Upload
kpm
View
229
Download
0
Embed Size (px)
Citation preview
7/24/2019 kpm aug 15
1/22
Annexure III.h
ICTC Code ICTC
Monthly Input Formats for Integrated Counseling and Testing Centres (ICTC)
Sections A and C common for all ICTC Clients
Section B for all clients excluding Pregnant omen
Section ! for Pregnant omen
Section " for #I$%TB colla&oration for all ICTC clients
Identification
' ame of ICTC*
+ Address*
City* Pin Code* Bloc,*
!istrict* State*
- .eporting Period* Month /ear
0 ame of 1fficer In%charge (ICTC)*
2 Contact num&er (phone)*
3 "mail Address*
4 Type of ICTC*
5 ICTC 6ocation*
Section A * Summary Ta&le * Status for the month
Total ICTC
1. Total clients registered at ANC this month 116 116
2. Number of clients provided pre-test counseling 139 116 255
3. Number of clients tested for HI 139 116 255
!. Number of Clients received results "ithin # da$s of HI test 139 116 255
%. Number of clients provided post-test counseling and given results 139 116 255
&. Number of clients diagnosed HI positive 'after 3 specified tests( 0 0 0
0 0
#.1 Number of babies tested first time under )I* 0 0
0 0
0 0
+. Number of ICTC clients referred to ,NTC 'T /icroscop$ center( 14 14
0. Number of HI infected T patients out of above 0 0
Indicator(All fields are auto%generated from other sections)ICTC Clients
'ecluding regnant"omen(
ICTC Clients -regnant"omen reastfeeding
/others
#. Total number of pregnantbreastfeeding "omen "ho are on lifelongA,T and babies "ho are initiated on s$rup Nevirapine '&"ees12
"ees(-/ air
#.2 Number of babies tested for confirmator$ test be$ond 1+ months of
age
#.3 Number of babies found HI positive out of tested 'ro" #.2( be$ond1+ months of age
7/24/2019 kpm aug 15
2/22
xure III.h
ICTC Code
4ection 5 rogress /ade *uring the /onth b$ the ICTC 6All cli
etails of client7s 8isit to ICTC and #I$ tests underta,en (excluding pregnant omen)Clie
Male
52
52
Number of clients received result "ithin # da$s of HI Test 52
52
9
9
ii #I$ Status of spouse;partn
$ Status of spouse;partner
iii Composition of clients undergoing #I$ test;diagnosed p
iiia Age%ise distri&uti
a Age%ise distri&utionTotal Number of client initiated Clients diagnosed HIV positive
Male Female TS;T< Total Male Female TS;T< Total
9 9 9 9 9 9 9 9
- + 9 2 9 9 9 9
-2 - 9 -5 9 9 9 9
+2 '4 9 0+ 9 9 9 9
++ '+ 9 -0 9 9 9 9
9 9 9 9 9 9 9 9al 52 -0 9 '': 9 9 9 9
iii& .oute of transmission reported &y
iii& .oute of transmission reported &y #I$ positi8e cases
tal
i8 6in,ages and referra
!epartments ; Agencies
In referral - Tested In referral - diagnose
Male Female TS/TG Total Male Female
TI ;/aternit$ Homes 9 9 9 9 9 9
Number of clients received pre-test counselinginformation
Number of clients tested for HI (.o is Bloc,ed % Auto
7/24/2019 kpm aug 15
3/22
ICTC Code
'ont#l( Input )orm
Section C* +aborator( Information, Consumable
1escription
$0 Total number of blood specimens from ICTC tested t#is mont#
$0i0 n( ot#er HIV tests underta.en !sentinel surveillance, etc0&
%0 Number of blood specimens found indeterminate !after 2 HIV tests&
20 Number of blood samples detected Positive in t#e first "ee. of t#e 3uarter ! 4an, pril, 4ul(, October&
20i0 Out of above number of sample sent for 5ualit( control to S+/N+
20i0a0 Out of !20i& number reported concordant
20i0b0 Out of !20i& number reported discordant
60 Number of blood samples detected Negative in t#e first "ee. of t#e 3uarter ! 4an, pril, 4ul(, October&
60i0 Out of t#e above number of sample sent for 5ualit( control to S+/N+
60i0a0 Out of !60i& number reported concordant
60i0b0 Out of !60i& number reported discordant
Consumables Name of 7it
$0 HIV test .it $!No0 of tests&
%0 HIV test .it %!No0 of tests&
20 HIV test .it 2!No0 of tests&
80 1isposable gloves pairs
ii0 Stoc. of HIV Test 7its and ot#er Consum
Opening
Stoc.
