Ic.xls

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 women Section E for HIV-TB collaboration for all ICTC clients 1. Total clients registered this month2. Number of clients receiving pre-test counselling / information3. Number of clients tested for HIV4. Number of clients receiving post-test counseling5. Number of clients receiving HIV test results6. Total no. of clients testing sero-positive (after 3 specified tests) 7. Number of mother-baby pairs receiving nevirapine out of those found positive 8. Number of ICTC clients referred to DOTS center (TB Microscopy center)9. Number of TB clients referred in ICTC from TB microscopy10.Total number of HIV-TB co-infection detected in month Monthly Input Formats for Integrated Counseling and Testing Centres (ICTC) [All clients excluding pregnant women] Section B: Progress Made During the Month by the ICTC [All clients excluding pregnant women] (i) Details of client's visit to ICTC and HIV tests 1. Number of clients received pre-test counseling/information 3. Number of clients receiving post-test counseling 4. Number of clients receiving HIV test results 5. Total number of clients diagnosed sero-positive (after three tests) 6. Number of clients for follow-up counseling 1. Number of newly detected discordant couples/partners 2. Number of couples where husband / male partner is negative and wife /female partner positive 3. Number of couples where husband / male partner is positive and wife /female negative 4.Number of newly detected concordant couples (both positive) (iii) Composition of clients undergoing HIV test/diagnosed positive and route of transmission Total no. of clients diagnosed sero-positive (iii)(a) Age-wise distribution of HIV Positive cases (iii)(b) Route of transmission of HIV positive cases Monthly Input Formats for Integrated Counseling and Testing Centres (ICTC) Section C: Laboratory Information, Equipment, Consumables and Staffing (All ICTC Clients including pregnant women) 1. Total number of blood specimens from ICTC tested this month 1.a) Any other HIV tests undertaken (sentinel surveillance, etc.) 2. Number of blood specimens found indeterminate (after 3 HIV tests)3. Number of positive specimens sent for confirmation 4. Number of negative specimens sent for confirmation (ii) Infrastructure, Staffing, Equipment, Consumables(ii)(a) Stock of HIV Test Kits and other Consumables 5. Other IEC materials (pamphlets, handouts) Monthly Input Formats for Integrated Counseling and Testing Centres (ICTC) Section D: Progress during the month ( only for pregnant women) 2. Number of cases receiving pre-test counseling/information out of all ANC registered 4. Number of cases received HIV test results 5. Number of cases received post-test counseling 6. Number of cases diagnosed HIV positive 7. Number of HIV positive cases received HIV test result 8. Number of spouses/ partners of women tested 9. Number of spouses/partners of HIV positive women found HIV positive 10. Number of spouses/partners of HIV negative women found HIV positive 11. Total number of deliveries this month 12. Total number of HIV positive deliveries this month 13. Total number of live births to HIV positive mothers 14. Total number of mother-baby pairs who received nevirapine 15. Number of HIV positive pregnant women receiving nevirapine during the month 16. Number of babies of HIV positive receiving Nevirapine during month 17. Number of HIV positive women opting for exclusive breast feeding 18. Number of HIV positive women accepting MTP after counseling 1. Number of HIV positive women coming for follow up at 6 weeks 2. Number of babies undergone HIV diagnostic testing (PCR) 4. Number of mothers counselled for breastfeeding 5. Number of positive mothers counselled for Family Planning 6. Number of HIV positive women coming for follow up at 6 months 7. Number of babies of HIV positive women undergone HIV diagnostic testing (PCR) at 6 months follow-up 8. Number of babies found positive at 6 months follow-up 9. Number of positive women coming for follow-up at 12 months 10. Number of babies of positive women coming for follow-up at 12 months 11. Number of positive women coming for follow-up at 18 months 12. Number of babies of positive women coming for follow-up at 18 months 13. Number of babies found HIV positive at 18 months 14. Number of clients referred for CD4 testing (iv) Linkages and Referrals for ANC Cases

Source: http://www.punjabsacs.org/Formats/Monthly%20ICTC%20format.Pdf