JUNE, 2014
Introduction
2
Instruction to complete general information: table headers and footer for self
assessment form in each technical area
Table Header :
Region: Write the name of the region where the facility is located.
Facility name: Write the name of the sites as designated by Federal Ministry of
Health or Regional Health Bureau.
Department: Write the department/service unit where the report is obtained from.
Reporting Month and year: Write the month and year during which the reported
activity was performed.
Table Footer
Compiled by: The person who compiled the data should write his/her name and
put his/her signature.
Checked by: The person who checked the data before sending to the next level
should write his /her name and put signature.
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1. HIV Care/ART Clinic Monthly Target Achievement Self-
Assessment Form
Purpose: to monitor the Care (PRE-ART) and treatment (ART) service uptake, defaulter
tracing and TB/HIV collaborative activity at care and treatment clinic.
HIV care/ART clinic Monthly Target Achievement Self-Assessment is composed of five
tables to compile enrolment and ART initiation, adherence (ART & Pre-ART) and TB/HIV
data.
HIV Care & Treatment
In this section there are three tables:
- Table 1: contains number of monthly new enrolment to HIV care disaggregated by
age and sex and monthly Pre ART target.
Data source: Pre-ART register/ Database
- Table 2: contains number of monthly new ART initiation monthly ART target and
currently on ART during the reporting month disaggregated by age and sex.
Data source: ART register/ Database
- Table 3: contains total number of patients who initiated ART in the 12 months prior
to the beginning of the reporting month (net cohort) and among those who are still
alive and on treatment at 12 months after initiating ART, disaggregated by age and
sex.
Indicators:
New Pre ART Enrolment by age /sex category: To complete this section in the
1st table, count number of persons newly enrolled in pre-ART during the month for each
sex and by age category (children under 12 months, 12-59 months, 5-14 years, 15 +
adult and 15+ pregnant women) from the register or database.
N.B: 15+ pregnant women number is the subset of total 15+ female.
4
Monthly New Pre ART enrolment target (T1): This number is obtained from the
respective facility annual target.
New ART Initiation by age /sex category: To complete this section in the 2 nd
table, count the number of persons newly initiated on ART during the month for each
sex and by age category (children under 12 months, 12-59 months, 5-14 years, 15 +
adult and 15+ pregnant women) from the register or database.
N.B: 15+ pregnant women number is the subset of total 15+ female
Monthly New ART initiation target (T 2): This number is obtained from the
respective facility annual target.
Total Number of persons Currently on ART: to complete this section, count the
number of persons who are currently on ART by the end of the reporting month for
each sex and by age category (children under 12 months, 12-59 months, 5-14 years,
15+ adult and 15+ pregnant women) from the register or database.
5
How to calculate target achievement indicators for this section:
PRE ART Target achievement (A1) is calculated as total number of persons newly
enrolled in care (PRE-ART) during the month divided by the monthly Pre-ART enrolment
target set by the facility. Record the result in the corresponding coloured column that
matches the percentage calculated.
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Adherence to ART
Data source: Appointment calendar/database
Active defaulter tracing for ART patients is tracing activity conducted to track
patients who are late (missed) appointment by one week to pick up their medication.
Indicator 1. Number of persons who missed appointment in the previous
reporting month: Among all patients who started on ART, count the number of
persons who had appointment to pick up their ARV drugs but missed (late) for their
appointment by a week during the previous reporting month disaggregated by age.
This is compiled from appointment calendar or generated from database.
Indicator 2. Number of persons for whom active defaulter tracing was
done: Among those who missed appointment during the previous reporting month
count the number of persons for whom defaulter tracing was done (through phone or
any other means) within one week of missed appointment; disaggregated by age.
This is compiled from appointment calendar action taken column or updated missed
appointment list generated from database.
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How to calculate the achievements for this section:
Proportion of ART patients for whom active defaulter tracing was done ;is
calculated as total number of persons for whom active defaulter tracing done divided by
the total number who missed appointment. Record the result in the column corresponding
to the value of the percentage calculated.
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Adherence to Pre ART
Data source: Appointment calendar/ database
Active defaulter tracing for Pre- ART client for whom tracing activity conducted to
track Pre-ART client who are late (missed) their HIV care follow up appointment by one
week.
