IDCODE
Region Code
District Code
Facility Code
Name of Interviewer
Date of Interview
Seek consent
s Time interview started
q1  Age(In completed years)
q2  Sex
q3  Number of (year)s working in this HIV care clinic (in completed years)
q4  Occupation category/Cadre of health worker
q4  Other Specify
q5  Level of education (highest level completed)
q6  Provides education
q6 freqency
q7  Provides counselling about TB screening
q7 freqency
q8  Uses TB screening questionnaire (clinical algorithm)
q8 freqency
q9  Asks client about cough of any duration
q9 freqency
q10 Ask if the client has pain in the chest
q10freqency
q11 Ask if the client has night sweats
q11 freqency
q12 Asks/checks if the client lost weight
q12freqency
q13 Asks if the client had fever
q13freqency
q14 Do you ask all the HIV clients all the TB screening questions?
q15 If yes How do you decide which clients to ask which screening question
q16 After screening the client for TB, what do you do next
q17 If you identify a client who you presumed of having TB, what steps would
q18 What do you do if a client does not present any sign or symptom for TB when
q20 I feel I am competent in counselling PLHIV about TB screen
q21 I feel I am competent in using the screening questionnaire to screen PLHIV
q22 I feel I am competent in determining whether or not a client is a presumed
q23 I feel competent to decide whether a client should be started on IPT
q24 I am confident in my ability to decide when a client needs to be referred fo
q25 I feel I am competent in initiating clients on IPT
q26 I am motivated to apply the questionnaire for TB screening on PLHIV
q27 TB screening of PLHIV is a useful intervention
q28 I have received adequate training to provide TB screening
q29 IPT initiate in PLHIV is a relevant intervention in this setting
q30 I am motivated to initiate IPT in PLHIV
q31 I feel I have received adequate training to initiate IPT
q32 The TB screening questionnaire is a useful tool or screening PLHIV for TB
q33 TB screening in PLHIV won't make a difference to the HIV epidemic
q34] I have adequate support from my colleagues to do TB screening
q35 I have adequate support from the HIV coordinator to do TB screening
q36 I have adequate support from my in charge to do TB screening
e Time Ended