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Quarterly Report for TB/HIV collaborative activity

AIDS/STD team / HIV Clinic

Quarter

TB Team

Year

Township/District

Block A: Reporting for AIDS/STD team / HIV Clinic		Newly enrolled								1st visit for calender year																Head count in current quarter
		0 - 14				>= 15				0 - 14				>= 15												0 - 14				>= 15
		Male		Female		Male		Female		Male		Female		Male		Female										Male		Female		Male		Female
Number of PLHIV attended HIV care during the reporting period
Number of PLHIV screened for TB during reporting period
Number of PLHIV referred for TB diagnostic evaluation
Number of PLHIV diagnosed with active TB diasease and registered for TB treatment
Number of PLHIV received IPT evaluation
Number of PLHIV who were eligible for IPT
Number of PLHIV who were givening IP in reporting period

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IPT outcome reporting for patient registered in IPT during the same quarter, one year earlier			Total number registered during same quarter, one year earlier			Completed >= 6 months						Incomplete (Discontinue due to side effects, lost to follow up)						TB disease while on IPT
Patients registered during:
Quarter		of
Year

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Block B: Reporting for TB Team		Number																								Data Source
		0-4								>=5-14								>=15
		Male				Female				Male				Female				Male				Female
Number of New + Relaplse TB patients registered during the reporting period		{{$cal_resultes["tb03_IPT_reg_0_4_male"]}}				{{$cal_resultes["tb03_IPT_reg_0_4_female"]}}				{{$cal_resultes["tb03_IPT_reg_5_14_male"]}}				{{$cal_resultes["tb03_IPT_reg_5_14_female"]}}				{{$cal_resultes["tb03_IPT_reg_15_male"]}}				{{$cal_resultes["tb03_IPT_reg_15_female"]}}
Number of New + Relapse TB patients registered during the reporting period who had an HIV test result recorded in the TB register		{{$cal_resultes["tb03_IPT_HIVT_0_4_male"]}}				{{$cal_resultes["tb03_IPT_HIVT_0_4_female"]}}				{{$cal_resultes["tb03_IPT_HIVT_5_14_male"]}}				{{$cal_resultes["tb03_IPT_HIVT_5_14_female"]}}				{{$cal_resultes["tb03_IPT_HIVT_15_male"]}}				{{$cal_resultes["tb03_IPT_HIVT_15_female"]}}
Number of New + Relapse TB patients registered over the reporting period with documented HIV-positive status		{{$cal_resultes["tb03_IPT_HIVP_0_4_male"]}}				{{$cal_resultes["tb03_IPT_HIVP_0_4_female"]}}				{{$cal_resultes["tb03_IPT_HIVP_5_14_male"]}}				{{$cal_resultes["tb03_IPT_HIVP_5_14_female"]}}				{{$cal_resultes["tb03_IPT_HIVP_15_male"]}}				{{$cal_resultes["tb03_IPT_HIVP_15_female"]}}
Number of New + Relapse HIV positive TB patients, registered during the reporting period, starting or continuing CPT treatment during their TB treatment		{{$cal_resultes["tb03_IPT_HIVC_0_4_male"]}}				{{$cal_resultes["tb03_IPT_HIVC_0_4_female"]}}				{{$cal_resultes["tb03_IPT_HIVC_5_14_male"]}}				{{$cal_resultes["tb03_IPT_HIVC_5_14_female"]}}				{{$cal_resultes["tb03_IPT_HIVC_15_male"]}}				{{$cal_resultes["tb03_IPT_HIVC_15_female"]}}
Number of New + Relapse HIV positive TB patients, registered during the reporting period, who are started on or continue previously initiated ART during TB treatment		{{$cal_resultes["tb03_IPT_HIVA_0_4_male"]}}				{{$cal_resultes["tb03_IPT_HIVA_0_4_female"]}}				{{$cal_resultes["tb03_IPT_HIVA_5_14_male"]}}				{{$cal_resultes["tb03_IPT_HIVA_5_14_female"]}}				{{$cal_resultes["tb03_IPT_HIVA_15_male"]}}				{{$cal_resultes["tb03_IPT_HIVA_15_female"]}}
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Signature																			Signature
Name																			Name
Disignation																			Disignation
Programme																			Programme