Indicator 2. Number of persons for whom active defaulter tracing was done:
count the number of persons for whom defaulter tracing was done (through phone or
any other means) among Pre-ART clients who missed appointment during the previous
reporting month disaggregated by age. This is compiled from appointment calendar
action taken column or updated missed appointment list generated from database.
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How to calculate the achievements for this section:
Proportion of Pre ART clients for whom active defaulter tracing was done; it is
calculated as number of Pre-ART clients for whom active defaulter tracing done divided by
the total number of Pre-ART clients who missed appointment. Record the result in the
column corresponding to the value of the percentage calculated.
Proportion of Pre ART patients who have returned to care and treatment; is
calculated as total number of persons who have returned to care and treatment divided by
the total number of persons for whom defaulter tracing done. Record the result in the
column corresponding to the value of the percentage calculated.
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TB HIV indicator from ART clinic
Data source: Pre- ART and ART Register / database
Indicators:
Indicator 1. Number of clients enrolled in HIV care (Pre-ART care) during the
month: this is compiled by counting the total number of clients who are enrolled in HIV
care (Pre-ART enrolment) during the month disaggregated by age, as pediatric (<15)
and adults (15+).
o *This indicator is collected from TB treatment start date column of Pre-ART register
for newly enrolled clients during the reporting month.
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Indicator 2. Number of persons diagnosed with active TB before
enrolment and started on TB Rx: this is compiled by counting the number of
persons who were diagnosed with TB and started on anti-TB treatment before
enrolment ,disaggregated by age as pediatric (<15) and adults (15 +).
*N.B. If a patient started on ART and anti TB treatment in the same month his/her TB
treatment start date will appear on both pre-ART and ART registers; they should be
counted from either the pre-ART or ART register, make sure they are not double counted.
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o Indicator 4a. Number newly diagnosed TB/HIV co-infected patients on (CPT)
irrespective of time of CPT initiation: this is compiled by counting the number of
patients in HIV care newly started on anti TB treatment during the reporting month on
CPT (count all new TB/HIV co-infected on CPT including those already on CPT) among
previously enrolled patients in care and treatment (Pre-ART & ART) disaggregated by
age and sex. Record the result in the space provided.
**N.B. If a patient started on ART, anti TB treatment and CPT in the same month
his/her TB treatment and CPT start date will appear on both Pre-ART and ART registers;
make sure they are not double counted (i.e. count either the pre-ART or ART register).
N.B. If a patient started on ART and INH in the same month his/her INH start date will
appear on both Pre-ART and ART registers; make sure they are not double counted (i.e.
count either the pre-ART or ART register).
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How to calculate achievements for this section:
pre ART care during the month (1a) divided by the number of clients enrolled in HIV
care(1) excluding those diagnosed with active TB and started on TB treatment before
enrolment(2), during the reporting month. Record the result in the column corresponding
This is calculated as the number of new enrolees diagnosed with active TB during the
month (newly identified TB/HIV co-infected patients) initiated on CPT (1c) divided by total
number of persons diagnosed with active TB and started TB treatment (1b) among the
new enrolees during the month. Record the result in the column corresponding to the value
of the percentage calculated.
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Proportion of TB patients diagnosed before enrolment initiated on CPT
This is calculated as the number of new enrolees diagnosed with active TB who have
started TB treatment before enrolment and initiated on CPT divided by the number
diagnosed with active and started on TB treatment before enrolment among the new
enrolees during the month. Record the result in the column corresponding to the value of
the percentage calculated.
This is calculated as the number newly diagnosed TB patients initiated on CPT among
previously enrolled clients diagnosed with active TB during the month(2a) divided by total
number of newly identified patients with active TB and started TB R x among previous
enrolees during the month(2). Record the result in the column corresponding to the value
of the percentage calculated.
Data clerks
ART care providers, data clerks, Zonal M&E officers, ART/ Palliative care advisors
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2. VCT Service Monthly Target Achievement Self-Assessment Form
Number of VCT clients counselled and tested: Count total number of VCT
client counselled and tested disaggregated by age and sex during the reporting month.
Number of VCT clients tested HIV+: Count total number of VCT client tested
HIV positive, disaggregated by age and sex during the reporting month.
