 Pre-ART - new and cumulative number of persons enrolled in HIV care Cumulative number of persons ever enrolled in HIV care at this facility at end of the previous reporting period Males (>14 years) Females (>14 years) Boys (0-14 years) Girls (0-14 years) Total a. 91 d. 56 g. 15 j. 14 m. 176 New persons enrolled in HIV care at this facility during the reporting period b. 60 e. 40 h. 4 k. 8 n. 112 Cumulative number of persons ever enrolled in HIV care at this facility at end of the current reporting period c. 151 f. 96 i. 19 l. 22 o. 288 Percentage (%)

c/o x 100 151/288= 52% f/o x 100 96/288= 33% i/o x 100 l/o x 100 100% 19/288= 7% 22/288= 8%

Subset of those cumulatively enrolled in HIV care Total number of persons who are enrolled and eligible for ART but have not been started on ART s. 45

Table 2 Pre-ART - seen for HIV care during the reporting period Pre-ART persons seen for HIV care during the reporting period (total) a. 160 Percentage (%) b/a x 100 160/160= 100% c/a x 100 1/160= 1%

Subset of those seen during the reporting period TB status assessed at last visit TB treatment started during the reporting period b. 160 c. 1

Exercise booklet Table 3 ART - new and cumulative number of persons started on ART Cumulative number of persons ever started on ART at this facility at the end of the previous reporting period Males (>14 years) Females (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total a. 47 d. 18 g. 9 j. 0 m. 0 p. 74 New persons started on ART at this facility during the reporting period b. 20 e. 17 h. 4 k. 0 n. 0 q. 41 Cumulative number of persons ever started on ART at this facility at end of the current reporting period c. 67 f. 35 i. 13 l. 0 o. 0 r. 115 Percentage (%)

c/r x 100 67/115= 58% f/r x 100 35/115= 30% i/r x 100 l/r x 100 o/r x 100 100% 13/115= 11% 0/115= 0% 0/115= 0%

Table 4 ART - current on ART - based on age at start ART ARV regimen at end of reporting period Male Female Total Percentage (%)

On 1st-line ARV regimen Adults (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total Adults and children on 1st-line regimens Percentage (%) a. 60 d. 6 g. 0 j. 0 m. 66 m/ag x 100 66/93= 71% b. 20 e. 7 h. 0 k. 0 n. 27 n/ag X 100 27/93=29% c. 80 f. 13 i. 0 l. 0 o. 93 o/ag x 100 93/93= 100% c/ag x 100 80/93 = 86% f/ag x 100 13/93 = 14% i/ag x 100 l/ag x 100 0/93= 0% 0/93= 0%

o/ag x 100 93/93= 100%

On 2nd-line ARV regimen Adults (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total Adults and children on 2nd-line regimens Percentage (%) Adults and children on 1st & 2nd-line regimens (Total current on ART) Percentage (%) p. 0 s. 0 v. 0 y. 0 ab. 0 ab/ag x 100 0/93= 0% ae. 66 ae/ag x 100 66/93= 71% q. 0 t. 0 w. 0 z. 0 ac. 0 ac/ag x 100 0/93= 0% af. 27 af/ag X 100 27/93=29% Subset of those current on ART TB status assessed at last visit during the reporting period TB treatment started during the reporting period ah. 93 ai. 2 ah/ag x 100 93/93= 100% ai/ag x 100 2/93= 2% r. 0 u. 0 x. 0 aa.0 ad. 0 ad/ag x 100 0/93= 0% ag. 93 100% 100% r/ag x 100 0/67= 0% u/ag x 100 0/67= 0% x/ag x 100 0/67= 0% aa/ag x 100 0/67= 0% ad/ag x 100 0/67= 0%

Reporting period: 1/1/2004- 31/3/2004 MOH or Project or Grantee:

Year: 15/4/2004 Facility: Bugenda

Bugenda Q 1

Location: Bukomansimbi, Masaka Country: Uganda

Table 1 Pre-ART - new and cumulative number of persons enrolled in HIV care Cumulative number of persons ever enrolled in HIV care at this facility at end of the previous reporting period Males (>14 years) Females (>14 years) Boys (0-14 years) Girls (0-14 years) Total a. 30 d. 42 g. 1 j. 2 m. 75 New persons enrolled in HIV care at this facility during the reporting period b. 75 e. 90 h. 5 k. 2 n. 172 Cumulative number of persons ever enrolled in HIV care at this facility at end of the current reporting period c. 105 f. 132 i. 6 l. 4 o. 247 Percentage (%)

c/o x 100 105/247= 43% f/o x 100 132/247= 53% i/o x 100 l/o x 100 100% 6/247= 2% 4/247= 2%

