DDI-BTN-MOH-HFS-2009-v01 Mongal Singh Gurung 2011-08-22 NADA Version 1.0 (August 2011) Health Facility Survey for Delivering Services Related to the Diagnosis and Management of HIV/AIDS and Sexually Transmitted Infections 2009 HFS-STI 2009 BTN_2009_STI_v02_M Ministry of Health

Research Ethics Board of Health

Dasho (Dr.) Gado Tshering

Mr Mongal Singh Gurung

 Dr Lungten Z Wangchuk Dr. Gampo Dorji Mr. Masud Reza Ms. Choden and Ms. Kinley Wangmo International Center for Diarrhoeal Disease Research Sonam Chophel, Dollay, Kinga, Rahal Singh Das, Samten and Namgay Tenzin Mr. Mongal Singh Gurung Mr. Sonam Phuntsho ©Ministry of Health(MoH) , 2011 NADA World Bank Royal Government of Bhutan Head, Health Research and Epidemiology Unit Health Facility Survey Version 2.0:For External Use STI Health Facility Counselling HIV/AIDS Health Facility Sexually Transmitted Infections (STIs) HIV/AIDS Prevention of HIV/ STIs as well as care and support for those living with HIV/ STIs has received considerable attention in Bhutan. The Ninth Five Year Plan provided a multi-sectoral strategy to prevent and control HIV/ AIDS. It also identified this as one of the country's most important programme in promoting healthy outcomes for women and children. Services related to prevention, treatment and care are provided at health facilities at different levels. The services include provision of Voluntary Counselling and Testing (VCT) for HIV, Syndromic Management for STIs, along with some laboratory diagnosis which ranges from simple tests in the district hospitals to a wider and comprehensive range of tests at regional and national referral hospitals. To further facilitate delivery of services, several manuals and guidelines on the Syndromic Management of STIs and VCT have been provided at health care facilities and also personnel have been trained to provide these services. To assess the health faculties' functionality and utilization of theses services for prevention and control of STIs and HIV in the country the Research and Epidemiology Unit of the Ministry of Health carried out Health Facility Survey (HSF 2009), with financial support from the World Bank, which is representative of the health facilities in the country. The findings are very useful in planning and future programme interventions to improve these services for the population of Bhutan. Bhutan National Dzongkhag (Districts) Regions: Eastern Bhutan, Central Bhutan, and Western Bhutan -health facility All health facilities providing STI/HIV services in Bhutan. The health facilities providing STI/HIV services in Bhutan assessed in this survey were grouped into five categories based on the services they provided and their capacities: 1.The OPD of the JDW National Referral Hospital, at Thimphu, and two Regional Referral Hospitals, at Mongar and Gelephu, which provide services for STIs and HIV as part of an integrated health system. 2.The laboratories of the Public Health Laboratory and the JDW National Referral Hospital, both at Thimphu, are more developed and provide a wider range of diagnostic tests for STIs and HIV. 3.Thirty District Hospitals in 20 districts (with some districts having more than one hospital) - these provide services for STIs and HIV as part of an integrated system. A basic laboratory is available in each of these hospitals designed to diagnose syphilis, gonorrhoea (by gram staining) and HIV (a single rapid test). VCT is also provided as part of the package of services. 4.172 BHUs, which provide syndromic management for STIs. 5.Two standalone VCT Centers (Health Information Service Center or HISC) at Thimphu and Phuntsholing where comprehensive VCT is provided and laboratory facilities are available for three rapid tests for HIV diagnosis. Outreach services to reach the more vulnerable populations with HIV prevention information is also provided through these Centers. Sample survey data [ssd] BHU, District Hospitals, Regional and National Referral Hospitals: Facility Management, Facility setup and services(Infrastructure,Equipment), Universal Precautions, Procedure for STI case management, Record keeping (Infrastructure, Equipment, Personnel and experience of the centre/clinic in maintaining records and confidentiality), Monitoring quality of services VCT Centers (HISC): Infrastructure/ Physical features of the facility, , Service delivery - nature of services, Personnel, Staff Roles and Responsibilities, Availability and adherence to Protocols, Record Keeping Systems, Availability of Health Education Material and Condoms, Test Kits and medical consumables (if tests are done at the facility, if not please note and skip this section), Confidentiality, Monitoring quality of services. NATIONAL REFERRAL HOSPITAL, PUBLIC HEALTH LABORATORY and REGIONAL HOSPITAL LABORATORIES: LABORATORY TESTS CONDUCTED, CARRYING OUT HIV/STI TESTS (Infrastructure, Equipment, Laboratory Supplies, Personnel and experience of the laboratory in conducting HIV/STI tests, reporting results and maintaining confidentiality, Universal Precautions and waste disposal), ABILITY TO STORE SAMPLES APPROPRIATELY, ABILITY TO MAINTAIN RECORDS AND CONFIDENTIALITY, QUALITY CONTROL (QC) SYSTEMS, CONFIDENTIALITY. DISTRICT HOSPITAL LABORATORIES AND BHUs: Laboratory tests conducted, CARRYING OUT HIV/STI TESTS (Infrastructure, Equipment, Laboratory Supplies, Personnel and experience of the laboratory in conducting HIV/STI tests, reporting results and maintaining confidentiality, Universal Precautions and waste disposal), ABILITY TO STORE SAMPLES APPROPRIATELY, ABILITY TO MAINTAIN RECORDS AND CONFIDENTIALITY, QUALITY CONTROL (QC) SYSTEMS, CONFIDENTIALITY. Ministry of Health Following health facilities were sampled: I. The National Referral Hospital in Thimphu, Public Health Laboratory in Thimphu, two Regional Referral Hospitals in Mongar and Gelephu and two stand-alone VCT Centers (HISC) in Thimphu and Phuntsholing. II. A random selection of District Hospitals and BHUs in three regions of Bhutan (east, west and central). For the selection of these sites the sample size calculation was done based on a standard formula used for health facility surveys. The formula provided a sample size of 13 for District Hospitals. For each region (east, west and central), the number of District Hospitals to be sampled was calculated as a proportion based on the number of District Hospitals available in the region. The formula provided a sample size of 45 for BHUs. For each region (east, west and central), the number of BHUs to be sampled was calculated as a proportion based on the number of BHUs available in the region. The first health facility at the district and BHU level was selected based on random number method. The subsequent facilities were selected systematically based on the sampling interval until the required sample size was met in each region. Face-to-face [f2f] and interviewer observation Different sets of questionnaires were administered to service providers (prescribers) as shown below: 1. Survey of STI and HIV services (for BHU) - the questionnaire to assess the comprehensive, integrated services for STI and HIV. 2. Survey of STI and HIV services (for BHU Grade-I, District, Regional and JDW National Referral Hospitals) - the questionnaire to assess the comprehensive, integrated services for STI and HIV diagnosis, management and referral. 3. Survey of stand-alone VCT Centers (the HISC sites in Thimphu and Phuentsholing) - the questionnaire was specifically designed to assess the VCT services available at these two sites. 4. Survey of laboratories in the JDW National Referral Hospital, Public Health Laboratory and the two Regional Referral Hospitals - the questionnaires to assess the laboratory services available at these sites. Each questionnaire was accompanied by a guideline, which was aimed at providing an understanding of the questions and what the appropriate response should be for each question. In some cases, the questions were open-ended and the guideline was designed to help the interviewer score the response although this may often have been subjective. Each question was scored and based on the score each sub-section was graded. The guideline also provided the appropriate score for each response. The questionnaires were administered to the most senior staff at the facility and to other relevant personnel as deemed necessary. Also, in several instances direct observation were made to assess the situation and/or to corroborate responses. In those cases, the instructions provided in the questionnaire as well as the guidelines were followed. Direct observations, where conducted took precedence over response by senior staff. Two sets of exit interviews (or client satisfaction questionnaires) were administered to the patients attending the facilities for comprehensive, integrated services for STI and HIV and with clients attending the VCT Centers. Each of these exit interview questionnaires were also accompanied by guidelines. All the interviewers and supervisors were trained for a period of 8 days (24th April till 1st May 2009) by facilitators from ICDDR, B and Research and Epidemiology Unit. In-house mock testing of the questionnaires by the interviewers followed by the field-testing of the questionnaires in presence of the facilitators helped the trainees improve their skills and gain hands-on experience in administering the questionnaires. The staff from the Research and Epidemiology Unit monitored the survey at frequent intervals in all the regions. Also, the survey teams in each region consisted of two interviewers. While in the field, one collected the data and other acted as a supervisor to check the consistency and the roles were reversed when one person was tired of one role.The scores were graded by the interviewer and checked by the supervisors before they left the Centers to ensure consistency. NA The entire field data and the scores were double checked on hard copies by the monitoring team before data entry. To ensure the accuracy and reliability of data, double entry of data was done using Epi Info. In addition, validity range of each response and consistency checks were incorporated in the data-entry screens. After completing double entry, data were compared using Epi Info and the entry errors were incorporated in the first entry. Further cleaning was done using Excel after which data files were converted into SPSS by using Stat transfer for analysis. Summary statistics (such as percentages, mean and median) were calculated. Response rate for health facilities is 100% Quality assurance of the survey was addressed by taking into consideration two issues: 1. A major concern with this survey was that several questions in the questionnaires were open-ended and scoring may have required subjective judgement. For this it was necessary to ensure that inter-interviewer variation was minimised. For this purpose, a thorough field-testing of the questionnaires after training was conducted. Any ambiguity found during the pre-testing was corrected in the guideline and the interviewers were re-trained using the corrected version. 2. In order to reduce interviewer bias, the health workers were assigned to conduct interviews in facilities, which were not their work place. Data access is provided to organizations or individuals upon writing an official application of request. There is a form to be filled where the data user has to indicate the reason for the data request, sort of analysis they will perform. The data user is made to sign an undertaking wherein they agree not to share the data with un-authorized/organizations. It is also made clear that deviations on the agreed upon conditions will be referred to a court of law in the country. Head, Health Research and Epidemiology Unit Ministry of Health(MoH), Bhutan. Health Facility Survey for delivering services related to the diagnosis and management of HIV/AIDS and Sexually Transmitted Infections (STIs) 2009 ,version 2.0 for External Use. Dataset downloaded from <http://www.nsb.gov.bt/ndas>. Public use files are accessible upon request and signing of an agreement form on the data usage. The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses Annexe1 The file contains data in Annexe I of the HFS 2009 questionnaire (For BHU-II). The questionnaire includes the following sections: Section 1: Nature of services provided in the facility Section 2: Facility setup and supplies Section 3: Personnel Section 4: Procedure for STI case management Section 5: Universal precautions and waste disposal Section 6: Availability and adherence to guideline Section 7: Record keeping system Section 11: Confidentialty Section 12: Referral linkages Section 13: Monitoring quality of services Section 14: Utilization of the services 0 217 Annexe2 The file contains data in Annexe II of the HFS 2009 questionnaire (For BHU-I and Above). The questionnaire includes the following sections: Section 1: Nature of services provided in the facility Section 2: Facility setup and supplies Section 3: Personnel Section 4: Procedure for STI case management Section 5: Procedure for VCT Section 6: Care and support for HIV positive cases Section 7: Universal Precaution and waste disposal Section 8: Availability and adherence to guideline Section 9: Record keeping system Section 10: Testing infrastructure and supplies Section 11: Confidentialty Section 12: Referral linkages Section 13: Monitoring quality of services Section 14: Utilization of the services 0 319 Annexe3 The file contains data in Annexe III of the HFS 2009 questionnaire (For Voluntary Counselling and Testing (VCT)). The questionnaire includes the following sections: Section 1: Nature of services provided in the facility Section 2: Physical setup of the VCT centre Section 3: Personnel Section 4: Procedures at the VCT centre Section 5: Availabilty and adherence to protocols Section 6: Record keeping system Section 7: Health education materials and condoms Section 8: HIV testing infrastructure and supplies Section 9: Universal precautions and waste disposal Section 10: Confidentiality Section 11: Linkages with other organizations Section 12: Monitoring quality of VCT centre Section 13: Utilization of VCT centre 0 259 Annexe4 The file contains data in Annexe IV of the HFS 2009 questionnaire (For JDW National Referral Hospital). The questionnaire includes the following sections: Section 1: Laboratory tests conducted Section 2: Facility setup and supplies Section 3: Personnel Section 4: Universal precautions and waste disposal Section 5: Record keeping Section 6: Quality control system (QC) Section 7: Confidentiality Section 8: Utilization of the services 0 179 Annexe5 The file contains data in Annexe V of the HFS 2009 questionnaire (For Public Health Laboratory). The questionnaire includes the following sections: Section 1: Laboratory tests conducted Section 2: Facility setup and supplies Section 3: Personnel Section 4: Universal precautions and waste disposal Section 5: Record keeping Section 6: Quality control system (QC) Section 7: Confidentiality Section 8: Utilization of the services 0 169 Annexe6 The file contains data in Annexe VI of the HFS 2009 questionnaire (For Regional Referral Hospitals). The questionnaire includes the following sections: Section 1: Laboratory tests conducted Section 2: Facility setup and supplies Section 3: Personnel Section 4: Universal precautions and waste disposal Section 5: Record keeping Section 6: Quality control system (QC) Section 7: Confidentiality Section 8: Utilization of the services 0 192 Annexe 13 The file contains data in Annexe XIII of the HFS 2009 questionnaire (For Assessment of STI/HIV Patient Satisfaction). 0 28 Health facility serial number Health facility serial number Health facility serial number Health facility serial number Health facility serial number Serial number of the health facility District District District District District District 1 Bumthang 2 Chukha 3 Dagana 4 Gasa 5 Ha 6 Lhuntse 7 Monggar 8 Paro 9 Pemagatshel 10 Punakha 11 Samdrup Jongkhar 12 Samtse 13 Sarpang 14 Thimphu 15 Trashigang 16 Trongsa 17 Tsirang 18 Wangdue Phodrang 19 Yangtsi 20 Zhemgang Gewog/ Town Gewog/ Town Gewog/ Town Gewog/ Town Gewog/ Town Interview completion status Interview completion status Interview completion status Interview completion status Interview completion status Interview completion status 1 Completed 2 Not completed Type of health facility Type of health facility Type of health facility Type of health facility Type of health facility Type of health facility 1 National Referral Hospital 2 Regional Referral Hospital 3 District Hospital 4 BHU-I 5 BHU-II STI method STI method STI method STI method STI method Q.1.1. Does the facility provide pre-test counselling? 1 Syndromic management 2 Syndromic management with some laboratory diagnosis STI treatment/ With counselling STI treatment/ With counselling STI treatment/ With counselling STI treatment/ With counselling STI treatment/ With counselling Q1.2. Do you provide STI treatment only or treatment with counseling? 1 STI treatment only 2 STI treatment with counseling Common source of STI, 1 Common source of STI, 1 Common source of STI, 1 Common source of STI, 1 Common source of STI, 1 Q1.3. What was/were the most common sources of STI in the last year (e.g. multiple partners, CSW, spouse, etc.) Common source of STI, 2 Common source of STI, 2 Common source of STI, 2 Common source of STI, 2 Common source of STI, 2 Q1.3. What was/were the most common sources of STI in the last year (e.g. multiple partners, CSW, spouse, etc.) Common source of STI, 3 Common source of STI, 3 Common source of STI, 3 Common source of STI, 3 Common source of STI, 3 Q1.3. What was/were the most common sources of STI in the last year (e.g. multiple partners, CSW, spouse, etc.) STI services available STI services available STI services available STI services available STI services available Q.1.4. Does the facility have provision for ongoing counselling? 1 Yes 2 No Population group served, 1 Population group served, 1 Population group served, 1 Population group served, 1 Population group served, 1 Q1.5. If yes, which population? Q1.4 = 1 Population group served, 2 Population group served, 2 Population group served, 2 Population group served, 2 Population group served, 2 Q1.5. If yes, which population? Population group served, 3 Population group served, 3 Population group served, 3 Population group served, 3 Population group served, 3 Q1.5. If yes, which population? Partner notification with patient consent Partner notification with patient consent Partner notification with patient consent Partner notification with patient consent Partner notification with patient consent Q.1.6. If yes, what was the maximum number of pre test counselling sessions done in one day by any counsellor in last year? Q.1.5 = 1 1 Yes 2 No STI drugs available STI drugs available STI drugs available STI drugs available STI drugs available Q.1.7. Did any group pre-test counselling carried out in the last year? No 2 -> Q.1.9 1 Yes 2 No STI leaflets available STI leaflets available STI leaflets available STI leaflets available STI leaflets available Q.1.8. If there was any group pre test counselling done in the last year, what was the maximum number of people participated in a group counseling session? Q.1.7 = 1 1 Yes 2 No VCT/ counselling services to ANC patients VCT/ counselling services to ANC patients VCT/ counselling services to ANC patients VCT/ counselling services to ANC patients VCT/ counselling services to ANC patients Q.1.9. Does the facility have any provision for promotion or advertisement about the services? No 2 -> Q.1.11 1 Yes 2 No VCT/ counselling services to STI patients VCT/ counselling services to STI patients VCT/ counselling services to STI patients VCT/ counselling services to STI patients VCT/ counselling services to STI patients Q1.10. Do you provide VCT/ counseling services to STI patients? 1 Yes 2 No VCT/ counselling services to TB patients VCT/ counselling services to TB patients VCT/ counselling services to TB patients VCT/ counselling services to TB patients VCT/ counselling services to TB patients Q.1.11. Does the centre provide services to the population with high risk behaviour for HIV? No 2 -> Q.1.13 1 Yes 2 No VCT/ counselling services to other patients VCT/ counselling services to other patients VCT/ counselling services to other patients VCT/ counselling services to other patients VCT/ counselling services to other patients Q1.12. If yes, do you provide counseling services to HIV postive patients? 1 Yes 2 No Services, specific 1 Services, specific 1 Services, specific 1 Services, specific 1 Services, specific 1 Q1.13. If yes, specify Services, specific 2 Services, specific 2 Services, specific 2 Services, specific 2 Services, specific 2 Q1.13. If yes, specify Services, specific 3 Services, specific 3 Services, specific 3 Services, specific 3 Services, specific 3 Q1.13. If yes, specify Q1.12 = 1 Section score, 1 Section score, 1 Section score, 1 Section score, 1 Section score, 1 Score for this section (.../...)*100 Section grade, 1 Section grade, 1 Section grade, 1 Section grade, 1 Section grade, 1 Grade for this section Minimum privacy level maintained Minimum privacy level maintained Minimum privacy level maintained Minimum privacy level maintained Minimum privacy level maintained Q2.1. Does the facility have a waiting area? Observation 1 Yes 2 No Privacy maintained for VCT/ counselling Privacy maintained for VCT/ counselling Privacy maintained for VCT/ counselling Privacy maintained for VCT/ counselling Privacy maintained for VCT/ counselling Q.2.2. Do counselling room(s) contain a table, two or more chairs and one or more BCC materials? Observation 1 Yes 2 No Group/ Family counselling Group/ Family counselling Group/ Family counselling Group/ Family counselling Group/ Family counselling Q.2.3. Is privacy maintained during counselling sessions? 1 Yes 2 No Subsection score, 2a Subsection score, 2a Subsection score, 2a Subsection score, 2a Subsection score, 2a Score for this subsection (.../...)*100 Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Grade for this subsection Patient examination bed, presence Patient examination bed, presence Patient examination bed, presence Patient examination bed, presence Patient examination bed, presence Q.3.1. Is there a receptionist available in the VCT centre? Observation 1 Yes 2 No Patient examination bed, functioning Patient examination bed, functioning Patient examination bed, functioning Patient examination bed, functioning Patient examination bed, functioning Q3.1. Patient examination bed, functioning Observation 1 Yes 2 No Screen, presence Screen, presence Screen, presence Screen, presence Screen, presence Q3.2 Screen, presence Observation 1 Yes 2 No Screen, functioning Screen, functioning Screen, functioning Screen, functioning Screen, functioning Q.3.2. Who provides counselling at this centre? Counsellor Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Sink, presence Sink, presence Sink, presence Sink, presence Sink, presence Q3.3. Sink, presence Observation 1 Yes 2 No Sink, functioning Sink, functioning Sink, functioning Sink, functioning Sink, functioning Q.3.3. Has the individual received any training on pre test, post test and ongoing counselling? Counsellor Multiple response possible DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Working spotlight, presence Working spotlight, presence Working spotlight, presence Working spotlight, presence Working spotlight, presence Q3.4. Working spotlight, presence Observation 1 Yes 2 No Working spotlight, functioning Working spotlight, functioning Working spotlight, functioning Working spotlight, functioning Working spotlight, functioning Q.3.4. If yes, from where has s/he received the training on pre, post and ongoing counselling? Designation: ________________ DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Torch with batteries, presence Torch with batteries, presence Torch with batteries, presence Torch with batteries, presence Torch with batteries, presence Q3.5. Torch with batteries, presence Observation 1 Yes 2 No Torch with batteries, functioning Torch with batteries, functioning Torch with batteries, functioning Torch with batteries, functioning Torch with batteries, functioning Q.3.5. For how long did s/he receive training (in days)? Designation: __________________ Multiple repsonse possible DO NOT READ OUT 1 Yes 2 No Drums for sterile equipments, presence Drums for sterile equipments, presence Drums for sterile equipments, presence Drums for sterile equipments, presence Drums for sterile equipments, presence Q3.6. Drums for sterile equipments, presence Observation 1 Yes 2 No Drums for sterile equipments, functioning Drums for sterile equipments, functioning Drums for sterile equipments, functioning Drums for sterile equipments, functioning Drums for sterile equipments, functioning Q.3.6. Who conducts blood drawing and HIV testing at this centre? Counsellor Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Instrument forceps, presence Instrument forceps, presence Instrument forceps, presence Instrument forceps, presence Instrument forceps, presence Q3.7. Chittle/Instrument forceps, presence Observation 1 Yes 2 No Instrument forceps, functioning Instrument forceps, functioning Instrument forceps, functioning Instrument forceps, functioning Instrument forceps, functioning Q.3.7. Has the individual received any training on the relevant tests that s/he conducts? Counsellor Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Forceps jar, presence Forceps jar, presence Forceps jar, presence Forceps jar, presence Forceps jar, presence Q3.8. Forceps jar, presence Observation 1 Yes 2 No Forceps jar, functioning Forceps jar, functioning Forceps jar, functioning Forceps jar, functioning Forceps jar, functioning Q.3.8. If yes, from where has s/he received the training on HIV testing? Designation: __________________ 1 Yes 2 No Sponge holding forceps, presence Sponge holding forceps, presence Sponge holding forceps, presence Sponge holding forceps, presence Sponge holding forceps, presence Q.3.9. Is there any support staff (cleaner/attendant) available at this centre? Observation No 2 -> Q.3.12 1 Yes 2 No Sponge holding forceps, functioning Sponge holding forceps, functioning Sponge holding forceps, functioning Sponge holding forceps, functioning Sponge holding forceps, functioning Q3.9. Sponge holding forceps, functioning Observation 1 Yes 2 No Specula, presence Specula, presence Specula, presence Specula, presence Specula, presence Q.3.10. Does the cleaner have to handle biohazard substances? No 2 -> Q.3.12 Q.3.9 = 1 1 Yes 2 No Specula, functioning Specula, functioning Specula, functioning Specula, functioning Specula, functioning Q3.10. Speculum, functioning Observation 1 Yes 2 No Proctoscope, presence Proctoscope, presence Proctoscope, presence Proctoscope, presence Proctoscope, presence Q3.11. Proctoscope, presence Observation 1 Yes 2 No Proctoscope, functioning Proctoscope, functioning Proctoscope, functioning Proctoscope, functioning Proctoscope, functioning Q.3.11. If yes, are measures taken for the individual's protection? Gloves Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.3.10 - 1 1 Yes 2 No Penile model, presence Penile model, presence Penile model, presence Penile model, presence Penile model, presence Q.3.12. Is there any clinical service provider in this centre? Observation No 2 -> Q.3.14 1 Yes 2 No Penile model, functioning Penile model, functioning Penile model, functioning Penile model, functioning Penile model, functioning Q3.12. Penile model, functioning Observation 1 Yes 2 No Clean sheets for examination bed Clean sheets for examination bed Clean sheets for examination bed Clean sheets for examination bed Clean sheets for examination bed Q.3.13. If yes, did s/he receive any training on HIV clinical case management? Q.3.12 = 1 1 Yes 2 No Soap on sink Soap on sink Soap on sink Soap on sink Soap on sink Q.3.14. If no, do you refer clinical cases to other facilities? 1 Yes 2 No Clean towel Clean towel Clean towel Clean towel Clean towel Q3.15. Clean towel Observation 1 Yes 2 No Condoms Condoms Condoms Condoms Condoms Q3.16. Condoms Observation 1 Yes 2 No BCC materials BCC materials BCC materials BCC materials BCC materials Q3.17. BCC materials Observation 1 Yes 2 No Subsection score, 2b Subsection score, 2b Subsection score, 2b Subsection score, 2b Subsection score, 2b Score for this subsection (.../...)*100 Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Grade for this subsection Condom grosses in stock Condom grosses in stock Condom grosses in stock Condom grosses in stock Condom grosses in stock Q.4.1. Does anyone greet or welcome a client in the VCT centre and explain the VCT service procedure? Condoms out of stock last year Condoms out of stock last year Condoms out of stock last year Condoms out of stock last year Condoms out of stock last year Q.4.2 How long does a pre test counselling session take on average? 