Number of VCT clients tested HIV+ and enrolled in care within the facility:
Count total number of VCT clients tested HIV+ and enrolled in care within the facility
disaggregated by age and sex, during the reporting month.
Number of VCT clients tested HIV+ and referred: count total number of
clients who tested HIV+ and referred to another facility for care and treatment.
Number of VCT clients tested HIV+ clients who refused to be linked: count total
number of clients who tested HIV+ and refused to be linked
N.B: The total number of clients counselled and tested should equal to the sum of
clients counselled & tested individually and number of individuals counselled and tested
in couple.
Monthly VCT target: This number is obtained from the facilities annual target.
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How to calculate the achievement for this section:
Proportion of VCT target achieved (A1): this is calculated as the total number of VCT
client counselled & tested during the month divided by the monthly VCT target for the
number counselled & tested (T1). Record the result in the column corresponding to the
Prop. VCT target achieved (A1) = # VCT clients counselled & tested X 100
Proportion of HIV+ VCT clients linked to care: this is calculated as the total number
of HIV+ VCT clients enrolled in HIV care/ART within the facility plus those referred to other
facility during the month divided by the total number of VCT clients tested HIV+ during the
month .Record the result in the column corresponding to the value of the percentage
calculated.
.
Prop. of HIV+ VCT clients linked to care (A1)
VCT counsellor
Responsible for data quality
VCT counsellor,Zonal M&E officers /Regional/Central M&E advisors.
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3. PMTCT Services Monthly Target achievement Self- Assessment
Purpose: to monitor performance in PMTCT testing up take and enrolment for mother
infant pair to PMTCT care with HAART initiation to the mother.
Indicator 2. Number of new ANC attendees for whom HIV test was
performed before the ANC visit: this is compiled by counting number of new ANC
attendees for whom HIV test was performed before the ANC visit during the reporting
month
2a: Number of new ANC clients who are HIV +ve: this is compiled by counting
number of new ANC attendees who are HIV +ve.
2b: Number of HIV +Ve ANC clients already enrolled in HIV/PMTCT care
and on HAART: this is compiled by counting the number of HIV +ve ANC clients
already enrolled in HIV/PMTCT care and on HAART.
2c: Number of HIV +Ve ANC clients newly initiated on HAART: this is
compiled by counting the number of HIV +ve ANC clients newly initiated on HAART.
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Indicator 3. Number of new ANC attendees for whom HIV test was
performed at ANC clinic: this is compiled by counting number of new ANC attendees
for whom HIV test was performed at ANC clinic during the reporting month.
3a: Number of new ANC clients who are HIV +ve: this is compiled by counting
number of new ANC attendees who are HIV +ve.
3b: Number of HIV +Ve ANC clients newly initiated on HAART: this is
compiled by counting the number of HIV +ve ANC clients newly initiated on HAART
Indicator 4. Number new ANC attendees tested for Syphilis: this is compiled by
counting number of new ANC attendees who were tested for syphilis during the
reporting month.
Indicator 5. Number of partners who are counselled and tested: this is
compiled by counting the total number of ANC attendees partners who were counselled
and tested for HIV during the reporting month.
Indicator 6. Number of partners who are tested HIV+: this is compiled by
counting the total number of ANC attendees partners who were tested HIV+ during the
reporting month.
o NB: If there are clients who tested HIV+ and referred to another facility for care
and treatment or HIV+ clients who refused to be linked during the month count
their number and enter it in the remark row.
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How to calculate the achievements for this section:
Proportion of new ANC attendees tested HIV+ before ANC visit and on HAART (A1): this
is calculated as the sum of number of new ANC attendees with Known HIV+ status already
on HAART (2b) and number of Known HIV+ newly initiated on HAART (2c) divided by the
number of new ANC attendees with known HIV+ status (2a). Record the result in the
column corresponding to the value of the percentage calculated.