Number received
t#is mont#
No0 of Itemselocated
!Inside t#e1istrict&
60 #ole 9lood )inger Pric.Test !No0 of tests&
7/24/2019 kpm aug 15
4/22
;0 Condoms pieces
0 Vials
$?0 Tubes
$$0 Vacutainer
$%0 P:P 1rugs
$20 Safe 1eliver( 7its
$60 19S 7it
$80 Nevirapine Tablets
$;0 Nevirapine S(rup $?ml
$0 :faviren@ ;??mgA+amivudine 2??mgATenofovir 2??mg
%?0 +amivudine 2??mgATenofovir 2??mg
%$0 Isonia@ide 2??mg
%%0 Isonia@ide $??mg
%20 P(ridoBine 8?mg
%60 P(ridoBine %8mg
%80 Ot#ers !Specif(&
Staff t(pe
$0 Counselor 1 0
%0 +aborator( Tec#nician 1 1
Number ofpositions
sanctioned
Number ofpositions fille
7/24/2019 kpm aug 15
5/22
20 Staff Nurse 0 0
60 Outreac# or.ers 1 1
80 ICTC Inc#arge ' O 1 1
;0 Ot#er Staff !Specif(& 0 0
T(pe of Visit
$0 Number of visits to !)S/'S'/TG/I1& TI proDect sites/Hotspots
%0 Number of visits to .e( villages
20a Number of visits to HIV Positive General Clients
20b Number of visits to HIV Positive Pregnant omen/ 9reastfeeding mot#ers0
60 Number of visits to migrant sites/ truc.er #alting sites
80 Number of visits to ot#er NGOEs/Sta.e#olders
7/24/2019 kpm aug 15
6/22
for Integrated Counseling and Testing Centres !ICTC&
Staffing and Outreac# or. !ll ICTC Clients including pregnant
+aborator( Information for ICTC
Control tests Closing Stoc. 9atc# Number
0
0
0
0
0
les !Section is 9loc.ed for data entr(, please enter data ON+IN:&
No0 of Itemselocated
!Outside t#e1istrict&
:Bpired items
returned
Number
Consumed
astage /1amage !if
an(F&
7/24/2019 kpm aug 15
7/22
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
iii0 Staffing 1etails
Number of staff trained during t#e mont#
Induction efres#er HIV-T9
$ 0 0 0
? 0 0 0
Number ofpositions vacant
7/24/2019 kpm aug 15
8/22
? 0 0 0
? 0 0 0
? 0 0 0
? 0 0 0
Out eac# ctivit( b( Counselors
No of v
7/24/2019 kpm aug 15
9/22
ICTC
omen&
nits
255
0
0
0
?
0
0
0
?
0
0
:Bpir( 1ate
!dd/mm/((&
5uantit(
Indented
1ate of Indent
!dd/mm/((&
7/24/2019 kpm aug 15
10/22
ICTC Team Training Ot#ers
0 0
0 0
7/24/2019 kpm aug 15
11/22
0 0
0 0
0 0
0 0
isits during t#e mont#
0
0
0
0
0
0
7/24/2019 kpm aug 15
12/22
CTC Code
'o
S0 No
$ Number of New ANC Registrations
% Number of regnant women ro!i"e" re#test $ounse%ing out of a%% regi
2 Number of regnant women teste" for &I'
6 4.(a) Among those "iagn
4.(b) Among those "iagn
4.($) Among those "iagn
60$ +nown &I' ,!e C%ients ("ete$te" in re!ious -ears from same ICC / f
8 Number of regnant women re$ei!e" resu%ts with in "a-s of &I' est
; Number of regnant women re$ei!e" ost#test $ounse%ing an" gi!en te