1 Yes 2 No Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Q4.3. Was this facility ever out of stock of gloves in the last year? Check register 1 Yes 2 No STI drugs in stock STI drugs in stock STI drugs in stock STI drugs in stock STI drugs in stock Q.4.4. Is there a penile model and condoms available with the counsellor? (observation) Observation 1 Yes 2 No Expired STI drug in stock Expired STI drug in stock Expired STI drug in stock Expired STI drug in stock Expired STI drug in stock Q.4.5. Is condom demonstration done during counselling? 1 Yes 2 No Expired STI drug use Expired STI drug use Expired STI drug use Expired STI drug use Expired STI drug use Q.4.6. How long does the client wait for a HIV test result? 1 Discarded 2 Returned 3 Used 4 Discarded with approval 99 Others Expired STI drug use, other specific Expired STI drug use, other specific Expired STI drug use, other specific Expired STI drug use, other specific Expired STI drug use, other specific Q4.6. What is done with expired STI drugs usually, if any? other, specific STI drugs stored by expiry date STI drugs stored by expiry date STI drugs stored by expiry date STI drugs stored by expiry date STI drugs stored by expiry date Q.4.7. Who gives the result to the client? 1 Yes 2 No STI drugs stored appropriately STI drugs stored appropriately STI drugs stored appropriately STI drugs stored appropriately STI drugs stored appropriately Q.4.8. How long does a post test counselling session take on average, if the result is negative? 1 Yes 2 No Out of stock STI drugs last year Out of stock STI drugs last year Out of stock STI drugs last year Out of stock STI drugs last year Out of stock STI drugs last year Q.4.9. How long does a post test counselling session take on average, if the result is positive? 1 Yes 2 No Subsection score, 2c Subsection score, 2c Subsection score, 2c Subsection score, 2c Subsection score, 2c Score for this subsection (.../...)*100 Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Grade for this subsection Facility OIC Facility OIC Facility OIC Facility OIC Facility OIC Q5.1 Is adequate water supply available in the laboratory? Observation 1 Doctor 2 ACO 3 Health worker 4 Counselor 5 Laboratory technician 6 Others Facility OIC, other specific Facility OIC, other specific Facility OIC, other specific Facility OIC, other specific Facility OIC, other specific Q5.1. Who is the overall in charge of the facility? other, specific STI management provider - doctor STI management provider - doctor STI management provider - doctor STI management provider - doctor STI management provider - doctor Q5.2. Who is providing STI management (prescriber) at this facility? Doctor Multiple response code 1 Yes 2 No STI management provider - ACO STI management provider - ACO STI management provider - ACO STI management provider - ACO STI management provider - ACO Q5.2. Who is providing STI management (prescriber) at this facility? ACO Multiple response code 1 Yes 2 No STI management provider - health worker STI management provider - health worker STI management provider - health worker STI management provider - health worker STI management provider - health worker Q5.2. Who is providing STI management (prescriber) at this facility? Health Worker Multiple response code 1 Yes 2 No STI management provider - all STI management provider - all STI management provider - all STI management provider - all STI management provider - all Q5.2. Who is providing STI management (prescriber) at this facility? All Multiple response code 1 Yes 2 No STI management provider - others STI management provider - others STI management provider - others STI management provider - others STI management provider - others Q5.2. Who is providing STI management (prescriber) at this facility? Others Multiple response code 1 Yes 2 No STI management provider - other specific STI management provider - other specific STI management provider - other specific STI management provider - other specific STI management provider - other specific Q5.2. Who is providing STI management (prescriber) at this facility? Other, specific Multiple response code Received training on STI syndromic management Received training on STI syndromic management Received training on STI syndromic management Received training on STI syndromic management Received training on STI syndromic management Q5.3 If autoclaving is done, is there an autoclave on site? Observation Q5.2 = 1 1 Yes 2 No Individual/s received training on STI syndromic management 2006 guideline Individual/s received training on STI syndromic management 2006 guideline Individual/s received training on STI syndromic management 2006 guideline Individual/s received training on STI syndromic management 2006 guideline Individual/s received training on STI syndromic management 2006 guideline Q5.4 Are standard procedures followed for autoclaving? Q5.2 = 1 1 Yes 2 No Length of training for individual/s Length of training for individual/s Length of training for individual/s Length of training for individual/s Length of training for individual/s Q5.5 If there is no autoclave, how are materials sterilized usually, in last 7 days? Q5.2 = 2 1 >= 2 days 2 < 2 days Individual/s received other training on STI Individual/s received other training on STI Individual/s received other training on STI Individual/s received other training on STI Individual/s received other training on STI Q5.6 Does the laboratory have access to a functioning incinerator? Observation No 2 -> Q6.1 1 Yes 2 No Place of other training on STI Place of other training on STI Place of other training on STI Place of other training on STI Place of other training on STI Q5.7 Is it within the reachable distance? Q5.6 = 1 1 Government 2 International 3 Others Place of other training on STI, other specific Place of other training on STI, other specific Place of other training on STI, other specific Place of other training on STI, other specific Place of other training on STI, other specific Q5.7. If yes, from where has s/he received the training? other, specific Proportion of prescribers with STI management training Proportion of prescribers with STI management training Proportion of prescribers with STI management training Proportion of prescribers with STI management training Proportion of prescribers with STI management training Q5.8. What proportion of the prescribers has been trained on STI management? Counselling provider - doctor Counselling provider - doctor Counselling provider - doctor Counselling provider - doctor Counselling provider - doctor Q5.9. Who provides counselling at this facility? Doctor 1 Yes 2 No Counselling provider - ACO Counselling provider - ACO Counselling provider - ACO Counselling provider - ACO Counselling provider - ACO Q5.9. Who provides counselling at this facility? ACO 1 Yes 2 No Counselling provider - health worker Counselling provider - health worker Counselling provider - health worker Counselling provider - health worker Counselling provider - health worker Q5.9. Who provides counselling at this facility? Health Worker 1 Yes 2 No Counselling provider - counsellor Counselling provider - counsellor Counselling provider - counsellor Counselling provider - counsellor Counselling provider - counsellor Q5.9. Who provides counselling at this facility? Counsellor 1 Yes 2 No Counselling provider - others Counselling provider - others Counselling provider - others Counselling provider - others Counselling provider - others Q5.9. Who provides counselling at this facility? Others 1 Yes 2 No Counselling provider - other specific Counselling provider - other specific Counselling provider - other specific Counselling provider - other specific Counselling provider - other specific Q5.9. Who provides counselling at this facility? Other, specific Individual received training on VCT Individual received training on VCT Individual received training on VCT Individual received training on VCT Individual received training on VCT Q5.10. Has the individual providing counselling received any training on VCT and confidentiality? No 2 -> Q5.13 1 Yes 2 No Place of training for VCT Place of training for VCT Place of training for VCT Place of training for VCT Place of training for VCT Q5.11. If yes, from where has s/he received the training? Q5.10 = 1 1 Government 2 International 3 Others Place of training for VCT, other specific Place of training for VCT, other specific Place of training for VCT, other specific Place of training for VCT, other specific Place of training for VCT, other specific Q5.11. If yes, from where has s/he received the training? other, specific Q5.10 = 1 Length of VCT training Length of VCT training Length of VCT training Length of VCT training Length of VCT training Q5.12. If yes, how long has s/he received training? Q5.11 = 1 1 >= 6 days 2 4-5 days 3 < 4 days Cleaner in facility Cleaner in facility Cleaner in facility Cleaner in facility Cleaner in facility Q5.13. isthere any laboratory technician in this facility? No 2 -> Q5.15 1 Yes 2 No Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Q5.14. if yes, has s/he received training on training on the relevant tests that s/he conducts? Q5.13 = 1 1 Yes 2 No Measures for protection - gloves Measures for protection - gloves Measures for protection - gloves Measures for protection - gloves Measures for protection - gloves Q5.15. If yes, are measures taken for the individual's protection? Gloves Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q5.16 = 1 1 Yes 2 No Measures for protection - mask Measures for protection - mask Measures for protection - mask Measures for protection - mask Measures for protection - mask Q5.15. If yes, are measures taken for the individual's protection? Mask Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q5.16 = 1 1 Yes 2 No Measures for protection - apron Measures for protection - apron Measures for protection - apron Measures for protection - apron Measures for protection - apron Q5.15. If yes, are measures taken for the individual's protection? Apron Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q5.16 = 1 1 Yes 2 No Measures for protection - footwear Measures for protection - footwear Measures for protection - footwear Measures for protection - footwear Measures for protection - footwear Q5.15. If yes, are measures taken for the individual's protection? Footwear Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q5.16 = 1 1 Yes 2 No Measures for protection - other Measures for protection - other Measures for protection - other Measures for protection - other Measures for protection - other Q5.15. If yes, are measures taken for the individual's protection? Other Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q5.16 = 1 1 Yes 2 No Measures for protection - other specific Measures for protection - other specific Measures for protection - other specific Measures for protection - other specific Measures for protection - other specific Q5.15. If yes, are measures taken for the individual's protection? Other, specific Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q5.16 = 1 Section score, 3 Section score, 3 Section score, 3 Section score, 3 Section score, 3 Score for this section (.../...)*100 Section grade, 3 Section grade, 3 Section grade, 3 Section grade, 3 Section grade, 3 Grade for this section Greeter in facility Greeter in facility Greeter in facility Greeter in facility Greeter in facility Q6.1 Microscope, presence Observation 1 Yes 2 No Condom demonstration done Condom demonstration done Condom demonstration done Condom demonstration done Condom demonstration done Q6.2 Sink for staining, presence Observation 1 Yes 2 No Frequency of condom demonstration Frequency of condom demonstration Frequency of condom demonstration Frequency of condom demonstration Frequency of condom demonstration Q6.3 Micropipettes, presence Observation 1 Always 2 Sometimes 3 Never Sexual history routinely asked Sexual history routinely asked Sexual history routinely asked Sexual history routinely asked Sexual history routinely asked Q6.4 ELISA washer, presence Observation 1 Yes 2 No Suspect STI patients routinely examined Suspect STI patients routinely examined Suspect STI patients routinely examined Suspect STI patients routinely examined Suspect STI patients routinely examined Q.6.5. If no, describe how the pre test counselling is recorded? Q.6.4 = 2 1 Yes 2 No Prevention against re-infection done Prevention against re-infection done Prevention against re-infection done Prevention against re-infection done Prevention against re-infection done Q.6.6. Is post test counselling form available? ->Q.6.8 1 Yes 2 No National guidelines on prevention followed National guidelines on prevention followed National guidelines on prevention followed National guidelines on prevention followed National guidelines on prevention followed Q6.7 Bunsen Burner/spirit lamp, presence Observation 1 Yes 2 No Approach to partner notification Approach to partner notification Approach to partner notification Approach to partner notification Approach to partner notification Q6.8 Hot air oven, presence Observation 1 Patient referral 2 Provider referral STI drugs for gonorrhea STI drugs for gonorrhea STI drugs for gonorrhea STI drugs for gonorrhea STI drugs for gonorrhea Q6.9 Incubator, presence Observation 1 Ceftriaxon (250mg I/M single dose) 2 Doxycyline 3 Both 4 Other STI drugs for gonorrhea, other specific STI drugs for gonorrhea, other specific STI drugs for gonorrhea, other specific STI drugs for gonorrhea, other specific STI drugs for gonorrhea, other specific Q.6.9. If no, how consent for HIV testing is taken? Others, specify Q.6.8 = 2 Section score, 4 Section score, 4 Section score, 4 Section score, 4 Section score, 4 Score for this section (../...)*100 Section grade, 4 Section grade, 4 Section grade, 4 Section grade, 4 Section grade, 4 Grade for this section Basic infection prevention measures followed Basic infection prevention measures followed Basic infection prevention measures followed Basic infection prevention measures followed Basic infection prevention measures followed Q7.1 Does the laboratory have adequate reagents/kits for STI diagnosis available? Observation 1 Yes 2 No Rules of hand washing followed Rules of hand washing followed Rules of hand washing followed Rules of hand washing followed Rules of hand washing followed Q7.2 Does the laboratory have adequate reagents/kits for HIV diagnosis available? Observation 1 Yes 2 No Gloves used during examination and testing Gloves used during examination and testing Gloves used during examination and testing Gloves used during examination and testing Gloves used during examination and testing Q7.3 Do the reagents/kits usually arrive in the reference laboratory in right conditions (e.g. temperature, intact packages, etc)? 1 Yes 2 No Appropriate disposal of sharps system Appropriate disposal of sharps system Appropriate disposal of sharps system Appropriate disposal of sharps system Appropriate disposal of sharps system Q7.4 What does the laboratory do if the supplies do not arrive in right condition? 1 Yes 2 No Appropriate disposal of sharps system, other specific Appropriate disposal of sharps system, other specific Appropriate disposal of sharps system, other specific Appropriate disposal of sharps system, other specific Appropriate disposal of sharps system, other specific Q7.4. Is there a system for appropriate disposal of sharps? Other, specific Observation Appropriate disposal of needle and syringe Appropriate disposal of needle and syringe Appropriate disposal of needle and syringe Appropriate disposal of needle and syringe Appropriate disposal of needle and syringe Q7.5 Are any of the reagents/kits available at the facility beyond expired date? Observation No 2 -> Q7.7 1 Yes 2 No Subsection score, 5a Subsection score, 5a Subsection score, 5a Subsection score, 5a Subsection score, 5a Score for this subsection (...)*100 Subsection grade, 5a Subsection grade, 5a Subsection grade, 5a Subsection grade, 5a Subsection grade, 5a Instruments decontaminated and sterilized after use Instruments decontaminated and sterilized after use Instruments decontaminated and sterilized after use Instruments decontaminated and sterilized after use Instruments decontaminated and sterilized after use Q8.1 Is there a virologist/microbiologist is present in this laboratory now? Observation No 2 -> Q8.3 1 Yes 2 No Hypochlorite/ savlon solution used Hypochlorite/ savlon solution used Hypochlorite/ savlon solution used Hypochlorite/ savlon solution used Hypochlorite/ savlon solution used Q8.2 If yes, has she/he received training in STI/HIV? Q8.1 = 1 1 Yes 2 No Frequency of hypochlorite preparation Frequency of hypochlorite preparation Frequency of hypochlorite preparation Frequency of hypochlorite preparation Frequency of hypochlorite preparation Q8.3 Is there any laboratory technologist is present in this laboratory now? Observation No 2 -> Q8.5 1 Daily/ whenever required 2 Once in 2 days 99 Others Frequency of hypochlorite preparation, other specific Frequency of hypochlorite preparation, other specific Frequency of hypochlorite preparation, other specific Frequency of hypochlorite preparation, other specific Frequency of hypochlorite preparation, other specific Q8.3. Who are the members of this core team? Doctor Multiple response Circle 1 if mentioned Circle 2 if not mentioned ->Q8.5 Facilities which have handled HIV cases (Q8.1 = 1) Q8.2 = 1 Frequency of savlon solution preparation Frequency of savlon solution preparation Frequency of savlon solution preparation Frequency of savlon solution preparation Frequency of savlon solution preparation Q8.4 If yes, has she/he training on the relevant tests that s/he conducts? Q8.3 = 1 1 Daily/ whenever required 2 Once in 2 days 99 Others Frequency of savlon solution preparation Frequency of savlon solution preparation Frequency of savlon solution preparation Frequency of savlon solution preparation Frequency of savlon solution preparation Q.8.4. How soon the HIV result is usually provided to the client? Q.8.1 = 1 Instruments dipped in hypochlorite/ savlon solution Instruments dipped in hypochlorite/ savlon solution Instruments dipped in hypochlorite/ savlon solution Instruments dipped in hypochlorite/ savlon solution Instruments dipped in hypochlorite/ savlon solution Q8.5 Is there a laboratory technician is present in this laboratory now? (observation) Observation 1 Yes 2 No Length of time instrument is dipped Length of time instrument is dipped Length of time instrument is dipped Length of time instrument is dipped Length of time instrument is dipped Q8.6 If yes, has she/he training on the relevant tests that s/he conducts? No 2 -> Q8.7 Q8.5 = 1 1 < 10 mins 2 10-30 mins 3 > 30 mins Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Q8.7 Is there any cleaner/attendant available in this laboratory? Observation No 2 -> Q8.10 1 Yes 2 No Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Q8.8 Does the cleaner/attendant have to handle biohazard substances? Q8.7 = 1 1 Yes 2 No Functioning autoclave on site Functioning autoclave on site Functioning autoclave on site Functioning autoclave on site Functioning autoclave on site Q.8.9. What is done with expired reagents/kits usually, if any? Q.8.1 = 1 & Q.8.8 = 1 1 Yes 2 No Easy access to autoclave Easy access to autoclave Easy access to autoclave Easy access to autoclave Easy access to autoclave Q8.10 Is there an engineer available who is responsible for maintaining the equipment in this laboratory? Observation No 2 -> Q9.1 1 Yes 2 No Autoclaving standard procedures followed Autoclaving standard procedures followed Autoclaving standard procedures followed Autoclaving standard procedures followed Autoclaving standard procedures followed Q8.11 If yes, does she/he have B.Sc level of qualification? Q8.10 = 1 1 Yes 2 No Storage: double-layered cloth, closed cabinet, 2 weeks Storage: double-layered cloth, closed cabinet, 2 weeks Storage: double-layered cloth, closed cabinet, 2 weeks Storage: double-layered cloth, closed cabinet, 2 weeks Storage: double-layered cloth, closed cabinet, 2 weeks Q8.12. After sterilization, how long are instruments kept before use? Covered with double layers of cloth and kept in a closed cabinet, 2 weeks 1 Yes 2 No Storage: double-layered cloth, open shelf, 1 week Storage: double-layered cloth, open shelf, 1 week Storage: double-layered cloth, open shelf, 1 week Storage: double-layered cloth, open shelf, 1 week Storage: double-layered cloth, open shelf, 1 week Q8.12. After sterilization, how long are instruments kept before use? Covered with double layers of cloth and kept in an open cabinet (on shelf), 1 week 1 Yes 2 No Storage: single-layered cloth, closed cabinet, 1 week Storage: single-layered cloth, closed cabinet, 1 week Storage: single-layered cloth, closed cabinet, 1 week Storage: single-layered cloth, closed cabinet, 1 week Storage: single-layered cloth, closed cabinet, 1 week Q8.12. After sterilization, how long are instruments kept before use? Covered with single layer of cloth and kept in a closed cabinet, 1 week 1 Yes 2 No Storage: single-layered cloth, open shelf, 2 days Storage: single-layered cloth, open shelf, 2 days Storage: single-layered cloth, open shelf, 2 days Storage: single-layered cloth, open shelf, 2 days Storage: single-layered cloth, open shelf, 2 days Q8.12. After sterilization, how long are instruments kept before use? Covered with single layer of cloth and kept in an open shelf, 2 days 1 Yes 2 No Storage: other Storage: other Storage: other Storage: other Storage: other Q8.12. After sterilization, how long are instruments kept before use? Other 1 Yes 2 No Storage: other specific Storage: other specific Storage: other specific Storage: other specific Storage: other specific Q8.12. After sterilization, how long are instruments kept before use? Other, specific Subsection score, 5b Subsection score, 5b Subsection score, 5b Subsection score, 5b Subsection score, 5b Score for this subsection (...)*100 Subsection grade, 5b Subsection grade, 5b Subsection grade, 5b Subsection grade, 5b Subsection grade, 5b Grade for this subsection Buckets for contaminated waste available Buckets for contaminated waste available Buckets for contaminated waste available Buckets for contaminated waste available Buckets for contaminated waste available Q9.1 Is adequate water supply available in the laboratory? Observation 1 Yes 2 No Sharp disposal system Sharp disposal system Sharp disposal system Sharp disposal system Sharp disposal system Q9.2 Does the laboratory have access to a functioning autoclave? Observation No 2 -> Q9.5 1 Collected in hard closed bin and taken to deep pit burial 2 Collected in any bucket and taken to deep pit burial 99 Other Sharp disposal system, other specific Sharp disposal system, other specific Sharp disposal system, other specific Sharp disposal system, other specific Sharp disposal system, other specific Q9.12. How are sharps dispose currently? Other, specific Observation Glass disposal system Glass disposal system Glass disposal system Glass disposal system Glass disposal system Q9.3 If autoclaving is done, is there an autoclave on site? Observation Q9.2 = 1 1 Collected in hard closed bin and taken to deep pit burial 2 Collected in hard closed bin and reused after autoclaving 3 Collected in any bucket and taken to deep pit burial 4 Collected in any bucket and reused after autoclaving 99 Other Glass disposal system, other specific Glass disposal system, other specific Glass disposal system, other specific Glass disposal system, other specific Glass disposal system, other specific Q11.3. How are glasswares (anything made of glass like glass slides, injection vial, etc.) disposed currently? Other, specify Observation Common way of infectious material disposal Common way of infectious material disposal Common way of infectious material disposal Common way of infectious material disposal Common way of infectious material disposal Q9.4 Are standard procedures followed for autoclaving? Q9.2 = 1 1 Deep pit burial 2 Burnt 99 Other Common way of infectious material disposal, other specific Common way of infectious material disposal, other specific Common way of infectious material disposal, other specific Common way of infectious material disposal, other specific Common way of infectious material disposal, other specific Q9.4. How are infectious materials disposed (e.g. blood, used cotton, gauge) most of the time? Other, specific Observation Common way of liquid clinical waste disposal Common way of liquid clinical waste disposal Common way of liquid clinical waste disposal Common way of liquid clinical waste disposal Common way of liquid clinical waste disposal Q9.5 If there is no autoclave, how are materials sterilized usually, in last 7 days? 1 Decontaminate with disinfectant for 30 mins and lead to underground drainage 2 Lead to underground drainage 99 Other Common way of liquid clinical waste disposal, other specific Common way of liquid clinical waste disposal, other specific Common way of liquid clinical waste disposal, other specific Common way of liquid clinical waste disposal, other specific Common way of liquid clinical waste disposal, other specific Q9.5 If there is no autoclave, how are materials sterilized usually, in last 7 days? Others, specify Subsection score, 5c Subsection score, 5c Subsection score, 5c Subsection score, 5c Subsection score, 5c Score for this subsection (...)*100 Subsection grade 5c Subsection grade 5c Subsection grade 5c Subsection grade 5c Subsection grade 5c Grade for this subsection National guidelines for STI management available National guidelines for STI management available National guidelines for STI management available National guidelines for STI management available National guidelines for STI management available Q10.1 Microscope, presence Observation 1 Yes 2 No Infection control guideline available Infection control guideline available Infection control guideline available Infection control guideline available Infection control guideline available Q10.2 Sink for staining, presence Observation 1 Yes 2 No National guidelines for VCT available National guidelines for VCT available National guidelines for VCT available National guidelines for VCT available National guidelines for VCT available Q10.3 ELISA reader, presence Observation 1 Yes 2 No Written PEP protocol available Written PEP protocol available Written PEP protocol available Written PEP protocol available Written PEP protocol available Q10.4 ELISA washer, presence Observation 1 Yes 2 No Section score, 6 Section score, 6 Section score, 6 Section score, 6 Section score, 6 Score for this section (.../...)*100 Section grade, 6 Section grade, 6 Section grade, 6 Section grade, 6 Section grade, 6 Grade for this section Record of STI patients maintained Record of STI patients maintained Record of STI patients maintained Record of STI patients maintained Record of STI patients maintained Q11.1 Does the laboratory have adequate reagents/kits for STI diagnosis available? Observation 1 Yes 2 No Records maintained as in STI register Records maintained as in STI register Records maintained as in STI register Records maintained as in STI register Records maintained as in STI register Q11.2 Does the laboratory have adequate reagents/kits for HIV diagnosis available? Observation 1 Yes 2 No Monthly/ Quarterly report form for STI available Monthly/ Quarterly report form for STI available Monthly/ Quarterly report form for STI available Monthly/ Quarterly report form for STI available Monthly/ Quarterly report form for STI available Q11.3 Do the reagents/kits usually arrive in the reference laboratory in right conditions (e.g. temperature, intact packages, etc)? 1 Yes 2 No STI report provided to authority in timely manner STI report provided to authority in timely manner STI report provided to authority in timely manner STI report provided to authority in timely manner STI report provided to authority in timely manner Q11.4 What does the laboratory do if the supplies do not arrive in right condition? 1 Yes 2 No Section score, 7 Section score, 7 Section score, 7 Section score, 7 Section score, 7 Score for this section (.../...)