Prop. of new ANC attendees tested HIV+ before ANC visit initiated on HAART(A1)
= # Known HIV+ already on HAART + # Known HIV+ newly initiated on HAART X 100
Number of new ANC attendees (with known HIV+ status) for whom HIV test was
performed before ANC visit during the current pregnancy
Proportion of new ANC attendees with unknown status for whom HIV test was
performed at ANC clinic (A2): this is calculated as the number of new ANC attendees
who accepted HIV testing and for whom HIV test was performed at ANC clinic (3) divided
by the difference between total number of new ANC attendees (1) and the number of new
ANC attendees (with known HIV status) for whom HIV test was performed before the ANC
visit during current pregnancy (2). Record the result in the column corresponding to the
value of the percentage calculated.
Proportion of new ANC attendees with unknown status for whom HIV test was performed at ANC clinic (A2):
= Number of new ANC attendees with unknown HIV status for whom HIV test was performed at ANC clinic X 100
The total number of new ANC attendees - new ANC attendees (with known status) for whom HIV test was
performed before the ANC visit during the current pregnancy
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Proportion new ANC attendees identified HIV+ at ANC and initiated on HAART (A3): this
is calculated as the number of newly identified HIV+ new ANC attendees initiated on HAART(3b)
divided by total number of newly identified HIV+ at ANC clinic (3a). Record the result in the
Proportion of new ANC attendees identified HIV+ at ANC and initiated on HAART (A3)
Responsible for data quality: - ANC service provider, Zonal M&E officers /Regional
PMTCT/Paediatric advisors and Regional/Central M&E advisor.
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Labour & Delivery PMTCT service Monthly Target Achievement Self-
Assessment
Data Source: Labour & Delivery register
Indicator 1. Number of deliveries during the month: Count the total number of
deliveries during the month at the labour and delivery ward/unit regardless of HIV status.
Indicator 2. Number of labouring mothers (known HIV status) for whom HIV
test was performed before the visit for delivery: this is compiled by counting the
number of labouring mothers for whom HIV test was performed before the visit for
delivery during the reporting month.
2a: Number of labouring mothers who are HIV +ve: this is compiled by
counting number of labouring mothers who have known HIV+ status.
2b: Number of HIV +ve labouring mothers already enrolled in HIV /PMTCT
care and are on HAART: this is compiled by counting the number of HIV
labouring mothers already enrolled in HIV care/PMTCT care and are on HAART.
2c: Number of HIV +ve labouring mothers newly initiated on HAART: this is
compiled by counting the number of HIV +ve laboring mothers newly initiated on
HAART.
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Indicator 4: Number of live born HIV exposed infants: count the total number of live
born HIV exposed infants born during the month.
4a: Number of HIV exposed infants received NVP prophylaxis for 6 weeks:
Count the total number of infants delivered from HIV positive mothers at L&D who
have received NVP prophylaxis for 6 weeks after birth during the reporting month.
Indicator 6. Number of partners tested HIV+: to compile this count the number
of partners of labouring mothers tested HIV+.
NB: If there are labouring mothers who tested HIV+ and referred to another facility for
HIV care or HIV+ labouring mothers who refused to be enrolled within the facility during
the month count their number and write it on the remark section.
Number HIV +ve already reported from ANC clinic of the same facility during
the calendar year: Count the number of HIV positive mothers who were identified during
ANC visit and already reported during the calendar year, from ANC register.
Number HIV +ve already reported as receiving HAART from ANC clinic during
the calendar year: Count the number of HIV positive labouring mothers who received
HAART at ANC clinic and already reported during the calendar year, from Labour and
Delivery register.
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How to calculate the achievements for this section:
Proportion Known HIV+ labouring mothers on HAART(A1): this is calculated as the
number labouring mothers tested HIV+ before L&D visit and already on HAART (those
already on HAART at ART clinic (2b) / PMTCT clinic plus newly initiated on HAART at L&D;
option B+(2c) ) divided by the number labouring mothers tested HIV+ before L&D visit
(2a). Record the result in the column corresponding to the value of the percentage
calculated.
= (No. of HIV+ mothers already enrolled and on HAART + No. of HIV+ mothers newly initiated on HAART) x 100
Number of Labouring mothers tested HIV+ before L&D visit
Proportion of labouring mothers for whom HIV test was performed at L&D: this
is calculated as the number of labouring mothers for whom HIV test was performed at L&D
(3) divided by the difference between the total number of deliveries during the month and
number labouring mothers (with known HIV status) for whom HIV test was performed
before the visit for delivery (1-2). Record the result in the column corresponding to the
value of the percentage calculated.