Subset of those cumulatively enrolled in HIV care Total number of persons who are enrolled and eligible for ART but have not been started on ART s. 34

Table 2 Pre-ART - seen for HIV care during the reporting period Pre-ART persons seen for HIV care during the reporting period (total) a. 203 Percentage (%) b/a x 100 203/203= 100% c/a x 100 1/203= 0.5%

Subset of those seen during the reporting period TB status assessed at last visit TB treatment started during the reporting period b. 203 c. 1

Exercise booklet Table 3 ART - new and cumulative number of persons started on ART Cumulative number of persons ever started on ART at this facility at the end of the previous reporting period Males (>14 years) Females (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total a. 20 d. 37 g. 0 j. 0 m. 0 p. 57 New persons started on ART at this facility during the reporting period b. 45 e. 68 h. 3 k. 0 n. 0 q. 116 Cumulative number of persons ever started on ART at this facility at end of the current reporting period c. 65 f. 105 i. 3 l. 0 o. 0 r. 173 Percentage (%)

c/r x 100 65/173= 38% f/r x 100 105/173= 61% i/r x 100 l/r x 100 o/r x 100 100% 3/173= 2% 0/173= 0% 0/173= 0%

Table 4 ART - current on ART - based on age at start ART ARV regimen at end of reporting period Male Female Total Percentage (%)

On 1st-line ARV regimen Adults (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total Adults and children on 1st-line regimens Percentage (%) a. 55 d. 1 g. 0 j. 0 m. 56 m/ag x 100 56/151= 37% b. 93 e. 2 h. 0 k. 0 n. 95 n/ag X 100 95/151=63% c. 148 f. 3 i. 0 l. 0 o. 151 o/ag x 100 151/151= 100% c/ag x 100 148/151 = 98% f/ag x 100 3/151 = 2% i/ag x 100 l/ag x 100 0/151= 0% 0/151= 0%

o/ag x 100 151/151= 100%

On 2nd-line ARV regimen Adults (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total Adults and children on 2nd-line regimens Percentage (%) Adults and children on 1st & 2nd-line regimens (Total current on ART) Percentage (%) p. 0 s. 0 v. 0 y. 0 ab. 0 ab/ag x 100 0/151= 0% ae. 56 ae/ag x 100 56/151= 37% q. 0 t. 0 w. 0 z. 0 ac. 0 ac/ag x 100 0/151= 0% af. 95 af/ag X 100 95/151=63% Subset of those current on ART TB status assessed at last visit during the reporting period TB treatment started during the reporting period ah. 151 ai. 3 ah/ag x 100 151/151= 100% ai/ag x 100 3/151= 2% r. 0 u. 0 x. 0 aa.0 ad. 0 ad/ag x 100 0/151= 0% ag. 151 100% 100% r/ag x 100 0/151= 0% u/ag x 100 0/151= 0% x/ag x 100 0/151= 0% aa/ag x 100 0/151= 0% ad/ag x 100 0/151= 0%

Reporting period: 1/4/2004- 30/6/2004 MOH or Project or Grantee:

Year: 15/7/2004 Facility: Bugenda

Bugenda Q 2

Location: Bukomansimbi, Masaka Country: Uganda

Table 1 Pre-ART - new and cumulative number of persons enrolled in HIV care Cumulative number of persons ever enrolled in HIV care at this facility at end of the previous reporting period Males (>14 years) Females (>14 years) Boys (0-14 years) Girls (0-14 years) Total a. 105 d. 132 g. 6 j. 4 m. 247 New persons enrolled in HIV care at this facility during the reporting period b. 35 e. 43 h. 2 k. 1 n. 81 Cumulative number of persons ever enrolled in HIV care at this facility at end of the current reporting period c. 140 f. 175 i. 8 l. 5 o. 328 Percentage (%)

c/o x 100 140/328= 43% f/o x 100 175/328= 53% i/o x 100 l/o x 100 100% 8/328= 2% 5/328= 2%