*100 Section grade, 7 Section grade, 7 Section grade, 7 Section grade, 7 Section grade, 7 Grade for this section Prescribers understands confidentiality Prescribers understands confidentiality Prescribers understands confidentiality Prescribers understands confidentiality Prescribers understands confidentiality Q12.1 Is there a virologist/microbiologist is present in this laboratory now? Observation No 2 -> Q12.3 1 Yes 2 No STI registers kept in secure place STI registers kept in secure place STI registers kept in secure place STI registers kept in secure place STI registers kept in secure place Q12.2 If yes, has she/he received training in STI/HIV? Q12.1 = 1 1 Yes 2 No Counsellor understands confidentiality Counsellor understands confidentiality Counsellor understands confidentiality Counsellor understands confidentiality Counsellor understands confidentiality Q12.3 Is there any laboratory technologist is present in this laboratory now? Observation No 2 -> Q12.5 1 Yes 2 No Had break in confidentiality Had break in confidentiality Had break in confidentiality Had break in confidentiality Had break in confidentiality Q12.4 If yes, has she/he training on the relevant tests that s/he conducts? Q12.3 = 1 1 Yes 2 No Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Q12.5. If yes, how was this managed? Meeting with all staff Multiple response Do not read out Circle 1 if mentioned Circle 2 if not mentioned Q15.6 = 1 1 Yes 2 No Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Q12.5. If yes, how was this managed? Meeting with individual person Multiple response Do not read out Circle 1 if mentioned Circle 2 if not mentioned Q15.6 = 1 1 Yes 2 No Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Q12.5. If yes, how was this managed? Who broke confidentiality Multiple response Do not read out Circle 1 if mentioned Circle 2 if not mentioned Q15.6 = 1 1 Yes 2 No Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Q12.5. If yes, how was this managed? Other Multiple response Do not read out Circle 1 if mentioned Circle 2 if not mentioned Q15.6 = 1 1 Yes 2 No Manage confidentiality break, other specific Manage confidentiality break, other specific Manage confidentiality break, other specific Manage confidentiality break, other specific Manage confidentiality break, other specific Q12.5. If yes, how was this managed? Other, specific Multiple response Do not read out Circle 1 if mentioned Circle 2 if not mentioned Q15.6 = 1 Section score, 11 Section score, 11 Section score, 11 Section score, 11 Section score, 11 Score for this section (.../...)*100 Score for this section (.../...)*100 Section grade, 11 Section grade, 11 Section grade, 11 Section grade, 11 Section grade, 11 Grade for this section Grade for this section Available referral form Available referral form Available referral form Available referral form Available referral form Q13.1 Is there an internal QC system for HIV/STI testing in this laboratory? Observation No 2 -> Q13.3 1 Yes 2 No Referred STI/ HIV patients to other facility last year Referred STI/ HIV patients to other facility last year Referred STI/ HIV patients to other facility last year Referred STI/ HIV patients to other facility last year Referred STI/ HIV patients to other facility last year Q13.2 Have staffs working in this laboratory received any training on universal precaution and waste disposal? 1 Yes 2 No Record for referral of patients to other facilities, prescribed form Record for referral of patients to other facilities, prescribed form Record for referral of patients to other facilities, prescribed form Record for referral of patients to other facilities, prescribed form Record for referral of patients to other facilities, prescribed form Q13.3. If yes, is there a record for this? Prescribed form Observation and multiple response Circle 1 if mentioned Circle 2 if not mentioned Q16.2 = 1 1 Yes 2 No Record for referral of patients to other facilities, register book Record for referral of patients to other facilities, register book Record for referral of patients to other facilities, register book Record for referral of patients to other facilities, register book Record for referral of patients to other facilities, register book Q13.3. If yes, is there a record for this? Register book Observation and multiple response Circle 1 if mentioned Circle 2 if not mentioned Q16.2 = 1 1 Yes 2 No Record for referral of patients to other facilities, other Record for referral of patients to other facilities, other Record for referral of patients to other facilities, other Record for referral of patients to other facilities, other Record for referral of patients to other facilities, other Q13.3. If yes, is there a record for this? Other Observation and multiple response Circle 1 if mentioned Circle 2 if not mentioned Q16.2 = 1 1 Yes 2 No Record for referral of patients to other facilities, other specific Record for referral of patients to other facilities, other specific Record for referral of patients to other facilities, other specific Record for referral of patients to other facilities, other specific Record for referral of patients to other facilities, other specific Q13.3. If yes, is there a record for this? Other, specify Observation and multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Section score, 12 Section score, 12 Section score, 12 Section score, 12 Section score, 12 Score for this section (.../...)*100 Section grade, 12 Section grade, 12 Section grade, 12 Section grade, 12 Section grade, 12 Grade for this section Unique key Unique key Unique key Unique key Unique key Recstatus Recstatus Recstatus Recstatus Recstatus Record of service monitoring in place Record of service monitoring in place Record of service monitoring in place Record of service monitoring in place Record of service monitoring in place Q14.1 Are the instruments decontaminated and sterilized after each use? 1 Yes 2 No Number of supervisory visits last year Number of supervisory visits last year Number of supervisory visits last year Number of supervisory visits last year Number of supervisory visits last year Q14.2 Is hypochlorite solution/savlon used in this facility? No 2 -> Q14.6 ->Q14.6 Checked last year - facility setup Checked last year - facility setup Checked last year - facility setup Checked last year - facility setup Checked last year - facility setup Q14.3 If yes, how was this managed? Meeting with all staff Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q14.2 = 1 1 Yes 2 No Checked last year - personnel Checked last year - personnel Checked last year - personnel Checked last year - personnel Checked last year - personnel Q14.3 If yes, how was this managed? Meeting with individual person Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q14.2 = 1 1 Yes 2 No Checked last year - records Checked last year - records Checked last year - records Checked last year - records Checked last year - records Q14.3 If yes, how was this managed? Who breaks confidentiality Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q14.2 = 1 1 Yes 2 No Checked last year - unviersal precaution Checked last year - unviersal precaution Checked last year - unviersal precaution Checked last year - unviersal precaution Checked last year - unviersal precaution Q14.3 If yes, how was this managed? Others Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q14.2 = 1 1 Yes 2 No Checked last year - other Checked last year - other Checked last year - other Checked last year - other Checked last year - other Q14.3 If yes, how was this managed? Others, specify Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q14.2 = 1 1 Yes 2 No Checked last year - other specify Checked last year - other specify Checked last year - other specify Checked last year - other specify Checked last year - other specify Q14.3. What was checked during the last visit? Other, specify Multiple response Circle 1 if mentioned Circle 2 if not mentioned Recommendations made in last visit Recommendations made in last visit Recommendations made in last visit Recommendations made in last visit Recommendations made in last visit Q14.4 How frequently is the hypochlorite solution/savlon prepared? 1 Yes 2 No Recommendation implemented in last visit Recommendation implemented in last visit Recommendation implemented in last visit Recommendation implemented in last visit Recommendation implemented in last visit Q14.5 After dipping in hypochlorite solution/savlon, are the instruments washed by continuous flow of water? 1 Yes 2 No Section score, 13 Section score, 13 Section score, 13 Section score, 13 Section score, 13 Score for this section (.../...)*100 Section grade, 13 Section grade, 13 Section grade, 13 Section grade, 13 Section grade, 13 Grade for this section Number of STI patients visited last year Number of STI patients visited last year Number of STI patients visited last year Number of STI patients visited last year Number of STI patients visited last year Q15.1 Is there any established procedure for waste disposal? Proportion of patients who received STI service Proportion of patients who received STI service Proportion of patients who received STI service Proportion of patients who received STI service Proportion of patients who received STI service Q15.2 How sharps are disposed usually? Observation Proportion of ANC women referred for screening by RPR Proportion of ANC women referred for screening by RPR Proportion of ANC women referred for screening by RPR Proportion of ANC women referred for screening by RPR Proportion of ANC women referred for screening by RPR Q15.3 How glass wares are disposed usually? Observation Proportion of STI patients who received condoms Proportion of STI patients who received condoms Proportion of STI patients who received condoms Proportion of STI patients who received condoms Proportion of STI patients who received condoms Q15.4 How liquid clinical waste is disposed usually? Observation Proportion of STI patients who received counselling Proportion of STI patients who received counselling Proportion of STI patients who received counselling Proportion of STI patients who received counselling Proportion of STI patients who received counselling Q15.5 Are there separate buckets for disposal of contaminated waste (e.g. swab), instruments (e.g. forceps)? Observation Proportion of STI cases that underwent partner notification Proportion of STI cases that underwent partner notification Proportion of STI cases that underwent partner notification Proportion of STI cases that underwent partner notification Proportion of STI cases that underwent partner notification Q15.6 How are infectious materials disposed (e.g. blood, used cotton, gauge) usually? Observation Proportion of ANC mothers who received HIV couunselling Proportion of ANC mothers who received HIV couunselling Proportion of ANC mothers who received HIV couunselling Proportion of ANC mothers who received HIV couunselling Proportion of ANC mothers who received HIV couunselling Q15.7. Proportion of ANC mothers received counselling for HIV in the last year. Check register Proportion of TB patients who received HIV counselling Proportion of TB patients who received HIV counselling Proportion of TB patients who received HIV counselling Proportion of TB patients who received HIV counselling Proportion of TB patients who received HIV counselling Q15.8. Proportion of TB patients received HIV counselling services in the last year. Check register Proportion of STI patients who received HIV counselling Proportion of STI patients who received HIV counselling Proportion of STI patients who received HIV counselling Proportion of STI patients who received HIV counselling Proportion of STI patients who received HIV counselling Q15.9. Proportion of STI patients received HIV counselling services in the last year. Check register Section score, 14 Section score, 14 Section score, 14 Section score, 14 Section score, 14 Score for this section (...)*100 Section grade, 14 Section grade, 14 Section grade, 14 Section grade, 14 Section grade, 14 Grade for this section Health facility serial number Health facility serial number Health facility serial number Health facility serial number Health facility serial number Serial number of the health facility District District District District District District 1 Bumthang 2 Chukha 3 Dagana 4 Gasa 5 Ha 6 Lhuntse 7 Monggar 8 Paro 9 Pemagatshel 10 Punakha 11 Samdrup Jongkhar 12 Samtse 13 Sarpang 14 Thimphu 15 Trashigang 16 Trongsa 17 Tsirang 18 Wangdue Phodrang 19 Yangtsi 20 Zhemgang Gewog/ Town Gewog/ Town Gewog/ Town Gewog/ Town Gewog/ Town Interview completion status Interview completion status Interview completion status Interview completion status Interview completion status Interview completion status 1 Completed 2 Not completed Type of health facility Type of health facility Type of health facility Type of health facility Type of health facility Type of health facility 1 National Referral Hospital 2 Regional Referral Hospital 3 District Hospital 4 BHU-I 5 BHU-II STI method STI method STI method STI method STI method Q.1.1. Does the facility provide pre-test counselling? 1 Syndromic management 2 Syndromic management with some laboratory diagnosis STI treatment/ With counselling STI treatment/ With counselling STI treatment/ With counselling STI treatment/ With counselling STI treatment/ With counselling Q1.2. Do you provide STI treatment only or treatment with counseling? 1 STI treatment only 2 STI treatment with counseling Common sources of STI Common sources of STI Common sources of STI Common sources of STI Common sources of STI Q.1.3. Does the facility provide post test counselling? 1 Multiple partner STI services available STI services available STI services available STI services available STI services available Q.1.4. Does the facility have provision for ongoing counselling? 1 Yes 2 No Population group served Population group served Population group served Population group served Population group served Q.1.5. Did the counsellors ever conducted more than 5 pre test counselling sessions or have seen more than 10 individual clients in one day (per counsellor) in last year? -> Q.1.7 Partner notification with patient consent Partner notification with patient consent Partner notification with patient consent Partner notification with patient consent Partner notification with patient consent Q.1.6. If yes, what was the maximum number of pre test counselling sessions done in one day by any counsellor in last year? Q.1.5 = 1 1 Yes 2 No STI drugs available STI drugs available STI drugs available STI drugs available STI drugs available Q.1.7. Did any group pre-test counselling carried out in the last year? No 2 -> Q.1.9 1 Yes 2 No STI leaflets available STI leaflets available STI leaflets available STI leaflets available STI leaflets available Q.1.8. If there was any group pre test counselling done in the last year, what was the maximum number of people participated in a group counseling session? Q.1.7 = 1 1 Yes 2 No VCT/ counselling services to ANC patients VCT/ counselling services to ANC patients VCT/ counselling services to ANC patients VCT/ counselling services to ANC patients VCT/ counselling services to ANC patients Q.1.9. Does the facility have any provision for promotion or advertisement about the services? No 2 -> Q.1.11 1 Yes 2 No VCT/ counselling services to STI patients VCT/ counselling services to STI patients VCT/ counselling services to STI patients VCT/ counselling services to STI patients VCT/ counselling services to STI patients Q1.10. Do you provide VCT/ counseling services to STI patients? 1 Yes 2 No Services to HIV patients Services to HIV patients Services to HIV patients Services to HIV patients Services to HIV patients Q.1.11. Does the centre provide services to the population with high risk behaviour for HIV? No 2 -> Q.1.13 1 Yes 2 No Counselling services to HIV patients Counselling services to HIV patients Counselling services to HIV patients Counselling services to HIV patients Counselling services to HIV patients Q1.12. If yes, do you provide counseling services to HIV postive patients? 1 Yes 2 No VCT/ counselling services to TB patients VCT/ counselling services to TB patients VCT/ counselling services to TB patients VCT/ counselling services to TB patients VCT/ counselling services to TB patients Q.1.13. When HIV testing is done, is it conducted with the written informed consent of the client? Observation 1 Yes 2 No VCT/ counselling services to other patients VCT/ counselling services to other patients VCT/ counselling services to other patients VCT/ counselling services to other patients VCT/ counselling services to other patients Q1.14. If yes, do you provide VCT/ counseling services to others? No 2 -> Q2.1 1 Yes 2 No Services, specific Services, specific Services, specific Services, specific Services, specific Q.1.15. Does the facility have an appointment system? Section score, 1 Section score, 1 Section score, 1 Section score, 1 Section score, 1 Score for this section (.../...)*100 Section grade, 1 Section grade, 1 Section grade, 1 Section grade, 1 Section grade, 1 Grade for this section Minimum privacy level maintained Minimum privacy level maintained Minimum privacy level maintained Minimum privacy level maintained Minimum privacy level maintained Q2.1. Does the facility have a waiting area? Observation 1 Yes 2 No Privacy maintained for VCT/ counselling Privacy maintained for VCT/ counselling Privacy maintained for VCT/ counselling Privacy maintained for VCT/ counselling Privacy maintained for VCT/ counselling Q.2.2. Do counselling room(s) contain a table, two or more chairs and one or more BCC materials? Observation 1 Yes 2 No Group/ Family counselling Group/ Family counselling Group/ Family counselling Group/ Family counselling Group/ Family counselling Q.2.3. Is privacy maintained during counselling sessions? 1 Yes 2 No Room for group/ family counselling Room for group/ family counselling Room for group/ family counselling Room for group/ family counselling Room for group/ family counselling Q.2.4. If the centre provides group counselling, is there a room available for group counselling sessions? Observation 1 Yes 2 No Adequate water supply Adequate water supply Adequate water supply Adequate water supply Adequate water supply Q.2.5. If blood is collected here, is there a separate blood collection area/room? Observation 1 Yes 2 No Adequate laboratory space Adequate laboratory space Adequate laboratory space Adequate laboratory space Adequate laboratory space Q.2.6. Is adequate water supply available in this centre? Observation 1 Yes 2 No Subsection score, 2a Subsection score, 2a Subsection score, 2a Subsection score, 2a Subsection score, 2a Score for this subsection (.../...)*100 Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Grade for this subsection Patient examination bed, presence Patient examination bed, presence Patient examination bed, presence Patient examination bed, presence Patient examination bed, presence Q.3.1. Is there a receptionist available in the VCT centre? Observation 1 Yes 2 No Patient examination bed, functioning Patient examination bed, functioning Patient examination bed, functioning Patient examination bed, functioning Patient examination bed, functioning Q3.1. Patient examination bed, functioning Observation 1 Yes 2 No Screen, presence Screen, presence Screen, presence Screen, presence Screen, presence Q3.2 Screen, presence Observation 1 Yes 2 No Screen, functioning Screen, functioning Screen, functioning Screen, functioning Screen, functioning Q.3.2. Who provides counselling at this centre? Counsellor Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Sink, presence Sink, presence Sink, presence Sink, presence Sink, presence Q3.3. Sink, presence Observation 1 Yes 2 No Sink, functioning Sink, functioning Sink, functioning Sink, functioning Sink, functioning Q.3.3. Has the individual received any training on pre test, post test and ongoing counselling? Counsellor Multiple response possible DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Working spotlight, presence Working spotlight, presence Working spotlight, presence Working spotlight, presence Working spotlight, presence Q3.4. Working spotlight, presence Observation 1 Yes 2 No Working spotlight, functioning Working spotlight, functioning Working spotlight, functioning Working spotlight, functioning Working spotlight, functioning Q.3.4. If yes, from where has s/he received the training on pre, post and ongoing counselling? Designation: ________________ DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Torch with batteries, presence Torch with batteries, presence Torch with batteries, presence Torch with batteries, presence Torch with batteries, presence Q3.5. Torch with batteries, presence Observation 1 Yes 2 No Torch with batteries, functioning Torch with batteries, functioning Torch with batteries, functioning Torch with batteries, functioning Torch with batteries, functioning Q.3.5. For how long did s/he receive training (in days)? Designation: __________________ Multiple repsonse possible DO NOT READ OUT 1 Yes 2 No Drums for sterile equipments, presence Drums for sterile equipments, presence Drums for sterile equipments, presence Drums for sterile equipments, presence Drums for sterile equipments, presence Q3.6. Drums for sterile equipments, presence Observation 1 Yes 2 No Drums for sterile equipments, functioning Drums for sterile equipments, functioning Drums for sterile equipments, functioning Drums for sterile equipments, functioning Drums for sterile equipments, functioning Q.3.6. Who conducts blood drawing and HIV testing at this centre? Counsellor Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Chittle/Instrument forceps, presence Chittle/Instrument forceps, presence Chittle/Instrument forceps, presence Chittle/Instrument forceps, presence Chittle/Instrument forceps, presence Q3.7. Chittle/Instrument forceps, presence Observation 1 Yes 2 No Chittle/Instrument forceps, functioning Chittle/Instrument forceps, functioning Chittle/Instrument forceps, functioning Chittle/Instrument forceps, functioning Chittle/Instrument forceps, functioning Q.3.7. Has the individual received any training on the relevant tests that s/he conducts? Counsellor Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Forceps jar, presence Forceps jar, presence Forceps jar, presence Forceps jar, presence Forceps jar, presence Q3.8. Forceps jar, presence Observation 1 Yes 2 No Forceps jar, functioning Forceps jar, functioning Forceps jar, functioning Forceps jar, functioning Forceps jar, functioning Q.3.8. If yes, from where has s/he received the training on HIV testing? Designation: __________________ 1 Yes 2 No Sponge holding forceps, presence Sponge holding forceps, presence Sponge holding forceps, presence Sponge holding forceps, presence Sponge holding forceps, presence Q.3.9. Is there any support staff (cleaner/attendant) available at this centre? Observation No 2 -> Q.3.12 1 Yes 2 No Sponge holding forceps, functioning Sponge holding forceps, functioning Sponge holding forceps, functioning Sponge holding forceps, functioning Sponge holding forceps, functioning Q3.9. Sponge holding forceps, functioning Observation 1 Yes 2 No Speculum, presence Speculum, presence Speculum, presence Speculum, presence Speculum, presence Q.3.10. Does the cleaner have to handle biohazard substances? No 2 -> Q.3.12 Q.3.9 = 1 1 Yes 2 No Speculum, functioning Speculum, functioning Speculum, functioning Speculum, functioning Speculum, functioning Q3.10. Speculum, functioning Observation 1 Yes 2 No Proctoscope, presence Proctoscope, presence Proctoscope, presence Proctoscope, presence Proctoscope, presence Q3.11. Proctoscope, presence Observation 1 Yes 2 No Proctoscope, functioning Proctoscope, functioning Proctoscope, functioning Proctoscope, functioning Proctoscope, functioning Q.3.11. If yes, are measures taken for the individual's protection? Gloves Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.3.10 - 1 1 Yes 2 No Penile model, presence Penile model, presence Penile model, presence Penile model, presence Penile model, presence Q.3.12. Is there any clinical service provider in this centre? Observation No 2 -> Q.3.14 1 Yes 2 No Penile model, functioning Penile model, functioning Penile model, functioning Penile model, functioning Penile model, functioning Q3.12. Penile model, functioning Observation 1 Yes 2 No Clean sheets for examination bed Clean sheets for examination bed Clean sheets for examination bed Clean sheets for examination bed Clean sheets for examination bed Q.3.13. If yes, did s/he receive any training on HIV clinical case management? Q.3.12 = 1 1 Yes 2 No Soap on sink Soap on sink Soap on sink Soap on sink Soap on sink Q.3.14. If no, do you refer clinical cases to other facilities? 1 Yes 2 No Clean towel Clean towel Clean towel Clean towel Clean towel Q3.15. Clean towel Observation 1 Yes 2 No Condoms Condoms Condoms Condoms Condoms Q3.16. Condoms Observation 1 Yes 2 No BCC materials BCC materials BCC materials BCC materials BCC materials Q3.17. BCC materials Observation 1 Yes 2 No Functioning microscope Functioning microscope Functioning microscope Functioning microscope Functioning microscope Q3.18. Functioning microscope Observation 1 Yes 2 No Sink for staining Sink for staining Sink for staining Sink for staining Sink for staining Q3.19. Sink for staining Observation 1 Yes 2 No Subsection score, 2b Subsection score, 2b Subsection score, 2b Subsection score, 2b Subsection score, 2b Score for this subsection (.../...)*100 Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Grade for this subsection Condom grosses Condom grosses Condom grosses Condom grosses Condom grosses Q.4.1. Does anyone greet or welcome a client in the VCT centre and explain the VCT service procedure? Condoms out of stock last year Condoms out of stock last year Condoms out of stock last year Condoms out of stock last year Condoms out of stock last year Q.4.2 How long does a pre test counselling session take on average? 1 Yes 2 No Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Q4.3. Was this facility ever out of stock of gloves in the last year? Check register 1 Yes 2 No STI drugs in stock STI drugs in stock STI drugs in stock STI drugs in stock STI drugs in stock Q.4.4. Is there a penile model and condoms available with the counsellor? (observation) Observation 1 Yes 2 No Expired STI drug in stock Expired STI drug in stock Expired STI drug in stock Expired STI drug in stock Expired STI drug in stock Q.4.5. Is condom demonstration done during counselling? 1 Yes 2 No Expired STI drug use Expired STI drug use Expired STI drug use Expired STI drug use Expired STI drug use Q.4.6. How long does the client wait for a HIV test result? 1 Discarded 2 Returned 3 Used 4 Discarded with approval 99 Others Expired STI drug use, other specific Expired STI drug use, other specific Expired STI drug use, other specific Expired STI drug use, other specific Expired STI drug use, other specific Q4.6. What is done with expired STI drugs usually, if any? other, specific STI drugs stored by expiry date STI drugs stored by expiry date STI drugs stored by expiry date STI drugs stored by expiry date STI drugs stored by expiry date Q.4.7. Who gives the result to the client? 1 Yes 2 No STI drugs stored appropriately STI drugs stored appropriately STI drugs stored appropriately STI drugs stored appropriately STI drugs stored appropriately Q.4.8. How long does a post test counselling session take on average, if the result is negative? 1 Yes 2 No Out of stock STI drugs last year Out of stock STI drugs last year Out of stock STI drugs last year Out of stock STI drugs last year Out of stock STI drugs last year Q.4.9. How long does a post test counselling session take on average, if the result is positive? 1 Yes 2 No Subsection score, 2c Subsection score, 2c Subsection score, 2c Subsection score, 2c Subsection score, 2c Score for this subsection (.../...)*100 Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Grade for this subsection Facility OIC Facility OIC Facility OIC Facility OIC Facility OIC Q5.1 Is adequate water supply available in the laboratory? Observation 1 Doctor 2 ACO 3 Health worker 4 Counselor 5 Laboratory technician 6 Others Facility OIC, other specific Facility OIC, other specific Facility OIC, other specific Facility OIC, other specific Facility OIC, other specific Q5.1. Who is the overall in charge of the facility? other, specific STI management provider STI management provider STI management provider STI management provider STI management provider Q5.2 Does the laboratory have access to a functioning autoclave? Observation No 2 -> Q5.5 1 Doctor 2 ACO 3 Health worker 4 All 5 Others STI management provider, other specific STI management provider, other specific STI management provider, other specific STI management provider, other specific STI management provider, other specific Check with Q.15.1. Multiple response possible Received training on STI syndromic management Received training on STI syndromic management Received training on STI syndromic management Received training on STI syndromic management Received training on STI syndromic management Q5.3 If autoclaving is done, is there an autoclave on site? Observation Q5.2 = 1 1 Yes 2 No Individual/s received training on STI syndromic management 2006 guideline Individual/s received training on STI syndromic management 2006 guideline Individual/s received training on STI syndromic management 2006 guideline Individual/s received training on STI syndromic management 2006 guideline Individual/s received training on STI syndromic management 2006 guideline Q5.4 Are standard procedures followed for autoclaving? Q5.2 = 1 1 Yes 2 No Length of training for individual/s Length of training for individual/s Length of training for individual/s Length of training for individual/s Length of training for individual/s Q5.5 If there is no autoclave, how are materials sterilized usually, in last 7 days? Q5.2 = 2 1 >= 2 days 2 < 2 days Individual/s received other training on STI Individual/s received other training on STI Individual/s received other training on STI Individual/s received other training on STI Individual/s received other training on STI Q5.6 Does the laboratory have access to a functioning incinerator? Observation No 2 -> Q6.1 1 Yes 2 No Place of other training on STI Place of other training on STI Place of other training on STI Place of other training on STI Place of other training on STI Q5.7 Is it within the reachable distance? Q5.6 = 1 1 Government 2 International 3 Others Place of other training on STI, other specific Place of other training on STI, other specific Place of other training on STI, other specific Place of other training on STI, other specific Place of other training on STI, other specific Q5.7. If yes, from where has s/he received the training? other, specific Proportion of prescribers with STI management training Proportion of prescribers with STI management training Proportion of prescribers with STI management training Proportion of prescribers with STI management training Proportion of prescribers with STI management training Q5.8. What proportion of the prescribers has been trained on STI management? Counselling provider Counselling provider Counselling provider Counselling provider Counselling provider Q5.9. Who provides counselling at this facility? Check with Q15.4. 