Proportion of labouring mothers for whom HIV test was performed at L&D (A2):
= Number of labouring mothers for whom HIV test was performed at L&D X 100
The total number of deliveries _ labouring mothers for whom HIV test was
Performed before the visit for delivery
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Proportion of labouring mothers identified HIV +ve at L&D and initiated on
HAART (A3): this is calculated as the number of newly identified HIV+ labouring mothers
initiated on HAART (3b) divided by total number of newly identified HIV+ labouring
mothers (3a). Record the result in the column corresponding to the value of the
percentage calculated.
Prop. of labouring mothers identified HIV + at L&D and initiated on HAART (A3)
= Number of new HIV +ve laboring mothers initiated on HAART X 100
Number of laboring mothers who are HIV +ve (new)
Proportion of HIV exposed infant (HEI) received NVP prophylaxis for 6 weeks
(A4): this is calculated as the number of HIV exposed infants who received NVP
prophylaxis for 6 weeks after delivery(4a) divided by the number of live-born HIV exposed
infants(4) during the reporting month. Record the result in the column corresponding to
the value of the percentage calculated.
Labour ward nurse, Central PMTCT/Paediatric advisors and Zonal M&E officers
/Regional/Central M&E advisors
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NB: For HIV+ women not on HAART, explanation should be looked at the remark column
of L&D HMIS register.
Indicator 1. Number of new PNC attendees during the month: to compile this
count the total number of new PNC attendees during the reporting month.
Indicator 2. Number of new PNC attendees (with known HIV status) for whom
HIV test was performed before the PNC visit: to compile this count the total number
of new PNC attendees for whom HIV test was performed before PNC visit.
2a. Number new PNC attendees who are HIV+: to compile this count the total
number of new PNC attendees who are HIV+.
2b. Number of HIV+ PNC attendees - HIV exposed infant pair already enrolled
in HIV/ PMTCT care: to compile this count the total number of HIV+ new PNC attendees
and HIV exposed infant pair already enrolled in care.
2c. Number of HIV+ PNC attendees - HIV exposed infant pair linked to ANC
clinic for PMTCT service to compile this count the total number of HIV+ new PNC
attendees and HIV exposed infant pair enrolled in care.
Indicator 3. Number of new PNC attendees (unknown HIV status) for whom HIV
test was performed at PNC: this is compiled by counting number of PNC attendes for
whom HIV test was performed at PNC clinic during the reporting month
3a. Number new PNC attendees who are tested HIV+ at PNC clinic: to compile
this count the total number of new PNC attendees tested HIV+ during the reporting month.
3b. Number of HIV+ PNC attendees - HIV exposed infant pair linked to ANC
clinic for PMTCT service (option B+) : to compile this count the total number of HIV+
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new PNC attendees and HIV exposed infant pair enrolled in care during the reporting
month.
Indicator 4. Number of partners counselled and tested: to compile this count the
total number of PNC attendees partners who were counselled and tested for HIV during
the reporting month.
Indicator 5. Number of partners tested HIV+: to compile this count the total number
of PNC attendees partners who were tested HIV+ during the reporting month.
Proportion of HIV+ PNC attendees - HIV exposed infant pair enrolled in PMTCT care (A1)
= Total number of HIV+ PNC attendees - HIV exposed infant pair enrolled in PMTCT care x 100
Number of new PNC attendees (with known HIV status) HIV test was performed before PNC visit
Proportion of new PNC attendees for whom HIV test was performed at PNC
clinic (A2): this is calculated as the number of new PNC attendees for whom HIV test was
performed at PNC clinic (3) divided by (the total number of new PNC attendees during the
month (1) minus number of new PNC attendees (known HIV status) for whom HIV test
was performed before PNC visit (2)). Record the result in the column corresponding to the
value of the percentage calculated.
Prop. of new PNC attendees for whom HIV test was performed at PNC clinic (A2):
= No. of new PNC attendees (with unknown status) for whom HIV test was performed at PNC clinic X 100
Number of new PNC attendees - new PNC attendees (with known HIV status) for whom HIV test
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during the month was performed before the PNC visit
Proportion of new HIV+ PNC attendees - HIV exposed infant pair enrolled in
PMTCT(A3): This is calculated as the total number of HIV+ PNC attendee -HIV exposed
infant pair linked to PMTCT care divided by the number of new PNC attendees (with
unknown HIV status) tested HIV+ during the reporting month. Record the result in the
column corresponding to the value of the percentage calculated.