Subset of those cumulatively enrolled in HIV care Total number of persons who are enrolled and eligible for ART but have not been started on ART s. 61

Table 2 Pre-ART - seen for HIV care during the reporting period Pre-ART persons seen for HIV care during the reporting period (total) a. 175 Percentage (%) b/a x 100 175/175= 100% c/a x 100 1/175= 1%

Subset of those seen during the reporting period TB status assessed at last visit TB treatment started during the reporting period b. 175 c. 1

Exercise booklet Table 3 ART - new and cumulative number of persons started on ART Cumulative number of persons ever started on ART at this facility at the end of the previous reporting period Males (>14 years) Females (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total a. 65 d. 105 g. 3 j. 0 m. 0 p. 173 New persons started on ART at this facility during the reporting period b. 20 e. 32 h. 1 k. 0 n. 0 q. 53 Cumulative number of persons ever started on ART at this facility at end of the current reporting period c. 85 f. 137 i. 4 l. 0 o. 0 r. 226 Percentage (%)

c/r x 100 85/226= 38% f/r x 100 137/226= 61% i/r x 100 l/r x 100 o/r x 100 100% 4/226= 2% 0/226= 0% 0/226= 0%

Table 4 ART - current on ART - based on age at start ART ARV regimen at end of reporting period Male Female Total Percentage (%)

On 1st-line ARV regimen Adults (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total Adults and children on 1st-line regimens Percentage (%) a. 83 d. 1 g. 0 j. 0 m. 84 m/ag x 100 84/207= 41% b. 120 e. 3 h. 0 k. 0 n. 123 n/ag X 100 123/207 =59% c. 203 f. 4 i. 0 l. 0 o. 207 o/ag x 100 207/207= 100% c/ag x 100 203/207 = 98% f/ag x 100 4/207 = 2% i/ag x 100 l/ag x 100 0/207= 0% 0/207= 0%

o/ag x 100 207/207= 100%

On 2nd-line ARV regimen Adults (>14 years) Children (5-14 years) Children (1-4 years) Children (< 1 year) Total Adults and children on 2nd-line regimens Percentage (%) Adults and children on 1st & 2nd-line regimens (Total current on ART) Percentage (%) p. 0 s. 0 v. 0 y. 0 ab. 0 ab/ag x 100 0/207= 0% ae. 84 ae/ag x 100 84/207= 41% q. 0 t. 0 w. 0 z. 0 ac. 0 ac/ag x 100 0/207= 0% af. 123 af/ag X 100 123/207 =59% Subset of those current on ART TB status assessed at last visit during the reporting period TB treatment started during the reporting period ah. 207 ai. 1 ah/ag x 100 207/207= 100% ai/ag x 100 1/207= 1% r. 0 u. 0 x. 0 aa.0 ad. 0 ad/ag x 100 0/207= 0% ag. 207 100% 100% r/ag x 100 0/207= 0% u/ag x 100 0/207= 0% x/ag x 100 0/207= 0% aa/ag x 100 0/207= 0% ad/ag x 100 0/207= 0%

ART cohort analysis report

Facility: Kitanda, Bukomansimbi, Masaka

Exercise O Kitanda

24 mos.Jul 08

24 mos.Aug 08

12 mos.Sep 08

24 mos.Sep 08

24 mos.Oct 08

24 mos.Nov 08

9 x x 9 9 0 0

9 1 1 9 8 0 0

10 x x

10 2 4 8

15 x x

15 5 2 18 15 0

20 x x

20 3 1 22 19

21 X X 21 21

23 X X 23 23

10 0

0 0 0

0 0 1 0 0 0 1 10/10 7/8 15/15 17/18 20/20 1 21/22 1 1 1

9/9

8/9

Child <5

Fraction with CD4% < 15% (of children <5 with available CD4 at baseline) CD4 median or fraction ≥200 (of adults with available CD4 - optional) 0/4

21/21

23/23

3/4

0/6

4/6

1/10

7/8

4/10

13/14

3/15

2/10

24 mos.Dec 08 x

12 mos. Jul 08

12 mos. Aug 08

12 mos. Oct 08

12 mos. Nov 08

12 mos. Dec 08

6 mo-s. May 08

6 mo-s. Jun 08

6 mos.Feb 08

6 mos.Mar 08

Cohort Aug 07

Cohort Nov 07

Cohort Dec 07

Cohort Jul 07

Cohort Sep 07

Cohort Oct 07

6 moJan 08

6 moApr 08

Exercise booklet ART cohort analysis report Facility: Kitanda, Bukomansimbi, Masaka