1 Doctor 2 ACO 3 Health worker 4 Counselor 5 Others Counselling provider, other specific Counselling provider, other specific Counselling provider, other specific Counselling provider, other specific Counselling provider, other specific 9. Who provides counselling at this facility? other, specific Check with Q15.4. Individual received training on VCT Individual received training on VCT Individual received training on VCT Individual received training on VCT Individual received training on VCT Q5.10. Has the individual providing counselling received any training on VCT and confidentiality? No 2 -> Q5.13 1 Yes 2 No Place of training for VCT Place of training for VCT Place of training for VCT Place of training for VCT Place of training for VCT Q5.11. If yes, from where has s/he received the training? Q5.10 = 1 1 Government 2 International 3 Others Place of training for VCT, other specific Place of training for VCT, other specific Place of training for VCT, other specific Place of training for VCT, other specific Place of training for VCT, other specific Q5.11. If yes, from where has s/he received the training? other, specific Q5.10 = 1 Length of VCT training Length of VCT training Length of VCT training Length of VCT training Length of VCT training Q5.12. If yes, how long has s/he received training? Q5.11 = 1 1 >= 6 days 2 4-5 days 3 < 4 days Laboratory technician in facility Laboratory technician in facility Laboratory technician in facility Laboratory technician in facility Laboratory technician in facility Q5.13. isthere any laboratory technician in this facility? No 2 -> Q5.15 1 Yes 2 No Lab tech received training on relevant test Lab tech received training on relevant test Lab tech received training on relevant test Lab tech received training on relevant test Lab tech received training on relevant test Q5.14. if yes, has s/he received training on training on the relevant tests that s/he conducts? Q5.13 = 1 1 Yes 2 No Cleaner in facility Cleaner in facility Cleaner in facility Cleaner in facility Cleaner in facility Q5.15. is there any cleaner/ attendant/ care taker available in this facility? No 2 -> Q6.1 1 Yes 2 No Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Q5.16. Does the cleaner/ attendant/ care taker have to handle biohazard substances? Q5.15 = 1 1 Yes 2 No Measures for protection - gloves Measures for protection - gloves Measures for protection - gloves Measures for protection - gloves Measures for protection - gloves Q5.17. If yes, are measures taken for the individual's protection? Gloves Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q5.16 = 1 1 Yes 2 No Measures for protection - mask Measures for protection - mask Measures for protection - mask Measures for protection - mask Measures for protection - mask Q5.17. If yes, are measures taken for the individual's protection? Mask Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q5.16 = 1 1 Yes 2 No Measures for protection - apron Measures for protection - apron Measures for protection - apron Measures for protection - apron Measures for protection - apron Q5.17. If yes, are measures taken for the individual's protection? Apron Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q5.16 = 1 1 Yes 2 No Measures for protection - footwear Measures for protection - footwear Measures for protection - footwear Measures for protection - footwear Measures for protection - footwear Q5.17. If yes, are measures taken for the individual's protection? Footwear Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q5.16 = 1 1 Yes 2 No Measures for protection - other Measures for protection - other Measures for protection - other Measures for protection - other Measures for protection - other Q5.17. If yes, are measures taken for the individual's protection? Other Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q5.16 = 1 1 Yes 2 No Measures for protection - other specific Measures for protection - other specific Measures for protection - other specific Measures for protection - other specific Measures for protection - other specific Q5.17. If yes, are measures taken for the individual's protection? Other, specific Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q5.16 = 1 Section score, 3 Section score, 3 Section score, 3 Section score, 3 Section score, 3 Section grade, 3 Section grade, 3 Section grade, 3 Section grade, 3 Section grade, 3 Greeter in facility Greeter in facility Greeter in facility Greeter in facility Greeter in facility Q6.1 Microscope, presence Observation 1 Yes 2 No Condom demonstration done Condom demonstration done Condom demonstration done Condom demonstration done Condom demonstration done Q6.2 Sink for staining, presence Observation 1 Yes 2 No Frequency of condom demonstration Frequency of condom demonstration Frequency of condom demonstration Frequency of condom demonstration Frequency of condom demonstration Q6.3 Micropipettes, presence Observation 1 Always 2 Sometimes 3 Never Sexual history routinely asked Sexual history routinely asked Sexual history routinely asked Sexual history routinely asked Sexual history routinely asked Q6.4 ELISA washer, presence Observation 1 Yes 2 No Suspect STI patients routinely examined Suspect STI patients routinely examined Suspect STI patients routinely examined Suspect STI patients routinely examined Suspect STI patients routinely examined Q.6.5. If no, describe how the pre test counselling is recorded? Q.6.4 = 2 1 Yes 2 No Prevention against re-infection done Prevention against re-infection done Prevention against re-infection done Prevention against re-infection done Prevention against re-infection done Q.6.6. Is post test counselling form available? ->Q.6.8 1 Yes 2 No National guidelines on prevention followed National guidelines on prevention followed National guidelines on prevention followed National guidelines on prevention followed National guidelines on prevention followed Q6.7 Bunsen Burner/spirit lamp, presence Observation 1 Yes 2 No Approach to partner notification Approach to partner notification Approach to partner notification Approach to partner notification Approach to partner notification Q6.8 Hot air oven, presence Observation 1 Patient referral 2 Provider referral STI drugs for gonorrhea STI drugs for gonorrhea STI drugs for gonorrhea STI drugs for gonorrhea STI drugs for gonorrhea Q6.9 Incubator, presence Observation 1 Ceftriaxon (250mg I/M single dose) 2 Doxycyline 3 Both 4 Other Post Exposure Prophylaxis (PEP) system in place Post Exposure Prophylaxis (PEP) system in place Post Exposure Prophylaxis (PEP) system in place Post Exposure Prophylaxis (PEP) system in place Post Exposure Prophylaxis (PEP) system in place Q6.10 Plate shaker, presence Observation 1 Yes 2 No Has focal person for PEP Has focal person for PEP Has focal person for PEP Has focal person for PEP Has focal person for PEP Q6.11 CD4, presence Observation 1 Yes 2 No System for recording in place System for recording in place System for recording in place System for recording in place System for recording in place Q6.12 Refrigerator, presence Observation 1 Yes 2 No Section score, 4 Section score, 4 Section score, 4 Section score, 4 Section score, 4 Score for this section (../...)*100 Section grade, 4 Section grade, 4 Section grade, 4 Section grade, 4 Section grade, 4 Grade for this section Pretest counselling done Pretest counselling done Pretest counselling done Pretest counselling done Pretest counselling done Q7.1 Does the laboratory have adequate reagents/kits for STI diagnosis available? Observation 1 Yes 2 No Length of pretest counselling Length of pretest counselling Length of pretest counselling Length of pretest counselling Length of pretest counselling Q7.2 Does the laboratory have adequate reagents/kits for HIV diagnosis available? Observation 1 >= 30 mins 2 < 30 mins Informed consent for HIV testing taken Informed consent for HIV testing taken Informed consent for HIV testing taken Informed consent for HIV testing taken Informed consent for HIV testing taken Q7.3 Do the reagents/kits usually arrive in the reference laboratory in right conditions (e.g. temperature, intact packages, etc)? 1 Yes 2 No Qualities of good counsellor, patient Qualities of good counsellor, patient Qualities of good counsellor, patient Qualities of good counsellor, patient Qualities of good counsellor, patient Q7.4. Please mention a few qualities of a good counsellor. Patience Multiple response Do not read out Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Qualities of good counsellor, understandable Qualities of good counsellor, understandable Qualities of good counsellor, understandable Qualities of good counsellor, understandable Qualities of good counsellor, understandable Q7.4. Please mention a few qualities of a good counsellor. Understandable Multiple response Do not read out Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Qualities of good counsellor, respectful Qualities of good counsellor, respectful Qualities of good counsellor, respectful Qualities of good counsellor, respectful Qualities of good counsellor, respectful Q7.4. Please mention a few qualities of a good counsellor. Respectful of clients Multiple response Do not read out Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Qualities of good counsellor, good attitude Qualities of good counsellor, good attitude Qualities of good counsellor, good attitude Qualities of good counsellor, good attitude Qualities of good counsellor, good attitude Q7.4. Please mention a few qualities of a good counsellor. Good attitude Multiple response Do not read out Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Post test counselling done Post test counselling done Post test counselling done Post test counselling done Post test counselling done Q7.5 Are any of the reagents/kits available at the facility beyond expired date? Observation No 2 -> Q7.7 1 Yes 2 No Length of post test counselling for negative result Length of post test counselling for negative result Length of post test counselling for negative result Length of post test counselling for negative result Length of post test counselling for negative result Q7.6 What is done with the expired reagents/kits? Q7.5 = 1 1 >= 10 mins 2 < 10 mins Length of post test counselling for positive result Length of post test counselling for positive result Length of post test counselling for positive result Length of post test counselling for positive result Length of post test counselling for positive result Q7.7 Does the laboratory usually have adequate quantity of disinfectants for STI? Observation 1 >= 30 mins 2 < 30 mins Follows partner notification policy Follows partner notification policy Follows partner notification policy Follows partner notification policy Follows partner notification policy Q.7.8. How many condom grosses are in stock at this centre today? Observation and Check register 1 Yes 2 No Partner notification done with patient consent Partner notification done with patient consent Partner notification done with patient consent Partner notification done with patient consent Partner notification done with patient consent Q.7.9. Was this facility ever out of stock of condoms in last year? Check register 1 Yes 2 No Group pretest counselling done last year Group pretest counselling done last year Group pretest counselling done last year Group pretest counselling done last year Group pretest counselling done last year Q7.10 Is separate glassware, tips, transfer pipettes etc used for testing? Observation 1 Yes 2 No Written/Verbal consent taken from VCT clients Written/Verbal consent taken from VCT clients Written/Verbal consent taken from VCT clients Written/Verbal consent taken from VCT clients Written/Verbal consent taken from VCT clients Q7.11 Was this facility ever out of stock of gloves in the last 12 months? 1 Yes 2 No Section score, 5 Section score, 5 Section score, 5 Section score, 5 Section score, 5 Score for this section (.../...)*100 Section grade, 5 Section grade, 5 Section grade, 5 Section grade, 5 Section grade, 5 Grade for this section Dealt with HIV postive case Dealt with HIV postive case Dealt with HIV postive case Dealt with HIV postive case Dealt with HIV postive case Q8.1 Is there a virologist/microbiologist is present in this laboratory now? Observation No 2 -> Q8.3 1 Yes 2 No Core team for support available Core team for support available Core team for support available Core team for support available Core team for support available Q8.2 If yes, has she/he received training in STI/HIV? Q8.1 = 1 1 Yes 2 No Core team member - doctor Core team member - doctor Core team member - doctor Core team member - doctor Core team member - doctor Q8.3. Who are the members of this core team? Doctor Multiple response Circle 1 if mentioned Circle 2 if not mentioned ->Q8.5 Facilities which have handled HIV cases (Q8.1 = 1) Q8.2 = 1 1 Yes 2 No Core team member - nurse Core team member - nurse Core team member - nurse Core team member - nurse Core team member - nurse Q8.3. Who are the members of this core team? Nurse Multiple response Circle 1 if mentioned Circle 2 if not mentioned ->Q8.5 Facilities which have handled HIV cases (Q8.1 = 1) Q8.2 = 1 1 Yes 2 No Core team member - VCT counsellor Core team member - VCT counsellor Core team member - VCT counsellor Core team member - VCT counsellor Core team member - VCT counsellor Q8.3. Who are the members of this core team? VCT counsellor Multiple response Circle 1 if mentioned Circle 2 if not mentioned ->Q8.5 Facilities which have handled HIV cases (Q8.1 = 1) Q8.2 = 1 1 Yes 2 No Core team member - Lab tech Core team member - Lab tech Core team member - Lab tech Core team member - Lab tech Core team member - Lab tech Q8.3. Who are the members of this core team? Laboratory technologist Multiple response Circle 1 if mentioned Circle 2 if not mentioned ->Q8.5 Facilities which have handled HIV cases (Q8.1 = 1) Q8.2 = 1 1 Yes 2 No Core team member - Pharmacist Core team member - Pharmacist Core team member - Pharmacist Core team member - Pharmacist Core team member - Pharmacist Q8.3. Who are the members of this core team? Pharmacist Multiple response Circle 1 if mentioned Circle 2 if not mentioned ->Q8.5 Facilities which have handled HIV cases (Q8.1 = 1) Q8.2 = 1 1 Yes 2 No Core team member - Other Core team member - Other Core team member - Other Core team member - Other Core team member - Other Q8.3. Who are the members of this core team? Other Multiple response Circle 1 if mentioned Circle 2 if not mentioned ->Q8.5 Facilities which have handled HIV cases (Q8.1 = 1) Q8.2 = 1 1 Yes 2 No Other personnel support available Other personnel support available Other personnel support available Other personnel support available Other personnel support available Q8.4 If yes, has she/he training on the relevant tests that s/he conducts? Q8.3 = 1 1 Yes 2 No Event of HIV case referred to other facility Event of HIV case referred to other facility Event of HIV case referred to other facility Event of HIV case referred to other facility Event of HIV case referred to other facility Q8.5 Is there a laboratory technician is present in this laboratory now? (observation) Observation 1 Yes 2 No Cause of refer - CD4 counts Cause of refer - CD4 counts Cause of refer - CD4 counts Cause of refer - CD4 counts Cause of refer - CD4 counts Q8.6. If yes, what was the cause of refer? CD4 counts Check register Multiple response Circle 1 if mentioned Circle 2 if not mentioned Facilities which have handled HIV cases (Q8.1 = 1) and Q8.5 = 1 1 Yes 2 No Cause of refer - Counselling Cause of refer - Counselling Cause of refer - Counselling Cause of refer - Counselling Cause of refer - Counselling Q8.6. If yes, what was the cause of refer? Counselling Check register Multiple response Circle 1 if mentioned Circle 2 if not mentioned Facilities which have handled HIV cases (Q8.1 = 1) and Q8.5 = 1 1 Yes 2 No Cause of refer - HAART follow up Cause of refer - HAART follow up Cause of refer - HAART follow up Cause of refer - HAART follow up Cause of refer - HAART follow up Q8.6. If yes, what was the cause of refer? HAART follow up Check register Multiple response Circle 1 if mentioned Circle 2 if not mentioned Facilities which have handled HIV cases (Q8.1 = 1) and Q8.5 = 1 1 Yes 2 No Cause of refer - Other Cause of refer - Other Cause of refer - Other Cause of refer - Other Cause of refer - Other Q8.6. If yes, what was the cause of refer? Other Check register Multiple response Circle 1 if mentioned Circle 2 if not mentioned Facilities which have handled HIV cases (Q8.1 = 1) and Q8.5 = 1 1 Yes 2 No Cause of refer - Other specific Cause of refer - Other specific Cause of refer - Other specific Cause of refer - Other specific Cause of refer - Other specific Q8.6. If yes, what was the cause of refer? Other, specific Check register Multiple response Circle 1 if mentioned Circle 2 if not mentioned Facilities which have handled HIV cases (Q8.1 = 1) and Q8.5 = 1 Section score, 6 Section score, 6 Section score, 6 Section score, 6 Section score, 6 Score for this section (.../...)*100 Section grade, 6 Section grade, 6 Section grade, 6 Section grade, 6 Section grade, 6 Grade for this section Basic infection prevention measures followed Basic infection prevention measures followed Basic infection prevention measures followed Basic infection prevention measures followed Basic infection prevention measures followed Q9.1 Is adequate water supply available in the laboratory? Observation 1 Yes 2 No Rules of hand washing followed Rules of hand washing followed Rules of hand washing followed Rules of hand washing followed Rules of hand washing followed Q9.2 Does the laboratory have access to a functioning autoclave? Observation No 2 -> Q9.5 1 Yes 2 No Gloves used during examination and testing Gloves used during examination and testing Gloves used during examination and testing Gloves used during examination and testing Gloves used during examination and testing Q9.3 If autoclaving is done, is there an autoclave on site? Observation Q9.2 = 1 1 Yes 2 No Appropriate disposal of sharps system Appropriate disposal of sharps system Appropriate disposal of sharps system Appropriate disposal of sharps system Appropriate disposal of sharps system Q9.4 Are standard procedures followed for autoclaving? Q9.2 = 1 1 Yes 2 No Appropriate disposal of sharps system, other specific Appropriate disposal of sharps system, other specific Appropriate disposal of sharps system, other specific Appropriate disposal of sharps system, other specific Appropriate disposal of sharps system, other specific Q9.4. Is there a system for appropriate disposal of sharps? Other, specific Observation Appropriate disposal of needle and syringe Appropriate disposal of needle and syringe Appropriate disposal of needle and syringe Appropriate disposal of needle and syringe Appropriate disposal of needle and syringe Q9.5 If there is no autoclave, how are materials sterilized usually, in last 7 days? 1 Yes 2 No Subsection score, 7a Subsection score, 7a Subsection score, 7a Subsection score, 7a Subsection score, 7a Score for this subsection (...)*100 Subsection grade, 7a Subsection grade, 7a Subsection grade, 7a Subsection grade, 7a Subsection grade, 7a Instruments decontaminated and sterilized after use Instruments decontaminated and sterilized after use Instruments decontaminated and sterilized after use Instruments decontaminated and sterilized after use Instruments decontaminated and sterilized after use Q10.1 Microscope, presence Observation 1 Yes 2 No Hypochlorite/ savlon solution used Hypochlorite/ savlon solution used Hypochlorite/ savlon solution used Hypochlorite/ savlon solution used Hypochlorite/ savlon solution used Q10.2. Is hypochlorite solution/ savlon used in this facility? Observation 1 Yes 2 No Frequency of hypochlorite preparation Frequency of hypochlorite preparation Frequency of hypochlorite preparation Frequency of hypochlorite preparation Frequency of hypochlorite preparation Q10.3 ELISA reader, presence Observation 1 Daily/ whenever required 2 Once in 2 days Frequency of savlon solution preparation Frequency of savlon solution preparation Frequency of savlon solution preparation Frequency of savlon solution preparation Frequency of savlon solution preparation Q10.4 ELISA washer, presence Observation 1 Daily/ whenever required 2 Once in 2 days 99 Others Instruments dipped in hypochlorite/ savlon solution Instruments dipped in hypochlorite/ savlon solution Instruments dipped in hypochlorite/ savlon solution Instruments dipped in hypochlorite/ savlon solution Instruments dipped in hypochlorite/ savlon solution Q10.5 Micropipettes, presence Observation 1 Yes 2 No Length of time instrument is dipped Length of time instrument is dipped Length of time instrument is dipped Length of time instrument is dipped Length of time instrument is dipped Q10.6 Candle jar, presence Observation 1 < 10 mins 2 10-30 mins 3 > 30 mins Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Q10.7 Bunsen Burner/spirit lamp, presence Observation 1 Yes 2 No Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Q10.8 Hot air oven, presence Observation 1 Yes 2 No Functioning autoclave on site Functioning autoclave on site Functioning autoclave on site Functioning autoclave on site Functioning autoclave on site Q10.9 Incubator, presence Observation 1 Yes 2 No Easy access to autoclave Easy access to autoclave Easy access to autoclave Easy access to autoclave Easy access to autoclave Q10.10 Plate shaker, presence Observation 1 Yes 2 No Autoclaving standard procedures followed Autoclaving standard procedures followed Autoclaving standard procedures followed Autoclaving standard procedures followed Autoclaving standard procedures followed Q10.11 CD4, presence Observation 1 Yes 2 No Length of time sterilized instruments kept before use Length of time sterilized instruments kept before use Length of time sterilized instruments kept before use Length of time sterilized instruments kept before use Length of time sterilized instruments kept before use Q10.12 Refrigerator, presence Observation 1 2 weeks 2 1 week 3 2 days Subsection score, 7b Subsection score, 7b Subsection score, 7b Subsection score, 7b Subsection score, 7b Score for this subsection (...)*100 Subsection grade, 7b Subsection grade, 7b Subsection grade, 7b Subsection grade, 7b Subsection grade, 7b Grade for this subsection Buckets for contaminated waste available Buckets for contaminated waste available Buckets for contaminated waste available Buckets for contaminated waste available Buckets for contaminated waste available Q11.1 Does the laboratory have adequate reagents/kits for STI diagnosis available? Observation 1 Yes 2 No Sharp disposal system Sharp disposal system Sharp disposal system Sharp disposal system Sharp disposal system Q11.2 Does the laboratory have adequate reagents/kits for HIV diagnosis available? Observation 1 Collected in hard closed bin and taken to deep pit burial 2 Collected in any bucket and taken to deep pit burial 99 Other Sharp disposal system, other specific Sharp disposal system, other specific Sharp disposal system, other specific Sharp disposal system, other specific Sharp disposal system, other specific Q11.2 How sharps are disposed usually? Others, specify Observation Glass disposal system Glass disposal system Glass disposal system Glass disposal system Glass disposal system Q11.3 Do the reagents/kits usually arrive in the reference laboratory in right conditions (e.g. temperature, intact packages, etc)? 1 Collected in hard closed bin and taken to deep pit burial 2 Collected in hard closed bin and reused after autoclaving 3 Collected in any bucket and taken to deep pit burial 4 Collected in any bucket and reused after autoclaving 99 Other Glass disposal system, other specific Glass disposal system, other specific Glass disposal system, other specific Glass disposal system, other specific Glass disposal system, other specific Q11.3 How glass wares are disposed usually? Others, specify Observation Common way of infectious material disposal Common way of infectious material disposal Common way of infectious material disposal Common way of infectious material disposal Common way of infectious material disposal Q11.4 What does the laboratory do if the supplies do not arrive in right condition? 1 Deep pit burial 2 Burnt 99 Other Common way of infectious material disposal, other specific Common way of infectious material disposal, other specific Common way of infectious material disposal, other specific Common way of infectious material disposal, other specific Common way of infectious material disposal, other specific Q11.4 What does the laboratory do if the supplies do not arrive in right condition? Others, specify Common way of liquid clinical waste disposal Common way of liquid clinical waste disposal Common way of liquid clinical waste disposal Common way of liquid clinical waste disposal Common way of liquid clinical waste disposal Q11.5 Are any of the reagents/kits available at the facility beyond expired date? Observation No 2 -> Q11.7 1 Decontaminate with disinfectant for 30 mins and lead to underground drainage 2 Lead to underground drainage 99 Other Common way of liquid clinical waste disposal, other specific Common way of liquid clinical waste disposal, other specific Common way of liquid clinical waste disposal, other specific Common way of liquid clinical waste disposal, other specific Common way of liquid clinical waste disposal, other specific Q11.5. How is liquid waste disposed of most of the time? Other, specific Observation Subsection score, 7c Subsection score, 7c Subsection score, 7c Subsection score, 7c Subsection score, 7c Score for this subsection (...)