Proportion of new HIV+ PNC attendees-HIV exposed infant pair enrolled in PMTCT care (A3)
= No. of new HIV+ PNC attendee-HIV exposed infant pair enrolled in PMTCT care x 100
# of new PNC attendees (with unknown) tested HIV+
PNC service provider, Zonal PMTCT officers / Zonal M & E officers/ Regional /Central
M&E advisors.
NB: If there are clients who tested HIV+ and refused to be linked; during the month
count their number and enter the remark row.
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HIV Exposed Infant Monthly Target Achievement Self Assessment Form
Purpose: To monitor HEI follow up service uptake and quality including; CPT prophylaxis
provision, PCR/DBS testing and HAART initiation for HIV exposed infants.
Data sources: HIV Exposed Infant Register
1a.Number of HIV exposed infants enrolled by 2 months of age: count the total
number of HIV exposed infants enrolled in follow up care by 2 months among those HIV
exposed Infants (HEI) enrolled during the reporting month.
1c. Number of HIV exposed infants enrolled after 12 months of age: count the
total number of HIV exposed infants who were enrolled in follow up care beyond 12
months of age among those HIV exposed infants enrolled during the reporting month.
Indicator 2: Total number received ARV prophylaxis by 6 weeks: count the total
number of HIV exposed infants who have received ARV prophylaxis by six weeks of age
among the total number of HIV exposed infants enrolled during the reporting month.
Indicator 3: Total number initiated on CPT : count the total number of HIV exposed
infants who were initiated on CPT among the total number of HIV exposed infants enrolled
during the reporting month.
3a. Number initiated on CPT by 2 months of age: count the total number of HIV
exposed infants who were initiated on CPT by 2 months of age among those HIV exposed
infants enrolled by 2 months of age during the reporting month.
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Indicator 4: Total number tested PCR/DBS or Rapid antibody test: count the total
number of HIV exposed infants tested by PCR/DBS or Rapid antibody test at any age
during the reporting month.
4a: Number tested by PCR/DBS by 2 months of age: count the total number of HIV
exposed infants tested by PCR/DBS by 2 months of age among those HEIs enrolled by 2
months of age.
4b: *Number tested by PCR/DBS for the first time between 2 and 12 months:
count the total number of HIV exposed infants tested by PCR/DBS between 2 and 12
months of age among those HEIs enrolled between 2-12 months of age.
4c: Number tested only by rapid HIV antibody test between 9 and 12 months of
age: count the total number of HIV exposed infants who are only tested by rapid HIV
antibody test between 9 and 12 months of age.
4d. *Number tested by PCR/DBS after 12 months of age: count the total number of
HIV exposed infants tested by PCR/DBS after 12 months of age among those infants
enrolled after 12months of age.
Indicator 5: Total number tested PCR/DBS positive: count the total number of HIV
exposed infants tested PCR/DBS positive.
5a. Number tested HIV+ within 12 months of birth: count the total number of HIV
exposed infants tested HIV+ within 12 months of birth.
5b. Number Tested HIV+ after 12 months of age: count the total number of HIV
exposed infants tested HIV+ after 12 months of birth.
*This includes HEI tested by PCR only or rapid HIV antibody test followed by PCR .
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How to calculate the achievements for this section:
Proportion of HEI initiated on CPT (A3): this is calculated as total number of HEI
initiated on CPT(3) divided by total number of HIV exposed infants enrolled in follow up
care during the month at any age (1). Record the result in the column corresponding to
the value of the percentage calculated.
31
Proportion of HEI initiated on CPT by two months of age (A4): this is calculated as
total number of exposed infants initiated on CPT by two months of age(3a) divided by
number of HEI enrolled by two month of age(1a) during the reporting period. Record the
result in the column corresponding to the value of the percentage calculated.