Exercise O

24 mos.Jul 08

24 mos.Aug 08

12 mos.Sep 08

24 mos.Sep 08

24 mos.Oct 08

24 mos.Nov 08

25 x x 25 25

26 X X 26 26

30 X X 30 29

32 X X 32 32 x x x x

25/25

26/26

30/30

32/32

Child <5

Fraction with CD4% < 15% (of children <5 with available CD4 at baseline) CD4 median or fraction ≥200 (of adults with available CD4 - optional) 2/12

5/18

7/21

8/20

24 mos.Dec 08 x

12 mos. Jul 08

12 mos. Aug 08

12 mos. Oct 08

12 mos. Nov 08

12 mos. Dec 08

6 mo-s. May 08

6 mo-s. Jun 08

6 mos.Feb 08

6 mos.Mar 08

Cohort Aug 07

Cohort Nov 07

Cohort Dec 07

Cohort Jul 07

Cohort Sep 07

Cohort Oct 07

6 moJan 08

6 moApr 08

ART cohort analysis report

Facility: Mirambi

Exercise O

24 mos.Jul 08

24 mos.Aug 08

12 mos.Sep 08

24 mos.Sep 08

24 mos.Oct 08

24 mos.Nov 08

15 x x 15 15

15 0 0 15 14

13 x x 13 13

13 0 0 13 12

9 x x 9 9

9 3 1 11 10

18 x x 18 18

18 5 5 18 15

19 X X 19 19

21 X X 21 21

1 1

1 15/15 15/15 13/13 12/13 9/9 11/11 18/18 17/18 19/19 21/21

1/4

1/8

2/5

0/15

0/14

0/12

Child <5

Fraction with CD4% < 15% (of children <5 with available CD4 at baseline) CD4 median or fraction ≥200 (of adults with available CD4 - optional) 2/4

3/4

1/8

6/8

0/5

5/5

2/15

12/14

1/14

2/12

24 mos.Dec 08 x

12 mos. Jul 08

12 mos. Aug 08

12 mos. Oct 08

12 mos. Nov 08

12 mos. Dec 08

6 mo-s. May 08

6 mo-s. Jun 08

6 mos.Feb 08

6 mos.Mar 08

Cohort Aug 07

Cohort Nov 07

Cohort Dec 07

Cohort Jul 07

Cohort Sep 07

Cohort Oct 07

6 moJan 08

6 moApr 08

Exercise booklet ART cohort analysis report Facility: Mirambi

Exercise O

24 mos.Jul 08

24 mos.Aug 08

12 mos.Sep 08

24 mos.Sep 08

24 mos.Oct 08

24 mos.Nov 08

20 x x 20 20

24 x x 24 24

31 x x 31 31 x x x x

20/20

24/24

31/31

0/12

0/13

0/20

Child <5

Fraction with CD4% < 15% (of children <5 with available CD4 at baseline) CD4 median or fraction ≥200 (of adults with available CD4 - optional) 2/12

3/13

1/10

6/20

24 mos.Dec 08 x

12 mos. Jul 08

12 mos. Aug 08

12 mos. Oct 08

12 mos. Nov 08

12 mos. Dec 08

6 mo-s. May 08

6 mo-s. Jun 08

6 mos.Feb 08

6 mos.Mar 08

Cohort Aug 07

Cohort Nov 07

Cohort Dec 07

Cohort Jul 07

Cohort Sep 07

Cohort Oct 07

6 moJan 08

6 moApr 08

World Health Organization 20 avenue Appia CH-1211 Geneva 27 Switzerland HIV Department E-mail: hiv-aids@who.int http://www.who.int/hiv/capacity/ STOP TB Department E-mail tbdocs@who.int Department of Maternal, Newborn, Child and Adolescents (MCA) E-mail: mncah@who.int

IMAI — Integrated Management of Adolescent and Adult Illness IMPAC — Integrated Management of Pregnancy and Childbirth IMCI — Integrated Management of Childhood Illness

Key facts

Organisation World Health Organization (WHO)

Document type Technical Documents

Adoption date May 29, 2013

Source World Health Organization