*100 Subsection grade 7c Subsection grade 7c Subsection grade 7c Subsection grade 7c Subsection grade 7c Grade for this subsection Unique key Unique key Unique key Unique key Unique key Recstatus Recstatus Recstatus Recstatus Recstatus STI management provider - doctor STI management provider - doctor STI management provider - doctor STI management provider - doctor STI management provider - doctor Q5.2. Who is providing STI management (prescriber) at this facility? Doctor Multiple response code 1 Yes 2 No STI management provider - ACO STI management provider - ACO STI management provider - ACO STI management provider - ACO STI management provider - ACO Q5.2. Who is providing STI management (prescriber) at this facility? ACO Multiple response code 1 Yes 2 No STI management provider - health worker STI management provider - health worker STI management provider - health worker STI management provider - health worker STI management provider - health worker Q5.2. Who is providing STI management (prescriber) at this facility? Health Worker Multiple response code 1 Yes 2 No STI management provider - all STI management provider - all STI management provider - all STI management provider - all STI management provider - all Q5.2. Who is providing STI management (prescriber) at this facility? All Multiple response code 1 Yes 2 No STI management provider - others STI management provider - others STI management provider - others STI management provider - others STI management provider - others Q5.2. Who is providing STI management (prescriber) at this facility? Others Multiple response code 1 Yes 2 No STI management provider - other specific STI management provider - other specific STI management provider - other specific STI management provider - other specific STI management provider - other specific Q5.2. Who is providing STI management (prescriber) at this facility? Other, specific Multiple response code Counselling provider - doctor Counselling provider - doctor Counselling provider - doctor Counselling provider - doctor Counselling provider - doctor Q5.9. Who provides counselling at this facility? Doctor 1 Yes 2 No Counselling provider - ACO Counselling provider - ACO Counselling provider - ACO Counselling provider - ACO Counselling provider - ACO Q5.9. Who provides counselling at this facility? ACO 1 Yes 2 No Counselling provider - health worker Counselling provider - health worker Counselling provider - health worker Counselling provider - health worker Counselling provider - health worker Q5.9. Who provides counselling at this facility? Health Worker 1 Yes 2 No Counselling provider - counsellor Counselling provider - counsellor Counselling provider - counsellor Counselling provider - counsellor Counselling provider - counsellor Q5.9. Who provides counselling at this facility? Counsellor 1 Yes 2 No Counselling provider - others Counselling provider - others Counselling provider - others Counselling provider - others Counselling provider - others Q5.9. Who provides counselling at this facility? Others 1 Yes 2 No Counselling provider - other specific Counselling provider - other specific Counselling provider - other specific Counselling provider - other specific Counselling provider - other specific Q5.9. Who provides counselling at this facility? Other, specific Storage: double-layered cloth, closed cabinet, 2 weeks Storage: double-layered cloth, closed cabinet, 2 weeks Storage: double-layered cloth, closed cabinet, 2 weeks Storage: double-layered cloth, closed cabinet, 2 weeks Storage: double-layered cloth, closed cabinet, 2 weeks Q10.12 Refrigerator, functioning Observation 1 Yes 2 No Storage: double-layered cloth, open shelf, 1 week Storage: double-layered cloth, open shelf, 1 week Storage: double-layered cloth, open shelf, 1 week Storage: double-layered cloth, open shelf, 1 week Storage: double-layered cloth, open shelf, 1 week Q10.12. After sterilization, how long are instruments kept before use? Covered with double layers of cloth and kept in an open cabinet (on shelf), 1 week 1 Yes 2 No Storage: single-layered cloth, closed cabinet, 1 week Storage: single-layered cloth, closed cabinet, 1 week Storage: single-layered cloth, closed cabinet, 1 week Storage: single-layered cloth, closed cabinet, 1 week Storage: single-layered cloth, closed cabinet, 1 week Q10.12. After sterilization, how long are instruments kept before use? Covered with single layer of cloth and kept in a closed cabinet, 1 week 1 Yes 2 No Storage: single-layered cloth, open shelf, 2 days Storage: single-layered cloth, open shelf, 2 days Storage: single-layered cloth, open shelf, 2 days Storage: single-layered cloth, open shelf, 2 days Storage: single-layered cloth, open shelf, 2 days Q10.12. After sterilization, how long are instruments kept before use? Covered with single layer of cloth and kept in an open shelf, 2 days 1 Yes 2 No Storage: other Storage: other Storage: other Storage: other Storage: other Q10.12. After sterilization, how long are instruments kept before use? Other 1 Yes 2 No Storage: other specific Storage: other specific Storage: other specific Storage: other specific Storage: other specific Q10.12. After sterilization, how long are instruments kept before use? Other, specific National guidelines for STI management available National guidelines for STI management available National guidelines for STI management available National guidelines for STI management available National guidelines for STI management available Q12.1 Is there a virologist/microbiologist is present in this laboratory now? Observation No 2 -> Q12.3 1 Yes 2 No Infection control guideline available Infection control guideline available Infection control guideline available Infection control guideline available Infection control guideline available Q12.2 If yes, has she/he received training in STI/HIV? Q12.1 = 1 1 Yes 2 No National guidelines for VCT available National guidelines for VCT available National guidelines for VCT available National guidelines for VCT available National guidelines for VCT available Q12.3 Is there any laboratory technologist is present in this laboratory now? Observation No 2 -> Q12.5 1 Yes 2 No Written PEP protocol available Written PEP protocol available Written PEP protocol available Written PEP protocol available Written PEP protocol available Q12.4 If yes, has she/he training on the relevant tests that s/he conducts? Q12.3 = 1 1 Yes 2 No Section score, 8 Section score, 8 Section score, 8 Section score, 8 Section score, 8 Score for this section (.../...)*100 Section grade, 8 Section grade, 8 Section grade, 8 Section grade, 8 Section grade, 8 Grade for this section Record of STI patients maintained Record of STI patients maintained Record of STI patients maintained Record of STI patients maintained Record of STI patients maintained Q13.1 Is there an internal QC system for HIV/STI testing in this laboratory? Observation No 2 -> Q13.3 1 Yes 2 No Records maintained as in STI register Records maintained as in STI register Records maintained as in STI register Records maintained as in STI register Records maintained as in STI register Q13.2 Have staffs working in this laboratory received any training on universal precaution and waste disposal? 1 Yes 2 No Written test result given to patient for STI/HIV Written test result given to patient for STI/HIV Written test result given to patient for STI/HIV Written test result given to patient for STI/HIV Written test result given to patient for STI/HIV Q13.3 Is all laboratory staff following rules of hand washing? Ask to show the procedure 1 Yes 2 No Monthly/ Quarterly report form for STI available Monthly/ Quarterly report form for STI available Monthly/ Quarterly report form for STI available Monthly/ Quarterly report form for STI available Monthly/ Quarterly report form for STI available Q13.4 Is the recent universal precaution guideline available? Observation 1 Yes 2 No STI report provided to authority in timely manner STI report provided to authority in timely manner STI report provided to authority in timely manner STI report provided to authority in timely manner STI report provided to authority in timely manner Q13.5 Are gloves usually used in the laboratory while handling samples? Observation 1 Yes 2 No Monthly/ Quarterly report form for HIV available Monthly/ Quarterly report form for HIV available Monthly/ Quarterly report form for HIV available Monthly/ Quarterly report form for HIV available Monthly/ Quarterly report form for HIV available Q13.6 Are gloves usually used in the laboratory while conducting HIV/STI tests? 1 Yes 2 No HIV report provided to authority in timely manner HIV report provided to authority in timely manner HIV report provided to authority in timely manner HIV report provided to authority in timely manner HIV report provided to authority in timely manner Q13.7 Are lab coats worn in laboratory while performing the tests? Observation 1 Yes 2 No Laboratory test results recorded Laboratory test results recorded Laboratory test results recorded Laboratory test results recorded Laboratory test results recorded Q13.8 Are mats placed on the testing area? Observation 1 Yes 2 No Record for VCT client maintained Record for VCT client maintained Record for VCT client maintained Record for VCT client maintained Record for VCT client maintained Q13.9 Is there any PEP system in place? 1 Yes 2 No System for recording of HIV testing samples exists System for recording of HIV testing samples exists System for recording of HIV testing samples exists System for recording of HIV testing samples exists System for recording of HIV testing samples exists Q13.10 Where are the sharps disposed usually? Observation 1 Yes 2 No Pretest counselling form available Pretest counselling form available Pretest counselling form available Pretest counselling form available Pretest counselling form available Q13.11 Do all clinical staff dispose needle and syringe appropriately? 1 Yes 2 No Pretest counselling recording Pretest counselling recording Pretest counselling recording Pretest counselling recording Pretest counselling recording Q13.12. If no, describe how the pre test counselling is recorded? Q13.11 = 2 1 Plain white paper 99 Others Pretest counselling recording, other specific Pretest counselling recording, other specific Pretest counselling recording, other specific Pretest counselling recording, other specific Pretest counselling recording, other specific Q13.12. If no, describe how the pre test counselling is recorded? Other, specific Q13.11 = 2 Post test counselling form available Post test counselling form available Post test counselling form available Post test counselling form available Post test counselling form available Q13.13. Is post test counselling form available? Observation Yes 1 -> Q13.15 1 Yes 2 No Post test counselling recording Post test counselling recording Post test counselling recording Post test counselling recording Post test counselling recording Q13.14. If no, describe how the post test counselling is recorded? Q13.13 = 2 1 Plain white paper 99 Others Post test counselling recording, other specific Post test counselling recording, other specific Post test counselling recording, other specific Post test counselling recording, other specific Post test counselling recording, other specific Q13.14. If no, describe how the post test counselling is recorded? Other, specific Q13.13 = 2 Informed consent for HIV testing available Informed consent for HIV testing available Informed consent for HIV testing available Informed consent for HIV testing available Informed consent for HIV testing available Q13.15. Is Informed consent form for HIV testing available? Observation Yes 1 -> Q14.1 1 Yes 2 No Usual manner of HIV testing Usual manner of HIV testing Usual manner of HIV testing Usual manner of HIV testing Usual manner of HIV testing Q13.16. If no, how consent for HIV testing is taken usually? Q13.15 = 2 1 Plain white paper 99 Others Usual manner of HIV testing, other specific Usual manner of HIV testing, other specific Usual manner of HIV testing, other specific Usual manner of HIV testing, other specific Usual manner of HIV testing, other specific Q13.16. If no, how consent for HIV testing is taken usually? Other, specific Q13.15 = 2 Section score, 9 Section score, 9 Section score, 9 Section score, 9 Section score, 9 Score for this section (...)*100 Section grade, 9 Section grade, 9 Section grade, 9 Section grade, 9 Section grade, 9 Grade for this section Gram staining method done Gram staining method done Gram staining method done Gram staining method done Gram staining method done Q14.1 Are the instruments decontaminated and sterilized after each use? 1 Yes 2 No Waiting time for release of Gram staining result Waiting time for release of Gram staining result Waiting time for release of Gram staining result Waiting time for release of Gram staining result Waiting time for release of Gram staining result Q14.2 Is hypochlorite solution/savlon used in this facility? No 2 -> Q14.6 ->Q14.6 1 Same day 2 After 1 day 3 After 2 days 4 More than 2 days 99 Other Waiting time for release of Gram staining result, other specific Waiting time for release of Gram staining result, other specific Waiting time for release of Gram staining result, other specific Waiting time for release of Gram staining result, other specific Waiting time for release of Gram staining result, other specific Q14.2. If yes, how soon is the result of the Gram staining provided to the patient usually? Other, specific Q14.1 = 1 RPR/ VDRL done RPR/ VDRL done RPR/ VDRL done RPR/ VDRL done RPR/ VDRL done Q14.3 If yes, for how long the instruments are dipped? Q14.2 = 1 1 Yes 2 No Waiting time for release of RPR/ VDRL result Waiting time for release of RPR/ VDRL result Waiting time for release of RPR/ VDRL result Waiting time for release of RPR/ VDRL result Waiting time for release of RPR/ VDRL result Q14.4 How frequently is the hypochlorite solution/savlon prepared? 1 Same day 2 After 1 day 3 After 2 days 4 More than 2 days 99 Other Waiting time for release of RPR/ VDRL result, other specific Waiting time for release of RPR/ VDRL result, other specific Waiting time for release of RPR/ VDRL result, other specific Waiting time for release of RPR/ VDRL result, other specific Waiting time for release of RPR/ VDRL result, other specific Q14.4 How frequently is the hypochlorite solution/savlon prepared? Others, specify HIV test done HIV test done HIV test done HIV test done HIV test done Q14.5 After dipping in hypochlorite solution/savlon, are the instruments washed by continuous flow of water? 1 Yes 2 No Method of HIV test, rapid test Method of HIV test, rapid test Method of HIV test, rapid test Method of HIV test, rapid test Method of HIV test, rapid test Q14.6. If yes, which method they follow? Rapid test Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q14.5 = 1 1 Yes 2 No Method of HIV test, ELISA Method of HIV test, ELISA Method of HIV test, ELISA Method of HIV test, ELISA Method of HIV test, ELISA Q14.6. If yes, which method they follow? ELISA Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q14.5 = 1 1 Yes 2 No Method of HIV test, Western Blot Method of HIV test, Western Blot Method of HIV test, Western Blot Method of HIV test, Western Blot Method of HIV test, Western Blot Q14.6. If yes, which method they follow? Western Blot Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q14.5 = 1 1 Yes 2 No Waiting time for release of HIV result Waiting time for release of HIV result Waiting time for release of HIV result Waiting time for release of HIV result Waiting time for release of HIV result Q14.7. If yes, how soon is the HIV result usually provided to the patient? Q14.6 = 1 1 Same day 2 After 1 day 3 After 2 days 4 More than 2 days 99 Other Proportion of patients who received HIV results on same day, last year Proportion of patients who received HIV results on same day, last year Proportion of patients who received HIV results on same day, last year Proportion of patients who received HIV results on same day, last year Proportion of patients who received HIV results on same day, last year Q14.8. Proportion of the patients received the HIV test result on the same day in the last year. Check register Available stock of glassware Available stock of glassware Available stock of glassware Available stock of glassware Available stock of glassware Q14.9. Is there a stock of laboratory supplies available? Glassware Check register Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Available stock of transfer pipettes Available stock of transfer pipettes Available stock of transfer pipettes Available stock of transfer pipettes Available stock of transfer pipettes Q14.9. Is there a stock of laboratory supplies available? Transfer pipettes Check register Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Available stock of tips Available stock of tips Available stock of tips Available stock of tips Available stock of tips Q14.9. Is there a stock of laboratory supplies available? Tips Check register Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Available stock of eppendorf tube Available stock of eppendorf tube Available stock of eppendorf tube Available stock of eppendorf tube Available stock of eppendorf tube Q14.9. Is there a stock of laboratory supplies available? Eppendorf tube Check register Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Available stock of bucket Available stock of bucket Available stock of bucket Available stock of bucket Available stock of bucket Q14.9. Is there a stock of laboratory supplies available? Bucket Check register Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Available stock of disposable syringe Available stock of disposable syringe Available stock of disposable syringe Available stock of disposable syringe Available stock of disposable syringe Q14.9. Is there a stock of laboratory supplies available? Disposable syringe Check register Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Available stock of needle Available stock of needle Available stock of needle Available stock of needle Available stock of needle Q14.9. Is there a stock of laboratory supplies available? Needle Check register Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Available stock of mask Available stock of mask Available stock of mask Available stock of mask Available stock of mask Q14.9. Is there a stock of laboratory supplies available? Mask Check register Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Available stock of reagents/ kits for STI diagnosis Available stock of reagents/ kits for STI diagnosis Available stock of reagents/ kits for STI diagnosis Available stock of reagents/ kits for STI diagnosis Available stock of reagents/ kits for STI diagnosis Q14.10. Does the laboratory have a stock of reagents/kits for STI diagnosis? Observation Yes 1 -> Q14.12 1 Yes 2 No Kits/ reagents not in stock, 1 Kits/ reagents not in stock, 1 Kits/ reagents not in stock, 1 Kits/ reagents not in stock, 1 Kits/ reagents not in stock, 1 Q14.11. If no, what are the kits/ reagents not available? Specify Q14.10 = 2 Kits/ reagents not in stock, 2 Kits/ reagents not in stock, 2 Kits/ reagents not in stock, 2 Kits/ reagents not in stock, 2 Kits/ reagents not in stock, 2 Q14.11. If no, what are the kits/ reagents not available? Specify Q14.10 = 2 Kits/ reagents not in stock, 3 Kits/ reagents not in stock, 3 Kits/ reagents not in stock, 3 Kits/ reagents not in stock, 3 Kits/ reagents not in stock, 3 Q14.11. If no, what are the kits/ reagents not available? Specify Q14.10 = 2 Available stock of reagents/ kits for HIV diagnosis Available stock of reagents/ kits for HIV diagnosis Available stock of reagents/ kits for HIV diagnosis Available stock of reagents/ kits for HIV diagnosis Available stock of reagents/ kits for HIV diagnosis Q14.12. Does the laboratory have a stock of reagents/kits for HIV diagnosis? Yes 1 -> Q14.14 1 Yes 2 No Unavailable reagents/ kits for HIV diagnosis, 1 Unavailable reagents/ kits for HIV diagnosis, 1 Unavailable reagents/ kits for HIV diagnosis, 1 Unavailable reagents/ kits for HIV diagnosis, 1 Unavailable reagents/ kits for HIV diagnosis, 1 Q14.3. If no, what are the kits/reagents not available? (Specify) Q14.2 = 2 Unavailable reagents/ kits for HIV diagnosis, 2 Unavailable reagents/ kits for HIV diagnosis, 2 Unavailable reagents/ kits for HIV diagnosis, 2 Unavailable reagents/ kits for HIV diagnosis, 2 Unavailable reagents/ kits for HIV diagnosis, 2 Q14.3. If no, what are the kits/reagents not available? (Specify) Q14.2 = 2 Unavailable reagents/ kits for HIV diagnosis, 3 Unavailable reagents/ kits for HIV diagnosis, 3 Unavailable reagents/ kits for HIV diagnosis, 3 Unavailable reagents/ kits for HIV diagnosis, 3 Unavailable reagents/ kits for HIV diagnosis, 3 Q14.3. If no, what are the kits/reagents not available? (Specify) Q14.2 = 2 Reagents/ kits arrive in right condition Reagents/ kits arrive in right condition Reagents/ kits arrive in right condition Reagents/ kits arrive in right condition Reagents/ kits arrive in right condition Q14.14. Do the reagents/kits usually arrive in the laboratory in right conditions (e.g. temperature, intact packages, etc)? Observation Yes 1 -> Q14.16 Q14.2 = 1 1 Yes 2 No Action taken on reagents/ kits not in right condition Action taken on reagents/ kits not in right condition Action taken on reagents/ kits not in right condition Action taken on reagents/ kits not in right condition Action taken on reagents/ kits not in right condition Q14.15. If no, what does the laboratory do? Q14.14 = 2 Action taken on reagents/ kits not in right condition, other Action taken on reagents/ kits not in right condition, other Action taken on reagents/ kits not in right condition, other Action taken on reagents/ kits not in right condition, other Action taken on reagents/ kits not in right condition, other Q14.15. If no, what does the laboratory do? Other, specific Q14.14 = 2 Has expired reagent/ kit Has expired reagent/ kit Has expired reagent/ kit Has expired reagent/ kit Has expired reagent/ kit Q14.16. Is there any expired reagent/kit in the facility at the moment? Observation No 2 -> Q14.18 1 Yes 2 No Action taken on expired reagent/ kit Action taken on expired reagent/ kit Action taken on expired reagent/ kit Action taken on expired reagent/ kit Action taken on expired reagent/ kit Q14.17. If yes, what do you do with this expired reagent/kit? Q14.16 = 1 1 Same day 2 After 1 day 3 After 2 days 4 More than 2 days 5 Other Action taken on expired reagent/ kit, other Action taken on expired reagent/ kit, other Action taken on expired reagent/ kit, other Action taken on expired reagent/ kit, other Action taken on expired reagent/ kit, other Q14.17. If yes, what do you do with this expired reagent/kit? Other, specific Q14.16 = 1 Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Q14.18. Does the laboratory usually have adequate quantity of disinfectants? 1 Yes 2 No Section score, 10 Section score, 10 Section score, 10 Section score, 10 Section score, 10 Score for this section (.../...)*100 Section grade, 10 Section grade, 10 Section grade, 10 Section grade, 10 Section grade, 10 Grade for this section Prescribers understands confidentiality Prescribers understands confidentiality Prescribers understands confidentiality Prescribers understands confidentiality Prescribers understands confidentiality Q15.1 Is there any established procedure for waste disposal? 1 Yes 2 No STI registers kept in secure place STI registers kept in secure place STI registers kept in secure place STI registers kept in secure place STI registers kept in secure place Q15.2 How sharps are disposed usually? Observation 1 Yes 2 No HIV registers kept in secure place HIV registers kept in secure place HIV registers kept in secure place HIV registers kept in secure place HIV registers kept in secure place Q15.3 How glass wares are disposed usually? Observation 1 Yes 2 No Counsellor understands confidentiality Counsellor understands confidentiality Counsellor understands confidentiality Counsellor understands confidentiality Counsellor understands confidentiality Q15.4 How liquid clinical waste is disposed usually? Observation 1 Yes 2 No Lab tech understands confidentiality Lab tech understands confidentiality Lab tech understands confidentiality Lab tech understands confidentiality Lab tech understands confidentiality Q15.5 Are there separate buckets for disposal of contaminated waste (e.g. swab), instruments (e.g. forceps)? Observation 1 Yes 2 No Had break in confidentiality Had break in confidentiality Had break in confidentiality Had break in confidentiality Had break in confidentiality Q15.6 How are infectious materials disposed (e.g. blood, used cotton, gauge) usually? Observation 1 Yes 2 No Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Q15.7. If yes, how was this managed? Meeting with all staff Multiple response Do not read out Circle 1 if mentioned Circle 2 if not mentioned Q15.6 = 1 1 Yes 2 No Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Q15.7. If yes, how was this managed? Meeting with individual person Multiple response Do not read out Circle 1 if mentioned Circle 2 if not mentioned Q15.6 = 1 1 Yes 2 No Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Q15.7. If yes, how was this managed? Who broke confidentiality Multiple response Do not read out Circle 1 if mentioned Circle 2 if not mentioned Q15.6 = 1 1 Yes 2 No Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Q15.7. If yes, how was this managed? Other Multiple response Do not read out Circle 1 if mentioned Circle 2 if not mentioned Q15.6 = 1 1 Yes 2 No Manage confidentiality break, other specific Manage confidentiality break, other specific Manage confidentiality break, other specific Manage confidentiality break, other specific Manage confidentiality break, other specific Q15.7. If yes, how was this managed? Other, specific Multiple response Do not read out Circle 1 if mentioned Circle 2 if not mentioned Q15.6 = 1 Section score, 11 Section score, 11 Section score, 11 Section score, 11 Section score, 11 Score for this section (.../...)*100 Score for this section (.../...)*100 Section grade, 11 Section grade, 11 Section grade, 11 Section grade, 11 Section grade, 11 Grade for this section Grade for this section Available referral form Available referral form Available referral form Available referral form Available referral form Q16.1 Does the laboratory keep records of samples that were tested for HIV? Observation 1 Yes 2 No Referred STI/ HIV patients to other facility last year Referred STI/ HIV patients to other facility last year Referred STI/ HIV patients to other facility last year Referred STI/ HIV patients to other facility last year Referred STI/ HIV patients to other facility last year Q16.2 Has the laboratory kept records of samples that were tested for STI? Observation 1 Yes 2 No Record for referral of patients to other facilities, prescribed form Record for referral of patients to other facilities, prescribed form Record for referral of patients to other facilities, prescribed form Record for referral of patients to other facilities, prescribed form Record for referral of patients to other facilities, prescribed form Q16.3 How are the records of STI/HIV recorded? Computerized Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Record for referral of patients to other facilities, register book Record for referral of patients to other facilities, register book Record for referral of patients to other facilities, register book Record for referral of patients to other facilities, register book Record for referral of patients to other facilities, register book Q16.3 How are the records of STI/HIV recorded? Register book Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Record for referral of patients to other facilities, other Record for referral of patients to other facilities, other Record for referral of patients to other facilities, other Record for referral of patients to other facilities, other Record for referral of patients to other facilities, other Q16.3 How are the records of STI/HIV recorded? Others Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Record for referral of patients to other facilities, other specific Record for referral of patients to other facilities, other specific Record for referral of patients to other facilities, other specific Record for referral of patients to other facilities, other specific Record for referral of patients to other facilities, other specific Q16.3 How are the records of STI/HIV recorded? Others, specify Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Proportion of HIV patients referred to other facilities Proportion of HIV patients referred to other facilities Proportion of HIV patients referred to other facilities Proportion of HIV patients referred to other facilities Proportion of HIV patients referred to other facilities Q16.4 Is there any person responsible for maintaining the laboratory test record? Observation Proportion of negative HIV patients referred to other facilities Proportion of negative HIV patients referred to other facilities Proportion of negative HIV patients referred to other facilities Proportion of negative HIV patients referred to other facilities Proportion of negative HIV patients referred to other facilities Q16.5 Does the facility provide STI and HIV report to the authority in a timely manner? (observation) Observation Section score, 12 Section score, 12 Section score, 12 Section score, 12 Section score, 12 Score for this section (.../...)