IDCODE
Region Code
District Code
Facility Code
Name of Interviewer:
Date of Interview
Seek Consent
S Time interview started
q1 Respondent
q2 Age (in completed years)
q3 Sex
q4 Number of years working in this HIV care clinic (in completed years)
q5 Occupation category/Cadre of health worker
q5 Other specify
q6 Number of years in your current capacity/role
q7 Level of education (highest level completed)
q8 What are the different units/clinic providing services to clients in this fac
q9 TB screening for PLHIV
q9 Frequency
q9 Other Frequency
q10Sputum testing for PLHIV (any)
q10Frequency
q10Other Frequency
q11Chest xray for TB testing
q11Frequency
q11Other Frequency
q12How do you ensure TB infection cont1ol in your clinic?
q12How do you ensure TB infection cont2ol in your clinic?
q12How do you ensure TB infection cont3ol in your clinic?
q12How do you ensure TB infection cont4ol in your clinic?
q12How do you ensure TB infection cont5ol in your clinic?
Does this HIV care clinic provide IPT for PLHIV?
q14 Only Children
q14How long has this clinic been providing IPT for this group
q15 Only Pregnant women
q15How long has this clinic been providing IPT for this group
q16 Only specialized cases recommended by clinician
q16How long has this clinic been providing IPT for this group
q17 ALL PLHIV
q17How long has this clinic been providing IPT for this group
q18 Does this facility conducts meetings on TB case findinf or TB Screening of P
q19 Does the meeting on the TB case finding programme include the HIV care provi
q20 Providing feedback to providers on their practice
q20 Sharing of data
q20 Discuss TB/HIV training
q21 On which days of the week is this facility open
q22 Infection control plan
q22 Infection control guidelines made available to staff
q22 Infection control taining for staff
q23 How many health workers have had infection control training in this HIV car
q24 How often does your facility assess for TB infection among health care worke
q25 What do you think is the level of awareness of TB screening amongst workers
q26 Are the other units within the facility aware of IPT for all HIV clients who
q27 Please may you describe how this facility monitors HIV providers in their pr
q28 TB screening questionnaire/algorithm
q28 Available for provider
q29 TB/HIV clinical manual
q29 Available for provider
q30 Guideline for TB screening
q30 Available for provider
q31 Guidelines for IPT provision
q31 Available for provider
q32 IEC materials for use by the providers
q32 Available for provider
q33 Infection control guidelines
q33 Available for provider
q34 Does your facility have lab facilities for sputum
q34 Available for provider
q35 HIV care provider initials 1
q35 Health education of PLHIV  1
q35 Counselling of PLHIV 1
q35 TB Screening?   1
q35 Referral for TB 1
q35 IPT Initiation 1
q35M Health education 1
q35M Counselling  1
q35M Use of screening tool 1
q35M IPT Initiation 1
q35 HIV care provider initials 2
q35 Health education of PLHIV  2
q35 Counselling of PLHIV 2
q35 TB Screening?   2
q35 Referral for TB 2
q35 IPT Initiation 2
q35M Health education 2
q35M Counselling  2
q35M Use of screening tool 2
q35M IPT Initiation 2
q35 HIV care provider initials 3
q35 Health education of PLHIV  3
q35 Counselling of PLHIV 3
q35 TB Screening?   3
q35 Referral for TB 3
q35 IPT Initiation 3
q35M Health education 3
q35M Counselling  3
q35M Use of screening tool 3
q35M IPT Initiation 3
q35 HIV care provider initials 4
q35 Health education of PLHIV  4
q35 Counselling of PLHIV 4
q35 TB Screening?   4
q35 Referral for TB 4
q35 IPT Initiation 4
q35M Health education 4
q35M Counselling  4
q35M Use of screening tool 4
q35M IPT Initiation 4
q35 HIV care provider initials 5
q35 Health education of PLHIV  5
q35 Counselling of PLHIV 5
q35 TB Screening?   5
q35 Referral for TB 5
q35 IPT Initiation 5
q35M Health education 5
q35M Counselling  5
q35M Use of screening tool 5
q35M IPT Initiation 5
q35 HIV care provider initials 6
q35 Health education of PLHIV  6
q35 Counselling of PLHIV 6
q35 TB Screening?   6
q35 Referral for TB 6
q35 IPT Initiation 6
q35M Health education 6
q35M Counselling  6
q35M Use of screening tool 6
q35M IPT Initiation 6
q35 HIV care provider initials 7
q35 Health education of PLHIV  7
q35 Counselling of PLHIV 7
q35 TB Screening?   7
q35 Referral for TB 7
q35 IPT Initiation 7
q35M Health education 7
q35M Counselling  7
q35M Use of screening tool 7
q35M IPT Initiation 7
q35 HIV care provider initials 8
q35 Health education of PLHIV  8
q35 Counselling of PLHIV 8
q35 TB Screening?   8
q35 Referral for TB 8
q35 IPT Initiation 8
q35M Health education 8
q35M Counselling  8
q35M Use of screening tool 8
q35M IPT Initiation 8
q35 HIV care provider initials 9
q35 Health education of PLHIV  9
q35 Counselling of PLHIV 9
q35 TB Screening?   9
q35 Referral for TB 9
q35 IPT Initiation 9
q35M Health education 9
q35M Counselling  9
q35M Use of screening tool 9
q35M IPT Initiation 9
q35 HIV care provider initials 10
q35 Health education of PLHIV  10
q35 Counselling of PLHIV 10
q35 TB Screening?   10
q35 Referral for TB 10
q35 IPT Initiation 10
q35M Health education 10
q35M Counselling  10
q35M Use of screening tool 10
q35M IPT Initiation 10
q35 HIV care provider initials 11
q35 Health education of PLHIV  11
q35 Counselling of PLHIV 11
q35 TB Screening?   11
q35 Referral for TB 11
q35 IPT Initiation 11
q35M Health education 11
q35M Counselling  11
q35M Use of screening tool 11
q35M IPT Initiation 11
q35 HIV care provider initials 12
q35 Health education of PLHIV  12
q35 Counselling of PLHIV 12
q35 TB Screening?   12
q35 Referral for TB 12
q35 IPT Initiation 12
q35M Health education 12
q35M Counselling  12
q35M Use of screening tool 12
q35M IPT Initiation 12
E Time Ended