32
Remark:
The reporting period falls one month behind schedule for HEI service monthly report due to
DBS result turnaround time which lags on average around one month. Thus while
compiling monthly report at the end of each reporting month for other service areas one is
expected to compile the previous month report for HEI service.
NB. This rule wont be followed during SAPR and APR reporting period and report collection
and compilation will be conducted at the end of each reporting month.
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4. PITC Services Monthly target achievement self assessment
Indicator 2. Number of new TB patient (with known HIV status) for whom
HIV test is performed before TB clinic visit: This indicator is compiled by counting
the number of new TB patients for whom HIV test is performed before TB clinic visit
during the month ,disaggregated by age and sex.
2a. Number who are HIV+: count the number of new TB patients who are already
known HIV+.
2b. Number HIV+ on ART: count the number of new HIV positive TB patients who are
on ART.
3a. Number of new TB patient tested HIV positive: this is compiled by counting
the number of new TB patient who were tested HIV+ at TB clinic.
3b. Number of new TB patients enrolled in HIV care within the facility: This is
compiled by counting the number of new TB patient enrolled in HIV care within the
facility among those newly identified as HIV+ new TB patients disaggregated by age and
sex.
34
3c. Number of HIV+ new TB patients referred to another facility for HIV care:
This is compiled by counting the number of HIV+ new TB patients who were referred to
another facility for HIV care among those newly identified as HIV+ new TB patients,
disaggregated by age and sex.
3d. Number of HIV+ new TB patients on ART: This is compiled by counting the
number of HIV+ new TB patient who are initiated on ART among those newly identified
HIV+ new TB patients, disaggregated by age and sex.
35
Proportion of HIV+ new TB patients enrolled in HIV care(A2): This is calculated as
the sum of number of HIV+ new TB patients enrolled in HIV care within the facility and
referred to another facility divided by the total number of new TB patients tested HIV+
during the month. Record the result in the column corresponding to the value of the
percentage calculated.
36
Out Patient department (OPD) PITC monthly target self assessment
Data Source: OPD abstract register in Medical OPD, Surgical OPD, Gyn OPD, POPD,
NB: OPD PITC service monthly self-assessment form should be filled for each OPD
available in the facility and the type of the OPD where the report was collected should be
identified by checking inside the boxes found at the top of the form.
Indicator 1.Number of patients/ clients seen at OPD during the month: this
is compiled by counting the total number of patients/clients seen at OPD during the
month.
3a. Number of patients/ clients tested HIV+ this is compiled by counting the
number of patients/clients who have HIV+ test result.
3b. Number of HIV+ patients/ clients tested enrolled in care within the
facility: this is compiled by counting the number of patients/clients who were identified
as HIV+ during the month and enrolled in HIV care within the facility.
3c. Number of HIV+ OPD patients/ clients referred to another facility for HIV
care: This is compiled by counting the number of patients/clients who were identified as
HIV+ during the month and referred to another facility for HIV care.
37
How to calculate the achievements for this section:
Proportion of OPD Patients/clients tested for HIV (A1): This is calculated as the
number of OPD patients/clients with unknown HIV status for whom HIV test is done at
OPD(3) divided by the number of OPD patients/clients seen during the month(1) minus
number of OPD patients/clients (with known HIV status) for whom HIV test is performed
before the OPD visit(2). Record the result in the column corresponding to the value of the
percentage calculated.
38
Respective department case team, zonal M&E officers /regional and central M&E
advisors
39
STI PITC monthly target achievement self assessment form
Indicator 1. Number of STI patients seen at OPD during the month: This is
compiled by counting the total number of patients treated for STI at OPD during the
month.
Indicator 3. Number of STI patients (with unknown HIV status) for whom
HIV test is performed in the OPD: This is compiled by counting the number of STI
patients seen at OPD who have unknown HIV status and tested for HIV at OPD during
the month.
3a. Number of STI patients tested HIV+: This is compiled by counting the number
of STI patients seen who were tested HIV+ at OPD during the month.
3b. Number of HIV+ STI patients enrolled in care within the facility: This is
compiled by counting the number of STI patients tested HIV+ at OPD during the month
and enrolled in HIV care within the facility.