*100 Section grade, 12 Section grade, 12 Section grade, 12 Section grade, 12 Section grade, 12 Grade for this section Record of service monitoring in place Record of service monitoring in place Record of service monitoring in place Record of service monitoring in place Record of service monitoring in place Q17.1 Is there an internal QC system for HIV/STI testing in this laboratory? Observation No 2 -> Q17.3 1 Yes 2 No Samples sent to other laboratory for QC Samples sent to other laboratory for QC Samples sent to other laboratory for QC Samples sent to other laboratory for QC Samples sent to other laboratory for QC Q17.2 If there is none now, was there ever an internal QC system in the laboratory? Q17.1 = 2 1 Yes 2 No Number of supervisory visits last year Number of supervisory visits last year Number of supervisory visits last year Number of supervisory visits last year Number of supervisory visits last year Q17.3 Is there an external QC system for HIV/STI testing in this laboratory? Observation No 2 -> Q17.5 Checked last year - facility setup Checked last year - facility setup Checked last year - facility setup Checked last year - facility setup Checked last year - facility setup Q17.4. What was checked during the last visit? Facility setup Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Checked last year - personnel Checked last year - personnel Checked last year - personnel Checked last year - personnel Checked last year - personnel Q17.4. What was checked during the last visit? Personnel Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Checked last year - records Checked last year - records Checked last year - records Checked last year - records Checked last year - records Q17.4. What was checked during the last visit? Records Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Checked last year - unviersal precaution Checked last year - unviersal precaution Checked last year - unviersal precaution Checked last year - unviersal precaution Checked last year - unviersal precaution Q17.4. What was checked during the last visit? Universal precaution Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Checked last year - other Checked last year - other Checked last year - other Checked last year - other Checked last year - other Q17.4. What was checked during the last visit? Other Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Checked last year - other specific Checked last year - other specific Checked last year - other specific Checked last year - other specific Checked last year - other specific Q17.4. What was checked during the last visit? Other, specify Multiple response Circle 1 if mentioned Circle 2 if not mentioned Recommendations made in last visit Recommendations made in last visit Recommendations made in last visit Recommendations made in last visit Recommendations made in last visit Q17.5 Is there any specific personnel for checking the QC system in the laboratory? 1 Yes 2 No Recommendation implemented in last visit Recommendation implemented in last visit Recommendation implemented in last visit Recommendation implemented in last visit Recommendation implemented in last visit Q17.6 Has the laboratory ever conducted any QC on any samples received from other laboratories? No 2 -> Q18.1 1 Yes 2 No Section score, 13 Section score, 13 Section score, 13 Section score, 13 Section score, 13 Score for this section (.../...)*100 Section grade, 13 Section grade, 13 Section grade, 13 Section grade, 13 Section grade, 13 Grade for this section Number of STI patients visited last year Number of STI patients visited last year Number of STI patients visited last year Number of STI patients visited last year Number of STI patients visited last year Q18.1 Do all laboratory personnel understand the meaning of confidentiality? Ask the meaning of confidentiality Proportion of patients who received STI service Proportion of patients who received STI service Proportion of patients who received STI service Proportion of patients who received STI service Proportion of patients who received STI service Q18.2 Have you had any break in confidentiality in this facility? Yes 1 -> Q18.3 No 2 -> Q19.1 ->Q19.1 Proportion of ANC women referred for screening by RPR Proportion of ANC women referred for screening by RPR Proportion of ANC women referred for screening by RPR Proportion of ANC women referred for screening by RPR Proportion of ANC women referred for screening by RPR Q18.3. Proportion of ANC women referred for screening by RPR in the last year. Check register Number of patients tested HIV positive Number of patients tested HIV positive Number of patients tested HIV positive Number of patients tested HIV positive Number of patients tested HIV positive Q18.4. Number of patients who tested HIV positive in last year. Check register/ verbal Proportion of STI patients who received condoms Proportion of STI patients who received condoms Proportion of STI patients who received condoms Proportion of STI patients who received condoms Proportion of STI patients who received condoms Q18.5. Proportion of STI patients who received condoms at the treatment site in the last year. Check register/ verbal Proportion of STI patients who received counselling Proportion of STI patients who received counselling Proportion of STI patients who received counselling Proportion of STI patients who received counselling Proportion of STI patients who received counselling Q18.6. Proportion of STI patients who received counselling services in the last year. Check register Proportion of STI cases that underwent partner notification Proportion of STI cases that underwent partner notification Proportion of STI cases that underwent partner notification Proportion of STI cases that underwent partner notification Proportion of STI cases that underwent partner notification Q18.7. Proportion of STI cases that underwent partner notification in the last year. Check register proportion of patients tested for HIV and received pretest counselling proportion of patients tested for HIV and received pretest counselling proportion of patients tested for HIV and received pretest counselling proportion of patients tested for HIV and received pretest counselling proportion of patients tested for HIV and received pretest counselling Q18.8. Proportion of patients who received pre test counselling and who were tested for HIV in last year. Check register Proportion of patients tested for HIV and received post test counselling Proportion of patients tested for HIV and received post test counselling Proportion of patients tested for HIV and received post test counselling Proportion of patients tested for HIV and received post test counselling Proportion of patients tested for HIV and received post test counselling Q18.9. Proportion of patients who were tested for HIV and received post test counselling in last year. Check register Proportion of ANC mothers who received HIV couunselling Proportion of ANC mothers who received HIV couunselling Proportion of ANC mothers who received HIV couunselling Proportion of ANC mothers who received HIV couunselling Proportion of ANC mothers who received HIV couunselling Q18.10. Proportion of ANC mothers received counselling for HIV in the last year. Check register Proportion of TB patients who received HIV counselling Proportion of TB patients who received HIV counselling Proportion of TB patients who received HIV counselling Proportion of TB patients who received HIV counselling Proportion of TB patients who received HIV counselling Q18.11. Proportion of TB patients received HIV counselling services in the last year. Check register Proportion of STI patients who received HIV counselling Proportion of STI patients who received HIV counselling Proportion of STI patients who received HIV counselling Proportion of STI patients who received HIV counselling Proportion of STI patients who received HIV counselling Q18.12. Proportion of STI patients received HIV counselling services in the last year. Check register Proportion of STI patients tested for laboratory diagnosis Proportion of STI patients tested for laboratory diagnosis Proportion of STI patients tested for laboratory diagnosis Proportion of STI patients tested for laboratory diagnosis Proportion of STI patients tested for laboratory diagnosis Q18.13. Proportion of the STI patients tested for laboratory diagnosis in the last year. Check register/ verbal Section score, 14 Section score, 14 Section score, 14 Section score, 14 Section score, 14 Score for this section (...)*100 Section grade, 14 Section grade, 14 Section grade, 14 Section grade, 14 Section grade, 14 Grade for this section Serial number of VCT centre Serial number of VCT centre Serial number of VCT centre Serial number of VCT centre Serial number of VCT centre Serial number of the health facility District District District District District District 1 Bumthang 2 Chukha 3 Dagana 4 Gasa 5 Ha 6 Lhuntse 7 Monggar 8 Paro 9 Pemagatshel 10 Punakha 11 Samdrup Jongkhar 12 Samtse 13 Sarpang 14 Thimphu 15 Trashigang 16 Trongsa 17 Tsirang 18 Wangdue Phodrang 19 Yangtsi 20 Zhemgang Gewog/town Gewog/town Gewog/town Gewog/town Gewog/town Interview completion status Interview completion status Interview completion status Interview completion status Interview completion status Interview completion status 1 Completed 2 Not completed Type of Health Facility Type of Health Facility Type of Health Facility Type of Health Facility Type of Health Facility Type of health facility 1 HISC, Thimphu 2 HISC, Phuentsholing Provides pretest counselling Provides pretest counselling Provides pretest counselling Provides pretest counselling Provides pretest counselling Q.1.1. Does the facility provide pre-test counselling? 1 Yes 2 No Ask client to think and return Ask client to think and return Ask client to think and return Ask client to think and return Ask client to think and return Q.1.2. If the client refuses testing after pre test counselling, what does the VCT centre do?Ask the clients to think and return DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Continue counselling for testing Continue counselling for testing Continue counselling for testing Continue counselling for testing Continue counselling for testing Q.1.2. If the client refuses testing after pre test counselling, what does the VCT centre do? Continue counselling for testing DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Request to do testing Request to do testing Request to do testing Request to do testing Request to do testing Q.1.2. If the client refuses testing after pre test counselling, what does the VCT centre do? Request to do testing DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Client refusal - other Client refusal - other Client refusal - other Client refusal - other Client refusal - other Q.1.2. If the client refuses testing after pre test counselling, what does the VCT centre do? Other DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Client refusal - other specify Client refusal - other specify Client refusal - other specify Client refusal - other specify Client refusal - other specify Q.1.2. If the client refuses testing after pre test counselling, what does the VCT centre do? Others, specify DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 99 others Provides post-test counselling Provides post-test counselling Provides post-test counselling Provides post-test counselling Provides post-test counselling Q.1.3. Does the facility provide post test counselling? 1 Yes 2 No Has provision for ongoing counselling Has provision for ongoing counselling Has provision for ongoing counselling Has provision for ongoing counselling Has provision for ongoing counselling Q.1.4. Does the facility have provision for ongoing counselling? 1 Yes 2 No > 5 pretest counselling/>10 clients per day > 5 pretest counselling/>10 clients per day > 5 pretest counselling/>10 clients per day > 5 pretest counselling/>10 clients per day > 5 pretest counselling/>10 clients per day Q.1.5. Did the counsellors ever conducted more than 5 pre test counselling sessions or have seen more than 10 individual clients in one day (per counsellor) in last year? -> Q.1.7 1 Yes 2 No Maximum no. of pretest counselling per day Maximum no. of pretest counselling per day Maximum no. of pretest counselling per day Maximum no. of pretest counselling per day Maximum no. of pretest counselling per day Q.1.6. If yes, what was the maximum number of pre test counselling sessions done in one day by any counsellor in last year? Q.1.5 = 1 Provides group pretest counselling Provides group pretest counselling Provides group pretest counselling Provides group pretest counselling Provides group pretest counselling Q.1.7. Did any group pre-test counselling carried out in the last year? No 2 -> Q.1.9 1 Yes 2 No Maximum no. of people in group pretest counselling Maximum no. of people in group pretest counselling Maximum no. of people in group pretest counselling Maximum no. of people in group pretest counselling Maximum no. of people in group pretest counselling Q.1.8. If there was any group pre test counselling done in the last year, what was the maximum number of people participated in a group counseling session? Q.1.7 = 1 1 <= 8 2 >8 Provides promotion/advertisement about services Provides promotion/advertisement about services Provides promotion/advertisement about services Provides promotion/advertisement about services Provides promotion/advertisement about services Q.1.9. Does the facility have any provision for promotion or advertisement about the services? No 2 -> Q.1.11 1 Yes 2 No Mode of ad, poster Mode of ad, poster Mode of ad, poster Mode of ad, poster Mode of ad, poster Q.1.10. If yes, what is/are the mode of advertisement? Poster Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.1.9 = 1 1 Yes 2 No Mode of ad, pamphlets Mode of ad, pamphlets Mode of ad, pamphlets Mode of ad, pamphlets Mode of ad, pamphlets Q.1.10. If yes, what is/are the mode of advertisement? Pamphlets Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.1.9 = 1 1 Yes 2 No Mode of ad, flyers Mode of ad, flyers Mode of ad, flyers Mode of ad, flyers Mode of ad, flyers Q.1.10. If yes, what is/are the mode of advertisement? Flyers Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.1.9 = 1 1 Yes 2 No Mode of ad, TV advertisements Mode of ad, TV advertisements Mode of ad, TV advertisements Mode of ad, TV advertisements Mode of ad, TV advertisements Q.1.10. If yes, what is/are the mode of advertisement? TV advertisements Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.1.9 = 1 1 Yes 2 No Mode of ad, newspaper Mode of ad, newspaper Mode of ad, newspaper Mode of ad, newspaper Mode of ad, newspaper Q.1.10. If yes, what is/are the mode of advertisement? Newspaper Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.1.9 = 1 1 Yes 2 No Mode of ad, others Mode of ad, others Mode of ad, others Mode of ad, others Mode of ad, others Q.1.10. If yes, what is/are the mode of advertisement? Others Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.1.9 = 1 1 Yes 2 No Mode of ad, other specify Mode of ad, other specify Mode of ad, other specify Mode of ad, other specify Mode of ad, other specify Q.1.10. If yes, what is/are the mode of advertisement? Others, specify Q.1.9 = 1 1 Yes 2 No Provides services for high risk behaviour for HIV Provides services for high risk behaviour for HIV Provides services for high risk behaviour for HIV Provides services for high risk behaviour for HIV Provides services for high risk behaviour for HIV Q.1.11. Does the centre provide services to the population with high risk behaviour for HIV? No 2 -> Q.1.13 1 Yes 2 No Population served, 1 Population served, 1 Population served, 1 Population served, 1 Population served, 1 Q.1.12. If yes, which population? Population served, 2 Population served, 2 Population served, 2 Population served, 2 Population served, 2 Q.1.12. Population served, 2 Population served, 3 Population served, 3 Population served, 3 Population served, 3 Population served, 3 Q.1.12. If yes, which population? HIV testing done with written informed consent HIV testing done with written informed consent HIV testing done with written informed consent HIV testing done with written informed consent HIV testing done with written informed consent Q.1.13. When HIV testing is done, is it conducted with the written informed consent of the client? Observation 1 Yes 2 No Form of consent for release of information to 3rd party: Written consent Form of consent for release of information to 3rd party: Written consent Form of consent for release of information to 3rd party: Written consent Form of consent for release of information to 3rd party: Written consent Form of consent for release of information to 3rd party: Written consent Q.1.14. Does the centre require a written signed consent form for release of information to a third party while referring? Written consent Observation 1 Yes 2 No Form of consent for release of information to 3rd party: Verbal consent Form of consent for release of information to 3rd party: Verbal consent Form of consent for release of information to 3rd party: Verbal consent Form of consent for release of information to 3rd party: Verbal consent Form of consent for release of information to 3rd party: Verbal consent Q.1.14. Does the centre require a written signed consent form for release of information to a third party while referring? Verbal consent Observation 1 Yes 2 No Form of consent for release of information to 3rd party: No consent Form of consent for release of information to 3rd party: No consent Form of consent for release of information to 3rd party: No consent Form of consent for release of information to 3rd party: No consent Form of consent for release of information to 3rd party: No consent Q.1.14. Does the centre require a written signed consent form for release of information to a third party while referring? No consent Observation 1 Yes 2 No Has an appointment system Has an appointment system Has an appointment system Has an appointment system Has an appointment system Q.1.15. Does the facility have an appointment system? 1 Yes 2 No Section Score, 1 Section Score, 1 Section Score, 1 Section Score, 1 Section Score, 1 Score for this section (.../...)*100 Section Grade, 1 Section Grade, 1 Section Grade, 1 Section Grade, 1 Section Grade, 1 Grade for this section Has waiting area Has waiting area Has waiting area Has waiting area Has waiting area Q2.1. Does the facility have a waiting area? Observation 1 Yes 2 No Counselling room has table, >= 2 chairs, >= 1 BCC materials Counselling room has table, >= 2 chairs, >= 1 BCC materials Counselling room has table, >= 2 chairs, >= 1 BCC materials Counselling room has table, >= 2 chairs, >= 1 BCC materials Counselling room has table, >= 2 chairs, >= 1 BCC materials Q.2.2. Do counselling room(s) contain a table, two or more chairs and one or more BCC materials? Observation 1 Yes 2 No Privacy maintained during counselling Privacy maintained during counselling Privacy maintained during counselling Privacy maintained during counselling Privacy maintained during counselling Q.2.3. Is privacy maintained during counselling sessions? 1 Yes 2 No Room available for group counselling Room available for group counselling Room available for group counselling Room available for group counselling Room available for group counselling Q.2.4. If the centre provides group counselling, is there a room available for group counselling sessions? Observation 1 Yes 2 No Separate blood collecting area/room available Separate blood collecting area/room available Separate blood collecting area/room available Separate blood collecting area/room available Separate blood collecting area/room available Q.2.5. If blood is collected here, is there a separate blood collection area/room? Observation 1 Yes 2 No Adequate water supply available Adequate water supply available Adequate water supply available Adequate water supply available Adequate water supply available Q.2.6. Is adequate water supply available in this centre? Observation 1 Yes Section score, 2 Section score, 2 Section score, 2 Section score, 2 Section score, 2 Score for this section (.../...)*100 Section grade, 2 Section grade, 2 Section grade, 2 Section grade, 2 Section grade, 2 Grade for this section Receptionist available Receptionist available Receptionist available Receptionist available Receptionist available Q.3.1. Is there a receptionist available in the VCT centre? Observation 1 Yes 2 No Counselling provider - Counsellor Counselling provider - Counsellor Counselling provider - Counsellor Counselling provider - Counsellor Counselling provider - Counsellor Q.3.2. Who provides counselling at this centre? Counsellor Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Counselling provider - Health worker Counselling provider - Health worker Counselling provider - Health worker Counselling provider - Health worker Counselling provider - Health worker Q.3.2. Who provides counselling at this centre? Health worker Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Counselling provider - Nurse Counselling provider - Nurse Counselling provider - Nurse Counselling provider - Nurse Counselling provider - Nurse Q.3.2. Who provides counselling at this centre? Nurse Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Counselling provider - Doctor Counselling provider - Doctor Counselling provider - Doctor Counselling provider - Doctor Counselling provider - Doctor Q.3.2. Who provides counselling at this centre? Doctor Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Counselling provider - Others Counselling provider - Others Counselling provider - Others Counselling provider - Others Counselling provider - Others Q.3.2. Who provides counselling at this centre? Others Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Counselling provider - Other specify Counselling provider - Other specify Counselling provider - Other specify Counselling provider - Other specify Counselling provider - Other specify Q.3.2. Who provides counselling at this centre? Others, specify Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Had training for pre, post test and ongoing counselling - Counsellor Had training for pre, post test and ongoing counselling - Counsellor Had training for pre, post test and ongoing counselling - Counsellor Had training for pre, post test and ongoing counselling - Counsellor Had training for pre, post test and ongoing counselling - Counsellor Q.3.3. Has the individual received any training on pre test, post test and ongoing counselling? Counsellor Multiple response possible DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Had training for pre, post test and ongoing counselling - Health worker Had training for pre, post test and ongoing counselling - Health worker Had training for pre, post test and ongoing counselling - Health worker Had training for pre, post test and ongoing counselling - Health worker Had training for pre, post test and ongoing counselling - Health worker Q.3.3. Has the individual received any training on pre test, post test and ongoing counselling? Health worker Multiple response possible DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Had training for pre, post test and ongoing counselling - Nurse Had training for pre, post test and ongoing counselling - Nurse Had training for pre, post test and ongoing counselling - Nurse Had training for pre, post test and ongoing counselling - Nurse Had training for pre, post test and ongoing counselling - Nurse Q.3.3. Has the individual received any training on pre test, post test and ongoing counselling? Nurse Multiple response possible DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Had training for pre, post test and ongoing counselling - Doctor Had training for pre, post test and ongoing counselling - Doctor Had training for pre, post test and ongoing counselling - Doctor Had training for pre, post test and ongoing counselling - Doctor Had training for pre, post test and ongoing counselling - Doctor Q.3.3. Has the individual received any training on pre test, post test and ongoing counselling? Doctor Multiple response possible DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Had training for pre, post test and ongoing counselling - Others Had training for pre, post test and ongoing counselling - Others Had training for pre, post test and ongoing counselling - Others Had training for pre, post test and ongoing counselling - Others Had training for pre, post test and ongoing counselling - Others Q.3.3. Has the individual received any training on pre test, post test and ongoing counselling? Others Multiple response possible DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Had training for pre, post test and ongoing counselling - Other specific Had training for pre, post test and ongoing counselling - Other specific Had training for pre, post test and ongoing counselling - Other specific Had training for pre, post test and ongoing counselling - Other specific Had training for pre, post test and ongoing counselling - Other specific Q.3.3. Has the individual received any training on pre test, post test and ongoing counselling? Others, specify DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Place of training for pre, post, ongoing test, designation 1 Place of training for pre, post, ongoing test, designation 1 Place of training for pre, post, ongoing test, designation 1 Place of training for pre, post, ongoing test, designation 1 Place of training for pre, post, ongoing test, designation 1 Q.3.4. If yes, from where has s/he received the training on pre, post and ongoing counselling? Designation: ________________ DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Government 2 International 3 Both 99 Others Place of training for pre, post, ongoing test, designation 1, other specific Place of training for pre, post, ongoing test, designation 1, other specific Place of training for pre, post, ongoing test, designation 1, other specific Place of training for pre, post, ongoing test, designation 1, other specific Place of training for pre, post, ongoing test, designation 1, other specific Q.3.4. If yes, from where has s/he received the training on pre, post and ongoing counselling? Others, specify Designation: ________________ DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Place of training for pre, post, ongoing test, designation 2 Place of training for pre, post, ongoing test, designation 2 Place of training for pre, post, ongoing test, designation 2 Place of training for pre, post, ongoing test, designation 2 Place of training for pre, post, ongoing test, designation 2 Q.3.4. If yes, from where has s/he received the training on pre, post and ongoing counselling? Designation: ________________ 1 Government 2 International 3 Both 99 Others Place of training for pre, post, ongoing test, designation 2, other specific Place of training for pre, post, ongoing test, designation 2, other specific Place of training for pre, post, ongoing test, designation 2, other specific Place of training for pre, post, ongoing test, designation 2, other specific Place of training for pre, post, ongoing test, designation 2, other specific Q.3.4. If yes, from where has s/he received the training on pre, post and ongoing counselling? Others, specify Designation: ________________ Place of training for pre, post, ongoing test, designation 3 Place of training for pre, post, ongoing test, designation 3 Place of training for pre, post, ongoing test, designation 3 Place of training for pre, post, ongoing test, designation 3 Place of training for pre, post, ongoing test, designation 3 Q.3.4. If yes, from where has s/he received the training on pre, post and ongoing counselling? Designation: ________________ 1 Government 2 International 3 Both 99 Others Place of training for pre, post, ongoing test, designation 3, other specific Place of training for pre, post, ongoing test, designation 3, other specific Place of training for pre, post, ongoing test, designation 3, other specific Place of training for pre, post, ongoing test, designation 3, other specific Place of training for pre, post, ongoing test, designation 3, other specific Q.3.4. If yes, from where has s/he received the training on pre, post and ongoing counselling? Others, specify Designation: ________________ Training duration in days, designation 1 Training duration in days, designation 1 Training duration in days, designation 1 Training duration in days, designation 1 Training duration in days, designation 1 Q.3.5. For how long did s/he receive training (in days)? Designation: __________________ Multiple repsonse possible DO NOT READ OUT 1 >= 6 days 2 4 - 5 days 3 < 4 days Training duration in days, designation 2 Training duration in days, designation 2 Training duration in days, designation 2 Training duration in days, designation 2 Training duration in days, designation 2 Q.3.5. For how long did s/he receive training (in days)? Designation: __________________ Multiple repsonse possible DO NOT READ OUT 1 >= 6 days 2 4 - 5 days 3 < 4 days Training duration in days, designation 3 Training duration in days, designation 3 Training duration in days, designation 3 Training duration in days, designation 3 Training duration in days, designation 3 Q.3.5. For how long did s/he receive training (in days)? Designation: __________________ Multiple repsonse possible DO NOT READ OUT 1 >= 6 days 2 4 - 5 days 3 < 4 days Blood drawing and HIV testing done by Counsellor Blood drawing and HIV testing done by Counsellor Blood drawing and HIV testing done by Counsellor Blood drawing and HIV testing done by Counsellor Blood drawing and HIV testing done by Counsellor Q.3.6. Who conducts blood drawing and HIV testing at this centre? Counsellor Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Blood drawing and HIV testing done by Health Worker Blood drawing and HIV testing done by Health Worker Blood drawing and HIV testing done by Health Worker Blood drawing and HIV testing done by Health Worker Blood drawing and HIV testing done by Health Worker Q.3.6. Who conducts blood drawing and HIV testing at this centre? Health worker Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Blood drawing and HIV testing done by Nurse Blood drawing and HIV testing done by Nurse Blood drawing and HIV testing done by Nurse Blood drawing and HIV testing done by Nurse Blood drawing and HIV testing done by Nurse Q.3.6. Who conducts blood drawing and HIV testing at this centre? Nurse Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Blood drawing and HIV testing done by Doctor Blood drawing and HIV testing done by Doctor Blood drawing and HIV testing done by Doctor Blood drawing and HIV testing done by Doctor Blood drawing and HIV testing done by Doctor Q.3.6. Who conducts blood drawing and HIV testing at this centre? Doctor Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Blood drawing and HIV testing done by Others Blood drawing and HIV testing done by Others Blood drawing and HIV testing done by Others Blood drawing and HIV testing done by Others Blood drawing and HIV testing done by Others Q.3.6. Who conducts blood drawing and HIV testing at this centre? Others Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Blood drawing and HIV testing done by Other, specific Blood drawing and HIV testing done by Other, specific Blood drawing and HIV testing done by Other, specific Blood drawing and HIV testing done by Other, specific Blood drawing and HIV testing done by Other, specific Q.3.6. Who conducts blood drawing and HIV testing at this centre? Others, specify Received training on relevant tests conducted: Counsellor Received training on relevant tests conducted: Counsellor Received training on relevant tests conducted: Counsellor Received training on relevant tests conducted: Counsellor Received training on relevant tests conducted: Counsellor Q.3.7. Has the individual received any training on the relevant tests that s/he conducts? Counsellor Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Received training on relevant tests conducted: Health worker Received training on relevant tests conducted: Health worker Received training on relevant tests conducted: Health worker Received training on relevant tests conducted: Health worker Received training on relevant tests conducted: Health worker Q.3.7. Has the individual received any training on the relevant tests that s/he conducts? Health Worker Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Received training on relevant tests conducted: Nurse Received training on relevant tests conducted: Nurse Received training on relevant tests conducted: Nurse Received training on relevant tests conducted: Nurse Received training on relevant tests conducted: Nurse Q.3.7. Has the individual received any training on the relevant tests that s/he conducts? Nurse Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Received training on relevant tests conducted: Doctor Received training on relevant tests conducted: Doctor Received training on relevant tests conducted: Doctor Received training on relevant tests conducted: Doctor Received training on relevant tests conducted: Doctor Q.3.7. Has the individual received any training on the relevant tests that s/he conducts? Doctor Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Received training on relevant tests conducted: Others Received training on relevant tests conducted: Others Received training on relevant tests conducted: Others Received training on relevant tests conducted: Others Received training on relevant tests conducted: Others Q.3.7. Has the individual received any training on the relevant tests that s/he conducts? Others Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Received training on relevant tests conducted: Other specific Received training on relevant tests conducted: Other specific Received training on relevant tests conducted: Other specific Received training on relevant tests conducted: Other specific Received training on relevant tests conducted: Other specific Q.3.7. Has the individual received any training on the relevant tests that s/he conducts? Others, specify Place of training for relevant tests, designation 1 Place of training for relevant tests, designation 1 Place of training for relevant tests, designation 1 Place of training for relevant tests, designation 1 Place of training for relevant tests, designation 1 Q.3.8. If yes, from where has s/he received the training on HIV testing? Designation: __________________ 1 Government 2 International 3 Both 99 Others Place of training for relevant tests, designation 1, other specific Place of training for relevant tests, designation 1, other specific Place of training for relevant tests, designation 1, other specific Place of training for relevant tests, designation 1, other specific Place of training for relevant tests, designation 1, other specific Q.3.8. If yes, from where has s/he received the training on HIV testing? Others, specify Designation: __________________ Place of training for relevant tests, designation 2 Place of training for relevant tests, designation 2 Place of training for relevant tests, designation 2 Place of training for relevant tests, designation 2 Place of training for relevant tests, designation 2 Q.3.8. If yes, from where has s/he received the training on HIV testing? Designation: __________________ 1 Government 2 International 3 Both 99 Others Place of training for relevant tests, designation 2, other specific Place of training for relevant tests, designation 2, other specific Place of training for relevant tests, designation 2, other specific Place of training for relevant tests, designation 2, other specific Place of training for relevant tests, designation 2, other specific Q.3.8. If yes, from where has s/he received the training on HIV testing? Others, specify Designation: __________________ Place of training for relevant tests, designation 3 Place of training for relevant tests, designation 3 Place of training for relevant tests, designation 3 Place of training for relevant tests, designation 3 Place of training for relevant tests, designation 3 Q.3.8. If yes, from where has s/he received the training on HIV testing? Designation: __________________ 1 Government 2 International 3 Both 99 Others Place of training for relevant tests, designation 3, other specific Place of training for relevant tests, designation 3, other specific Place of training for relevant tests, designation 3, other specific Place of training for relevant tests, designation 3, other specific Place of training for relevant tests, designation 3, other specific Q.3.8. If yes, from where has s/he received the training on HIV testing? Others, specify Designation: __________________ Support staff (cleaner/attendant) available Support staff (cleaner/attendant) available Support staff (cleaner/attendant) available Support staff (cleaner/attendant) available Support staff (cleaner/attendant) available Q.3.9. Is there any support staff (cleaner/attendant) available at this centre? Observation No 2 -> Q.3.12 1 Yes 2 No Cleaner has to handle biohazards Cleaner has to handle biohazards Cleaner has to handle biohazards Cleaner has to handle biohazards Cleaner has to handle biohazards Q.3.10. Does the cleaner have to handle biohazard substances? No 2 -> Q.3.12 Q.3.9 = 1 1 Yes 2 No Protection measures, gloves Protection measures, gloves Protection measures, gloves Protection measures, gloves Protection measures, gloves Q.3.11. If yes, are measures taken for the individual's protection? Gloves Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.3.10 - 1 1 Yes 2 No Protection measures, mask Protection measures, mask Protection measures, mask Protection measures, mask Protection measures, mask Q.3.11. If yes, are measures taken for the individual's protection? Mask Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.3.10 - 1 1 Yes 2 No Protection measures, apron Protection measures, apron Protection measures, apron Protection measures, apron Protection measures, apron Q.3.11. If yes, are measures taken for the individual's protection? Apron Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.3.10 - 1 1 Yes 2 No Protection measures, footwear Protection measures, footwear Protection measures, footwear Protection measures, footwear Protection measures, footwear Q.3.11. If yes, are measures taken for the individual's protection? Footwear Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.3.10 - 1 1 Yes 2 No Protection measures, others Protection measures, others Protection measures, others Protection measures, others Protection measures, others Q.3.11. If yes, are measures taken for the individual's protection? Others Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.3.10 - 1 1 Yes 2 No Protection measures, other specific Protection measures, other specific Protection measures, other specific Protection measures, other specific Protection measures, other specific Q.3.11. If yes, are measures taken for the individual's protection? Others, specify Q.3.10 - 1 Clinical service provider available Clinical service provider available Clinical service provider available Clinical service provider available Clinical service provider available Q.3.12. Is there any clinical service provider in this centre? Observation No 2 -> Q.3.14 1 Yes 2 No Received training on clinical case management Received training on clinical case management Received training on clinical case management Received training on clinical case management Received training on clinical case management Q.3.13. If yes, did s/he receive any training on HIV clinical case management? Q.3.12 = 1 1 Yes 2 No Clinical cases referred to other facilities Clinical cases referred to other facilities Clinical cases referred to other facilities Clinical cases referred to other facilities Clinical cases referred to other facilities Q.3.14. If no, do you refer clinical cases to other facilities? 1 Yes 2 No Section score, 3 Section score, 3 Section score, 3 Section score, 3 Section score, 3 Score for this section (.../...)*100 Section grade, 3 Section grade, 3 Section grade, 3 Section grade, 3 Section grade, 3 Grade for this section Greeter in facility Greeter in facility Greeter in facility Greeter in facility Greeter in facility Q.4.1. Does anyone greet or welcome a client in the VCT centre and explain the VCT service procedure? 1 Yes 2 No Length of pretest counselling Length of pretest counselling Length of pretest counselling Length of pretest counselling Length of pretest counselling Q.4.2 How long does a pre test counselling session take on average? 1 >= 30 mins 2 < 30 mins Issues in pretest counselling: Basic HIV information Issues in pretest counselling: Basic HIV information Issues in pretest counselling: Basic HIV information Issues in pretest counselling: Basic HIV information Issues in pretest counselling: Basic HIV information Q.4.3. What are the issues that are covered during pre test counselling? Basic HIV information Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Issues in pretest counselling: Personal risk assessment Issues in pretest counselling: Personal risk assessment Issues in pretest counselling: Personal risk assessment Issues in pretest counselling: Personal risk assessment Issues in pretest counselling: Personal risk assessment Q.4.3. What are the issues that are covered during pre test counselling? Personal risk assessment Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Issues in pretest counselling: Explore benefits Issues in pretest counselling: Explore benefits Issues in pretest counselling: Explore benefits Issues in pretest counselling: Explore benefits Issues in pretest counselling: Explore benefits Q.4.3. What are the issues that are covered during pre test counselling? Explore benefits and potential difficulties of knowing HIV status Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Issues in pretest counselling: Assessment of strategies Issues in pretest counselling: Assessment of strategies Issues in pretest counselling: Assessment of strategies Issues in pretest counselling: Assessment of strategies Issues in pretest counselling: Assessment of strategies Q.4.3. What are the issues that are covered during pre test counselling? Assessment of strategies for coping with HIV positive result Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Issues in pretest counselling: Condom use Issues in pretest counselling: Condom use Issues in pretest counselling: Condom use Issues in pretest counselling: Condom use Issues in pretest counselling: Condom use Q.4.3. What are the issues that are covered during pre test counselling? Condom use and demonstration Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Issues in pretest counselling: Explanation of test Issues in pretest counselling: Explanation of test Issues in pretest counselling: Explanation of test Issues in pretest counselling: Explanation of test Issues in pretest counselling: Explanation of test Q.4.3. What are the issues that are covered during pre test counselling? Explanation of test and result procedure Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Issues in pretest counselling: Informed consent Issues in pretest counselling: Informed consent Issues in pretest counselling: Informed consent Issues in pretest counselling: Informed consent Issues in pretest counselling: Informed consent Q.4.3. What are the issues that are covered during pre test counselling? Informed consent Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Issues in pretest counselling: Others Issues in pretest counselling: Others Issues in pretest counselling: Others Issues in pretest counselling: Others Issues in pretest counselling: Others Q.4.3. What are the issues that are covered during pre test counselling? Others Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Penile model and condom available Penile model and condom available Penile model and condom available Penile model and condom available Penile model and condom available Q.4.4. Is there a penile model and condoms available with the counsellor? (observation) Observation 1 Yes 2 No Condom demonstration during counselling Condom demonstration during counselling Condom demonstration during counselling Condom demonstration during counselling Condom demonstration during counselling Q.4.5. Is condom demonstration done during counselling? 1 Yes 2 No Length of waiting time before release of HIV result Length of waiting time before release of HIV result Length of waiting time before release of HIV result Length of waiting time before release of HIV result Length of waiting time before release of HIV result Q.4.6. How long does the client wait for a HIV test result? 1 Same day 2 Next day or more Person who gives result to client Person who gives result to client Person who gives result to client Person who gives result to client Person who gives result to client Q.4.7. Who gives the result to the client? 1 Same counsellor who did pretest counselling 2 Another counsellor Length of post test counselling for negative result Length of post test counselling for negative result Length of post test counselling for negative result Length of post test counselling for negative result Length of post test counselling for negative result Q.4.8. How long does a post test counselling session take on average, if the result is negative? 1 >= 10 mins 2 < 10 mins Length of post test counselling for positive result Length of post test counselling for positive result Length of post test counselling for positive result Length of post test counselling for positive result Length of post test counselling for positive result Q.4.9. How long does a post test counselling session take on average, if the result is positive? 1 >= 30 mins 2 < 30 mins Partner notification carried out Partner notification carried out Partner notification carried out Partner notification carried out Partner notification carried out Q.4.10. Do you carry out partner notification in this facility? No 2 -> Q.4.13 1 Yes 2 No Partner notification done without patient consent Partner notification done without patient consent Partner notification done without patient consent Partner notification done without patient consent Partner notification done without patient consent Q.4.11. If yes, did you ever notify the partner without the consent of the client? -> Q.4.13 Q.4.10 = 1 1 Yes 2 No Followed partner notification policy for HIV status disclosure Followed partner notification policy for HIV status disclosure Followed partner notification policy for HIV status disclosure Followed partner notification policy for HIV status disclosure Followed partner notification policy for HIV status disclosure Q.4.12. If yes, did you follow the “partner notification policy” for disclosure of HIV status? Q.4.11 = 1 1 Yes 2 No Post Exposure Prophylaxis (PEP) system in place Post Exposure Prophylaxis (PEP) system in place Post Exposure Prophylaxis (PEP) system in place Post Exposure Prophylaxis (PEP) system in place Post Exposure Prophylaxis (PEP) system in place Q.4.13. If blood is drawn at the facility, is there a system for Post Exposure Prophylaxis (PEP) in place? ->Q.5.1 1 Yes 2 No Has focal person for PEP Has focal person for PEP Has focal person for PEP Has focal person for PEP Has focal person for PEP Q.4.14. If yes, do you have an identified focal person who deals with the PEP? Q.4.13 = 1 1 Yes 2 No ARVs available for PEP ARVs available for PEP ARVs available for PEP ARVs available for PEP ARVs available for PEP Q.4.15. Are there ARVs available for PEP on site/ through referral? 1 Yes 2 No Section score, 4 Section score, 4 Section score, 4 Section score, 4 Section score, 4 Score for this section (../...)*100 Section grade, 4 Section grade, 4 Section grade, 4 Section grade, 4 Section grade, 4 Grade for this section National guidelines for VCT management available National guidelines for VCT management available National guidelines for VCT management available National guidelines for VCT management available National guidelines for VCT management available Q5.1 Is adequate water supply available in the laboratory? Observation 1 Yes 2 No HIV testing protocol available HIV testing protocol available HIV testing protocol available HIV testing protocol available HIV testing protocol available Q5.2 Does the laboratory have access to a functioning autoclave? Observation No 2 -> Q5.5 1 Yes 2 No Written procedure on confidentiality available Written procedure on confidentiality available Written procedure on confidentiality available Written procedure on confidentiality available Written procedure on confidentiality available Q5.3 If autoclaving is done, is there an autoclave on site? Observation Q5.2 = 1 1 Yes 2 No Universal Precautions (UP) guideline available Universal Precautions (UP) guideline available Universal Precautions (UP) guideline available Universal Precautions (UP) guideline available Universal Precautions (UP) guideline available Q5.4 Are standard procedures followed for autoclaving? Q5.2 = 1 1 Yes 2 No PEP guideline available PEP guideline available PEP guideline available PEP guideline available PEP guideline available Q5.5 If there is no autoclave, how are materials sterilized usually, in last 7 days? Q5.2 = 2 1 Yes 2 No Section score, 5 Section score, 5 Section score, 5 Section score, 5 Section score, 5 Score for this section (.../...)*100 Section grade, 5 Section grade, 5 Section grade, 5 Section grade, 5 Section grade, 5 Grade for this section Record of VCT clients maintained Record of VCT clients maintained Record of VCT clients maintained Record of VCT clients maintained Record of VCT clients maintained Q6.1 Microscope, presence Observation 1 Yes 2 No System for recording blood sample for HIV testing in place System for recording blood sample for HIV testing in place System for recording blood sample for HIV testing in place System for recording blood sample for HIV testing in place System for recording blood sample for HIV testing in place Q6.2 Sink for staining, presence Observation 1 Yes 2 No Blood sample recording system Blood sample recording system Blood sample recording system Blood sample recording system Blood sample recording system Q6.3 Micropipettes, presence Observation 1 Computerized 2 Register book 3 Both 99 Others Blood sample recording system, other specific Blood sample recording system, other specific Blood sample recording system, other specific Blood sample recording system, other specific Blood sample recording system, other specific Q.6.3. If yes, describe how? Other Pretest counselling form available Pretest counselling form available Pretest counselling form available Pretest counselling form available Pretest counselling form available Q6.4 ELISA washer, presence Observation 1 Yes 2 No Pretest counselling recording Pretest counselling recording Pretest counselling recording Pretest counselling recording Pretest counselling recording Q.6.5. If no, describe how the pre test counselling is recorded? Q.6.4 = 2 1 Plain white paper 99 Others Pretest counselling recording, other specific Pretest counselling recording, other specific Pretest counselling recording, other specific Pretest counselling recording, other specific Pretest counselling recording, other specific Q.6.5. If no, describe how the pre test counselling is recorded? Others, specify Q.6.4 = 2 Post test counselling form available Post test counselling form available Post test counselling form available Post test counselling form available Post test counselling form available Q.6.6. Is post test counselling form available? ->Q.6.8 1 Yes 2 No Post test counselling recording Post test counselling recording Post test counselling recording Post test counselling recording Post test counselling recording Q6.7 Bunsen Burner/spirit lamp, presence Observation 1 Plain white paper 99 Others Post test counselling recording, other specific Post test counselling recording, other specific Post test counselling recording, other specific Post test counselling recording, other specific Post test counselling recording, other specific Q.6.7. If no, describe how the post test counselling is recorded? Others, specify Q.6.6 = 2 Informed consent for HIV testing available Informed consent for HIV testing available Informed consent for HIV testing available Informed consent for HIV testing available Informed consent for HIV testing available Q6.8 Hot air oven, presence Observation 1 Yes 2 No Manner of taking consent for HIV testing Manner of taking consent for HIV testing Manner of taking consent for HIV testing Manner of taking consent for HIV testing Manner of taking consent for HIV testing Q6.9 Incubator, presence Observation 1 Plain white paper 99 Others Manner of taking consent for HIV testing, other specific Manner of taking consent for HIV testing, other specific Manner of taking consent for HIV testing, other specific Manner of taking consent for HIV testing, other specific Manner of taking consent for HIV testing, other specific Q.6.9. If no, how consent for HIV testing is taken? Others, specify Q.6.8 = 2 Record of clients referred to other fcilities available Record of clients referred to other fcilities available Record of clients referred to other fcilities available Record of clients referred to other fcilities available Record of clients referred to other fcilities available Q6.10 Plate shaker, presence Observation 1 Yes 2 No Monthly/quarterly report provided to authority in timely manner Monthly/quarterly report provided to authority in timely manner Monthly/quarterly report provided to authority in timely manner Monthly/quarterly report provided to authority in timely manner Monthly/quarterly report provided to authority in timely manner Q6.11 CD4, presence Observation 1 Yes 2 No Copy of monthly/quarterly report available Copy of monthly/quarterly report available Copy of monthly/quarterly report available Copy of monthly/quarterly report available Copy of monthly/quarterly report available Q6.12 Refrigerator, presence Observation 1 Yes 2 No Section score, 6 Section score, 6 Section score, 6 Section score, 6 Section score, 6 Score for this section (.../...)*100 Section grade, 6 Section grade, 6 Section grade, 6 Section grade, 6 Section grade, 6 Grade for this section VCT leaflets/pamphlets available VCT leaflets/pamphlets available VCT leaflets/pamphlets available VCT leaflets/pamphlets available VCT leaflets/pamphlets available Q7.1 Does the laboratory have adequate reagents/kits for STI diagnosis available? Observation 1 Yes 2 No HIV Risk reduction leaflets/pamphlets available HIV Risk reduction leaflets/pamphlets available HIV Risk reduction leaflets/pamphlets available HIV Risk reduction leaflets/pamphlets available HIV Risk reduction leaflets/pamphlets available Q7.2 Does the laboratory have adequate reagents/kits for HIV diagnosis available? Observation 1 Yes 2 No HIV Risk reduction poster in the waiting room HIV Risk reduction poster in the waiting room HIV Risk reduction poster in the waiting room HIV Risk reduction poster in the waiting room HIV Risk reduction poster in the waiting room Q7.3 Do the reagents/kits usually arrive in the reference laboratory in right conditions (e.g. temperature, intact packages, etc)? 1 Yes 2 No STI pamphlets available STI pamphlets available STI pamphlets available STI pamphlets available STI pamphlets available Q7.4 What does the laboratory do if the supplies do not arrive in right condition? 1 Yes 2 No Pamphlets for positive living for PLHIV available Pamphlets for positive living for PLHIV available Pamphlets for positive living for PLHIV available Pamphlets for positive living for PLHIV available Pamphlets for positive living for PLHIV available Q7.5 Are any of the reagents/kits available at the facility beyond expired date? Observation No 2 -> Q7.7 1 Yes 2 No Pamphlets on PPTCT available Pamphlets on PPTCT available Pamphlets on PPTCT available Pamphlets on PPTCT available Pamphlets on PPTCT available Q7.6 What is done with the expired reagents/kits? Q7.5 = 1 1 Yes 2 No Condoms available for client Condoms available for client Condoms available for client Condoms available for client Condoms available for client Q7.7 Does the laboratory usually have adequate quantity of disinfectants for STI? Observation 1 Yes 2 No Condom grosses in stock Condom grosses in stock Condom grosses in stock Condom grosses in stock Condom grosses in stock Q.7.8. How many condom grosses are in stock at this centre today? Observation and Check register Condoms out of stock last year Condoms out of stock last year Condoms out of stock last year Condoms out of stock last year Condoms out of stock last year Q.7.9. Was this facility ever out of stock of condoms in last year? Check register 1 Yes 2 No Section score, 7 Section score, 7 Section score, 7 Section score, 7 Section score, 7 Score for this section (.../...)