3c. Number of HIV+ STI patients referred to another facility for HIV care: This
is compiled by counting the number of STI patients tested positive at OPD and referred
to another facility for HIV care
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How to calculate the achievements for this section:
Proportion of STI patients tested for HIV at OPD (A1): This is calculated as the
number of STI patients (with unknown HIV status) tested for HIV at OPD (3) divided by
the number of STI patients seen at OPD during the month (1) minus the number of STI
patients with known HIV status for whom HIV test was performed before OPD visit (2).
Record the result in the column corresponding to the value of the percentage calculated.
Proportion of HIV+ STI patients enrolled in care (A2): This is calculated as the sum
of enrolled in HIV care within the facility(3b) and number of HIV+ STI patients referred to
another facility(3c) during the month divided by the number of STI patients tested HIV+
during the month(3a). Record the result in the column corresponding to the value of the
percentage calculated.
41
Respective department case team, zonal M & E officers /Regional/central M&E
advisors.
42
Inpatient PITC monthly target achievement self assessment
Data Source: Inpatient department (IPD) HMIS register (Medical IPD, Surgical IPD, Gyn
NB: Inpatient PITC service monthly self-assessment form should be compiled for each IPD
available in the facility and the type of the IPD where the report was collected should be
identified by checking inside the boxes found at the top of the form.
Indicator 2. Number of patients (with known HIV status) for whom HIV
test is performed before admission to ward: This is compiled by counting the
number of patients admitted during the month who were tested for HIV before
admission to ward.
Indicator 3. Number of patients (with Unknown HIV status) for whom HIV
test is performed in the ward: This is compiled by counting the number of patients
admitted with unknown HIV status and tested for HIV in the ward during the month.
3a. Number of patients tested HIV+: This is compiled by counting the number of
patients tested HIV+ at inpatient department during the month.
3b. Number of HIV+ patients enrolled in care within the facility for HIV care:
This is compiled by counting the number of admitted patients newly identified as HIV+
during the month and enrolled in HIV care within the facility.
3c.Number of HIV+ patients referred to another facility for HIV care: This is
compiled by counting the number admitted patients newly identified as HIV+ and
referred to another facility for HIV care during the month.
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Indicator 4: Number of HIV+ patients died before enrolment to HIV care:
This is compiled by counting the number of admitted patients newly identified as HIV+
during the month but died before enrolment to care and treatment service.
Proportion of IPD patients tested for HIV: This is calculated as the number of IPD
patients with unknown status for whom HIV test is performed in the ward divided by the
number of admission during the month minus number of patients with known HIV status
for whom HIV test was performed before admission. Record the result in the column
corresponding to the value of the percentage calculated.
Proportion of HIV+ IPD patients enrolled in HIV care: This is calculated as the sum
of number of newly identified HIV+ patients enrolled in HIV care within the facility and
referred to another facility for HIV care during the month divided by the number of IPD
patients tested HIV+ during the month. Record the result in the column corresponding to
the value of the percentage calculated.
44
Responsible for report compilation
Respective department case team, zonal M&E officers /Regional / Central M&E
advisors.
45
5. Post Exposure Prophylaxis (PEP) Target Achievement self-Assessment
Compile this by counting the number of clients registered with possible exposure during
the reporting month.
2a: Number of source person tested /known HIV+: This is compiled by counting
the number of source persons who are HIV positive.
2b: Number of source person tested HIV-ve. This is compiled by counting the
number of source persons who are tested HIV negative.
3a: Number of HIV-ve exposed persons started on PEP regimen : This is compiled
by counting the number of HIV -ve exposed person started on PEP regimen during the
month.
4a: Number of HIV +ve exposed persons linked: This is compiled by counting
the number of HIV+ exposed person linked to HIV care during the month.
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How to calculate the achievements for this section:
Proportion of HIV -ve exposed persons started on PEP (A1): This is calculated as
the number of HIV -ve exposed persons started on PEP regimen during the month (3a)
divided by the total number exposed persons tested HIV ve (3) during the month. Record
the result in the column corresponding to the value of the percentage calculated.
Proportion of HIV+ exposed persons enrolled in HIV care (A2): This is calculated
as the number of HIV+ exposed persons linked to HIV care during the month(4a) divided
by the total number of exposed persons tested HIV+ during the month(4). Record the
result in the column corresponding to the value of the percentage calculated.
ART provider
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