*100 Section grade, 7 Section grade, 7 Section grade, 7 Section grade, 7 Section grade, 7 Grade for this section HIV testing done HIV testing done HIV testing done HIV testing done HIV testing done Q8.1 Is there a virologist/microbiologist is present in this laboratory now? Observation No 2 -> Q8.3 1 Yes 2 No Method of HIV testing: One rapid test Method of HIV testing: One rapid test Method of HIV testing: One rapid test Method of HIV testing: One rapid test Method of HIV testing: One rapid test Q.8.2. What is the method of HIV testing in this centre? One rapid test Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.8.1 = 1 1 Yes 2 No Method of HIV testing: Two rapid tests Method of HIV testing: Two rapid tests Method of HIV testing: Two rapid tests Method of HIV testing: Two rapid tests Method of HIV testing: Two rapid tests Q.8.2. What is the method of HIV testing in this centre? Two rapid tests Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.8.1 = 1 1 Yes 2 No Method of HIV testing: Three rapid tests Method of HIV testing: Three rapid tests Method of HIV testing: Three rapid tests Method of HIV testing: Three rapid tests Method of HIV testing: Three rapid tests Q.8.2. What is the method of HIV testing in this centre? Three rapid tests Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.8.1 = 1 1 Yes 2 No Method of HIV testing: ELISA Method of HIV testing: ELISA Method of HIV testing: ELISA Method of HIV testing: ELISA Method of HIV testing: ELISA Q.8.2. What is the method of HIV testing in this centre? ELISA Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.8.1 = 1 1 Yes 2 No Method of HIV testing: Western Blot Method of HIV testing: Western Blot Method of HIV testing: Western Blot Method of HIV testing: Western Blot Method of HIV testing: Western Blot Q.8.2. What is the method of HIV testing in this centre? Western Blot Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.8.1 = 1 1 Yes 2 No HIV testing algorithm followed HIV testing algorithm followed HIV testing algorithm followed HIV testing algorithm followed HIV testing algorithm followed Q8.3 Is there any laboratory technologist is present in this laboratory now? Observation No 2 -> Q8.5 1 Yes 2 No Waiting time for release of HIV result Waiting time for release of HIV result Waiting time for release of HIV result Waiting time for release of HIV result Waiting time for release of HIV result Q8.4 If yes, has she/he training on the relevant tests that s/he conducts? Q8.3 = 1 1 Same day 2 After one day 3 After two days 4 More than two days 99 Others Waiting time for release of HIV result, other specific Waiting time for release of HIV result, other specific Waiting time for release of HIV result, other specific Waiting time for release of HIV result, other specific Waiting time for release of HIV result, other specific Q.8.4. How soon the HIV result is usually provided to the client? Q.8.1 = 1 Adequate reagents/ kits for HIV diagnosis available Adequate reagents/ kits for HIV diagnosis available Adequate reagents/ kits for HIV diagnosis available Adequate reagents/ kits for HIV diagnosis available Adequate reagents/ kits for HIV diagnosis available Q8.5 Is there a laboratory technician is present in this laboratory now? (observation) Observation 1 Yes 2 No Reagents/kits arrive in right condition Reagents/kits arrive in right condition Reagents/kits arrive in right condition Reagents/kits arrive in right condition Reagents/kits arrive in right condition Q8.6 If yes, has she/he training on the relevant tests that s/he conducts? No 2 -> Q8.7 Q8.5 = 1 1 Yes 2 No Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Q8.7 Is there any cleaner/attendant available in this laboratory? Observation No 2 -> Q8.10 1 Discarded 2 Returned 3 Used 99 Others Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Q.8.7. What does the laboratory usually do if the supplies do not arrive in good condition? Others, specify Q.8.1 = 1 Has expired reagent/kit Has expired reagent/kit Has expired reagent/kit Has expired reagent/kit Has expired reagent/kit Q8.8 Does the cleaner/attendant have to handle biohazard substances? Q8.7 = 1 1 Yes 2 No Action taken on expired reagent/kit Action taken on expired reagent/kit Action taken on expired reagent/kit Action taken on expired reagent/kit Action taken on expired reagent/kit Q.8.9. What is done with expired reagents/kits usually, if any? Q.8.1 = 1 & Q.8.8 = 1 1 Discarded 2 Returned 3 Used 99 Others Action taken on expired reagent/kit, other specific Action taken on expired reagent/kit, other specific Action taken on expired reagent/kit, other specific Action taken on expired reagent/kit, other specific Action taken on expired reagent/kit, other specific Q.8.9. What is done with expired reagents/kits usually, if any? Others, specify Q.8.1 = 1 & Q.8.8 = 1 Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Q8.10 Is there an engineer available who is responsible for maintaining the equipment in this laboratory? Observation No 2 -> Q9.1 1 Yes 2 No Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Q8.11 If yes, does she/he have B.Sc level of qualification? Q8.10 = 1 1 Yes 2 No Adequate stock of other lab supplies Adequate stock of other lab supplies Adequate stock of other lab supplies Adequate stock of other lab supplies Adequate stock of other lab supplies Q.8.12. Is there an adequate stock of other laboratory supplies? Check register Q.8.1 = 1 1 All esential supplies 2 Some supplies 3 None Sharps disposal container available Sharps disposal container available Sharps disposal container available Sharps disposal container available Sharps disposal container available Q.8.13. Is sharps disposal container available? Observation Q.8.1 = 1 1 Yes 2 No Staff wear gloves during blood sample collection Staff wear gloves during blood sample collection Staff wear gloves during blood sample collection Staff wear gloves during blood sample collection Staff wear gloves during blood sample collection Q.8.14. Do staff wear gloves during blood sample collection? Q.8.1 = 1 1 Yes 2 No Section score, 8 Section score, 8 Section score, 8 Section score, 8 Section score, 8 Score for this section (.../...)*100 Section grade, 8 Section grade, 8 Section grade, 8 Section grade, 8 Section grade, 8 Grade for this section Unique key Unique key Unique key Unique key Unique key Unique key RECSTATUS RECSTATUS RECSTATUS RECSTATUS RECSTATUS Basic infection prevention measures followed Basic infection prevention measures followed Basic infection prevention measures followed Basic infection prevention measures followed Basic infection prevention measures followed Q9.11 Do all clinical staff dispose needle and syringe appropriately? 1 Yes 2 No Rules of hand washing followed Rules of hand washing followed Rules of hand washing followed Rules of hand washing followed Rules of hand washing followed Q.9.12. Do the staffs involved in blood drawing and HIV testing follow rules of hand washing? 1 Yes 2 No Gloves used during blood drawing and testing Gloves used during blood drawing and testing Gloves used during blood drawing and testing Gloves used during blood drawing and testing Gloves used during blood drawing and testing Q.9.13. Are gloves usually used during blood drawing and testing? 1 Yes 2 No Appropriate disposal of sharps system Appropriate disposal of sharps system Appropriate disposal of sharps system Appropriate disposal of sharps system Appropriate disposal of sharps system Q.9.14. Is there a system for appropriate disposal of sharps? Observation 1 Pllastic bin 2 Sharp box/safety box 3 Bottle Appropriate disposal of sharps system, other specific Appropriate disposal of sharps system, other specific Appropriate disposal of sharps system, other specific Appropriate disposal of sharps system, other specific Appropriate disposal of sharps system, other specific Q.9.14. Is there a system for appropriate disposal of sharps? Others, specify Observation Appropriate disposal of needle and syringe Appropriate disposal of needle and syringe Appropriate disposal of needle and syringe Appropriate disposal of needle and syringe Appropriate disposal of needle and syringe Q.9.15. Do all staffs involved in blood drawing and HIV testing dispose needle and syringe appropriately? Observation 1 Yes 2 No Subsection score, 9a Subsection score, 9a Subsection score, 9a Subsection score, 9a Subsection score, 9a Score for this subsection (.../...)*100 Subsection grade, 9a Subsection grade, 9a Subsection grade, 9a Subsection grade, 9a Subsection grade, 9a Grade for this subsection Instruments decontaminated and sterilized after use Instruments decontaminated and sterilized after use Instruments decontaminated and sterilized after use Instruments decontaminated and sterilized after use Instruments decontaminated and sterilized after use Q.9.21. Are the instruments decontaminated and sterilized after each use? 1 Yes 2 No Hypochlorite/ savlon solution used Hypochlorite/ savlon solution used Hypochlorite/ savlon solution used Hypochlorite/ savlon solution used Hypochlorite/ savlon solution used Q.9.22. Is hypochlorite solution/savlon used in this facility? Observation 1 Yes 2 No Instruments dipped in hypochlorite/ savlon solution Instruments dipped in hypochlorite/ savlon solution Instruments dipped in hypochlorite/ savlon solution Instruments dipped in hypochlorite/ savlon solution Instruments dipped in hypochlorite/ savlon solution Q.9.23. After use are the instruments dipped in hypochlorite/savlon solution? No 2 -> Q.9.2.7 Q.9.2.3 = 1 1 Yes 2 No Length of time instrument is dipped Length of time instrument is dipped Length of time instrument is dipped Length of time instrument is dipped Length of time instrument is dipped Q.9.24. If yes, for how long? Q.9.2.3 = 1 1 <10 mins 2 10-30 mins 3 >30 mins Frequency of hypochlorite/ savlon preparation Frequency of hypochlorite/ savlon preparation Frequency of hypochlorite/ savlon preparation Frequency of hypochlorite/ savlon preparation Frequency of hypochlorite/ savlon preparation Q.9.25. How frequently is the hypochlorite solution/savlon prepared? Q.9.2.3 = 1 1 Daily/whenever required 2 Once in 2 days 99 Others Frequency of hypochlorite/ savlon preparation, other specific Frequency of hypochlorite/ savlon preparation, other specific Frequency of hypochlorite/ savlon preparation, other specific Frequency of hypochlorite/ savlon preparation, other specific Frequency of hypochlorite/ savlon preparation, other specific Q.9.25. How frequently is the hypochlorite solution/savlon prepared? Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Q.9.26. After dipping in hypochlorite solution/savlon, are the instruments washed by continuous flow of water? 1 Yes 2 No Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Q.9.27. After cleaning, are instruments autoclaved? No 2 -> Q.9.2.9 1 Yes 2 No Functioning autoclave on site Functioning autoclave on site Functioning autoclave on site Functioning autoclave on site Functioning autoclave on site Q.9.28. If autoclaving is done, is there a functioning autoclave on site? Observation Yes 1 -> Q.9.2.10 Q.9.2.7 = 1 1 Yes 2 No Easy access to autoclave Easy access to autoclave Easy access to autoclave Easy access to autoclave Easy access to autoclave Q.9.29. If not, is there easy access to an autoclave? Observation Q.9.2.8 = 2 1 Yes 2 No Autoclaving standard procedures followed Autoclaving standard procedures followed Autoclaving standard procedures followed Autoclaving standard procedures followed Autoclaving standard procedures followed Q.9.2.10 Are standard procedures followed for autoclaving? Check this only if autoclaving done on site. 1 Yes 2 No Length of time sterilized instruments kept before use Length of time sterilized instruments kept before use Length of time sterilized instruments kept before use Length of time sterilized instruments kept before use Length of time sterilized instruments kept before use Q.9.2.11 After sterilization, how long are instruments kept before use currently? 1 Covered with double layer of cloth and kept in a closed cabinet for 2 Covered with double layer of cloth and kept 3 Single layer of cloth and closed cabinet for 1 week 4 Single layer of cloth and open shelf for Length of time sterilized instruments kept before use, other specific Length of time sterilized instruments kept before use, other specific Length of time sterilized instruments kept before use, other specific Length of time sterilized instruments kept before use, other specific Length of time sterilized instruments kept before use, other specific Q.9.2.11. After sterilization, how long are instruments kept before use currently? Others, specify Subsection score, 9b Subsection score, 9b Subsection score, 9b Subsection score, 9b Subsection score, 9b Score for this subsection (.../...)*100 Subsection grade, 9b Subsection grade, 9b Subsection grade, 9b Subsection grade, 9b Subsection grade, 9b Grade for this subsection Buckets for contaminated waste available Buckets for contaminated waste available Buckets for contaminated waste available Buckets for contaminated waste available Buckets for contaminated waste available Q.9.3.1. Are there separate buckets with or without chemicals for disposal of contaminated waste (e.g. swab), instruments (e.g. forceps)? Observation 1 Yes 2 No Sharp disposal system Sharp disposal system Sharp disposal system Sharp disposal system Sharp disposal system Q.9.3.2. How sharps are disposed currently? Observation 1 Collected in hard closed bin and taken to deep pit burial 2 Collected in any bucket and taken to deep pit burial 99 Others Sharp disposal system, other specific Sharp disposal system, other specific Sharp disposal system, other specific Sharp disposal system, other specific Sharp disposal system, other specific Q.9.3.2. How sharps are disposed currently? Others, specify Glass disposal system Glass disposal system Glass disposal system Glass disposal system Glass disposal system Q.9.3.3. How glassware's are disposed currently? Observation 1 Collected in hard closed bin and taken to deep pit burial 2 Collected in hard closed bin and reused after autoclaving 3 Collected in any bucket and taken to deep pit burial 4 Collected in any bucket and reused after autoclaving Glass disposal system, other specific Glass disposal system, other specific Glass disposal system, other specific Glass disposal system, other specific Glass disposal system, other specific Q.9.3.3. How glassware's are disposed currently? Others, specify Common way of infectious material disposal Common way of infectious material disposal Common way of infectious material disposal Common way of infectious material disposal Common way of infectious material disposal Q.9.3.4. How infectious materials are disposed (e.g. Human placenta, blood, used cotton, gauge) most of the time? Observation 1 Deep pit burial 2 Burnt 99 Others Common way of infectious material disposal, other specific Common way of infectious material disposal, other specific Common way of infectious material disposal, other specific Common way of infectious material disposal, other specific Common way of infectious material disposal, other specific Q.9.3.4. How infectious materials are disposed (e.g. Human placenta, blood, used cotton, gauge) most of the time? Others, specify Common way of liquid clinical waste disposal Common way of liquid clinical waste disposal Common way of liquid clinical waste disposal Common way of liquid clinical waste disposal Common way of liquid clinical waste disposal Q.9.3.5. How liquid clinical waste is disposed most of the time? Observation 1 Decontaminate with disinfectant for 30 min and lead to underground drainage and lead to underground drainage 2 Lead to underground drainage 99 Others Common way of liquid clinical waste disposal, other specific Common way of liquid clinical waste disposal, other specific Common way of liquid clinical waste disposal, other specific Common way of liquid clinical waste disposal, other specific Common way of liquid clinical waste disposal, other specific Q.9.3.5. How liquid clinical waste is disposed most of the time? Others, specify Subsection score, 9c Subsection score, 9c Subsection score, 9c Subsection score, 9c Subsection score, 9c Score for this subsection (.../...)*100 Subsection grade, 9c Subsection grade, 9c Subsection grade, 9c Subsection grade, 9c Subsection grade, 9c Grade for this subsection Unique identifiers used for client record Unique identifiers used for client record Unique identifiers used for client record Unique identifiers used for client record Unique identifiers used for client record Q10.1 Microscope, presence Observation 1 Yes 2 No Unique identifier for blood samples labelling Unique identifier for blood samples labelling Unique identifier for blood samples labelling Unique identifier for blood samples labelling Unique identifier for blood samples labelling Q10.2 Sink for staining, presence Observation 1 Yes 2 No Counsellors understand confidentiality Counsellors understand confidentiality Counsellors understand confidentiality Counsellors understand confidentiality Counsellors understand confidentiality Q10.3 ELISA reader, presence Observation 1 Yes 2 No Staff understand confidentiality Staff understand confidentiality Staff understand confidentiality Staff understand confidentiality Staff understand confidentiality Q10.4 ELISA washer, presence Observation 1 Yes 2 No Locked cabinet for records available Locked cabinet for records available Locked cabinet for records available Locked cabinet for records available Locked cabinet for records available Q10.5 Micropipettes, presence Observation 1 Yes 2 No Had break in confidentiality Had break in confidentiality Had break in confidentiality Had break in confidentiality Had break in confidentiality Q10.6 Candle jar, presence Observation 1 Yes 2 No Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Q10.7 Bunsen Burner/spirit lamp, functioning Observation 1 Yes 2 No Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Q.10.7. If yes, how was this managed? Meeting with the individual person Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.10.6 = 1 1 Yes 2 No Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Q.10.7. If yes, how was this managed? Who broke confidentiality Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.10.6 = 1 1 Yes 2 No Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Q.10.7. If yes, how was this managed? Others Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.10.6 = 1 1 Yes 2 No Section score, 10 Section score, 10 Section score, 10 Section score, 10 Section score, 10 Score for this section (.../...)*100 Section grade, 10 Section grade, 10 Section grade, 10 Section grade, 10 Section grade, 10 Grade for this section Referral slip/form available Referral slip/form available Referral slip/form available Referral slip/form available Referral slip/form available Q11.1 Does the laboratory have adequate reagents/kits for STI diagnosis available? Observation 1 Yes 2 No HIV positive client referred to another facility HIV positive client referred to another facility HIV positive client referred to another facility HIV positive client referred to another facility HIV positive client referred to another facility Q11.2 Does the laboratory have adequate reagents/kits for HIV diagnosis available? Observation 1 Yes 2 No Record for referral available: Prescribed form Record for referral available: Prescribed form Record for referral available: Prescribed form Record for referral available: Prescribed form Record for referral available: Prescribed form Q.11.3. If yes, is there a record for this? Prescribed form Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.11.2 = 1 1 Yes 2 No Record for referral available: Register book Record for referral available: Register book Record for referral available: Register book Record for referral available: Register book Record for referral available: Register book Q.11.3. If yes, is there a record for this? Register Book Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.11.2 = 1 1 Yes 2 No Record for referral available: Other Record for referral available: Other Record for referral available: Other Record for referral available: Other Record for referral available: Other Q.11.3. If yes, is there a record for this? Others Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.11.2 = 1 1 yes 2 No Record for referral available: Other specific Record for referral available: Other specific Record for referral available: Other specific Record for referral available: Other specific Record for referral available: Other specific Q.11.3. If yes, is there a record for this? Others, specify Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.11.2 = 1 1 Yes 2 No Proportion of HIV negative clients referred to other facilities Proportion of HIV negative clients referred to other facilities Proportion of HIV negative clients referred to other facilities Proportion of HIV negative clients referred to other facilities Proportion of HIV negative clients referred to other facilities Q11.4 What does the laboratory do if the supplies do not arrive in right condition? Proportion of HIV positive clients reffered to other facilities Proportion of HIV positive clients reffered to other facilities Proportion of HIV positive clients reffered to other facilities Proportion of HIV positive clients reffered to other facilities Proportion of HIV positive clients reffered to other facilities Q11.5 Are any of the reagents/kits available at the facility beyond expired date? Observation No 2 -> Q11.7 Section score, 11 Section score, 11 Section score, 11 Section score, 11 Section score, 11 Score for this section (.../...)*100 Score for this section (.../...)*100 Section grade, 11 Section grade, 11 Section grade, 11 Section grade, 11 Section grade, 11 Grade for this section Grade for this section Method of monitoring of services in place Method of monitoring of services in place Method of monitoring of services in place Method of monitoring of services in place Method of monitoring of services in place Q12.1 Is there a virologist/microbiologist is present in this laboratory now? Observation No 2 -> Q12.3 1 Yes 2 No Number of supervisory visits Number of supervisory visits Number of supervisory visits Number of supervisory visits Number of supervisory visits Q12.2 If yes, has she/he received training in STI/HIV? Q12.1 = 1 1 0 visit 2 1-2 visits 3 >= 3 visits Checked during last visit: Facility setup Checked during last visit: Facility setup Checked during last visit: Facility setup Checked during last visit: Facility setup Checked during last visit: Facility setup Q12.3 How are the records of STI/HIV recorded? Computerized Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Checked during last visit: Personnel Checked during last visit: Personnel Checked during last visit: Personnel Checked during last visit: Personnel Checked during last visit: Personnel Q12.3 How are the records of STI/HIV recorded? Register book Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Checked during last visit: Records Checked during last visit: Records Checked during last visit: Records Checked during last visit: Records Checked during last visit: Records Q12.3 How are the records of STI/HIV recorded? Others Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Checked during last visit: Universal precaution Checked during last visit: Universal precaution Checked during last visit: Universal precaution Checked during last visit: Universal precaution Checked during last visit: Universal precaution Q12.3 How are the records of STI/HIV recorded? Others, specify Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Checked during last visit: Others Checked during last visit: Others Checked during last visit: Others Checked during last visit: Others Checked during last visit: Others Q.12.3. What was checked during the last visit? Others Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.12.2 <> 1 1 Yes 2 No Checked during last visit: Other specific Checked during last visit: Other specific Checked during last visit: Other specific Checked during last visit: Other specific Checked during last visit: Other specific Q.12.3. What was checked during the last visit? Others, specify Multiple response DO NOT READ OUT Circle 1 if mentioned Circle 2 if not mentioned Q.12.2 <> 1 1 Yes 2 No Recommendation made in last visit Recommendation made in last visit Recommendation made in last visit Recommendation made in last visit Recommendation made in last visit Q12.4 If yes, has she/he training on the relevant tests that s/he conducts? Q12.3 = 1 1 Yes 2 No Recommendation implemented in last visit Recommendation implemented in last visit Recommendation implemented in last visit Recommendation implemented in last visit Recommendation implemented in last visit Q12.5 Is there a laboratory technician is present in this laboratory now? (observation) Observation 1 Yes 2 No Has someone to assess client satisfaction Has someone to assess client satisfaction Has someone to assess client satisfaction Has someone to assess client satisfaction Has someone to assess client satisfaction Q12.6 If yes, has she/he training on the relevant tests that s/he conducts? No 2 -> Q12.7 Q12.5 = 1 1 Yes 2 No Has weekly/ monthly staff review meeting Has weekly/ monthly staff review meeting Has weekly/ monthly staff review meeting Has weekly/ monthly staff review meeting Has weekly/ monthly staff review meeting Q12.7 Is there any cleaner/attendant available in this laboratory? Observation No 2 -> Q12.10 1 Yes 2 No Has internal/external QC system Has internal/external QC system Has internal/external QC system Has internal/external QC system Has internal/external QC system Q12.8 Does the cleaner/attendant have to handle biohazard substances? Q12.7 = 1 1 Yes 2 No Section score, 12 Section score, 12 Section score, 12 Section score, 12 Section score, 12 Score for this section (.../...)*100 Section grade, 12 Section grade, 12 Section grade, 12 Section grade, 12 Section grade, 12 Grade for this section Proportion who received pretest counselling and tested for HIV Proportion who received pretest counselling and tested for HIV Proportion who received pretest counselling and tested for HIV Proportion who received pretest counselling and tested for HIV Proportion who received pretest counselling and tested for HIV Q13.1 Is there an internal QC system for HIV/STI testing in this laboratory? Observation No 2 -> Q13.3 Proportion who tested for HIV and received post test counselling Proportion who tested for HIV and received post test counselling Proportion who tested for HIV and received post test counselling Proportion who tested for HIV and received post test counselling Proportion who tested for HIV and received post test counselling Q13.2 Have staffs working in this laboratory received any training on universal precaution and waste disposal? Proportion who received result Proportion who received result Proportion who received result Proportion who received result Proportion who received result Q13.3 Is all laboratory staff following rules of hand washing? Ask to show the procedure Proportion who tested HIV positive Proportion who tested HIV positive Proportion who tested HIV positive Proportion who tested HIV positive Proportion who tested HIV positive Q13.4 Is the recent universal precaution guideline available? Observation Section score, 13 Section score, 13 Section score, 13 Section score, 13 Section score, 13 Score for this section (.../...)*100 Section grade, 13 Section grade, 13 Section grade, 13 Section grade, 13 Section grade, 13 Grade for this section Serial number of health facility Serial number of health facility Serial number of health facility Serial number of health facility Serial number of health facility Serial number of the health facility District District District District District District 1 Bumthang 2 Chukha 3 Dagana 4 Gasa 5 Ha 6 Lhuntse 7 Monggar 8 Paro 9 Pemagatshel 10 Punakha 11 Samdrup Jongkhar 12 Samtse 13 Sarpang 14 Thimphu 15 Trashigang 16 Trongsa 17 Tsirang 18 Wangdue Phodrang 19 Yangtsi 20 Zhemgang Gewog/town Gewog/town Gewog/town Gewog/town Gewog/town Interview completion status Interview completion status Interview completion status Interview completion status Interview completion status Interview completion status 1 Completed 2 Not completed Type of health facility Type of health facility Type of health facility Type of health facility Type of health facility Type of health facility 1 National Referral Hospital 2 Public Health Laboratory 3 Regional Referral Hospitals CD4 tests done for HIV positive patients CD4 tests done for HIV positive patients CD4 tests done for HIV positive patients CD4 tests done for HIV positive patients CD4 tests done for HIV positive patients 1. Was there a place for you to sit while you were waiting? 1 Yes 2 No Tests conducted for STI, Gonorrhoea Tests conducted for STI, Gonorrhoea Tests conducted for STI, Gonorrhoea Tests conducted for STI, Gonorrhoea Tests conducted for STI, Gonorrhoea Q2 What laboratory tests are conducted for STI? Gonorrhoea Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests conducted for STI, Chlamydia Tests conducted for STI, Chlamydia Tests conducted for STI, Chlamydia Tests conducted for STI, Chlamydia Tests conducted for STI, Chlamydia Q2 What laboratory tests are conducted for STI? Chlamydia Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Specimens used for STI testing, blood Specimens used for STI testing, blood Specimens used for STI testing, blood Specimens used for STI testing, blood Specimens used for STI testing, blood Q3 What specimens are used for STI testing? Blood Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Specimens used for STI testing, urethral swab (male) Specimens used for STI testing, urethral swab (male) Specimens used for STI testing, urethral swab (male) Specimens used for STI testing, urethral swab (male) Specimens used for STI testing, urethral swab (male) Q3 What specimens are used for STI testing? Urethral swab (male) Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Specimens used for STI testing, vaginal swab (female) Specimens used for STI testing, vaginal swab (female) Specimens used for STI testing, vaginal swab (female) Specimens used for STI testing, vaginal swab (female) Specimens used for STI testing, vaginal swab (female) Q3 What specimens are used for STI testing? Vaginal swab (female) Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Specimens used for STI testing, urine (male/female) Specimens used for STI testing, urine (male/female) Specimens used for STI testing, urine (male/female) Specimens used for STI testing, urine (male/female) Specimens used for STI testing, urine (male/female) Q3 What specimens are used for STI testing? Urine (male/female) Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests performed for STI, gram stain Tests performed for STI, gram stain Tests performed for STI, gram stain Tests performed for STI, gram stain Tests performed for STI, gram stain Q4 What are the tests performed for STI? Gram stain Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests performed for STI, culture & sensitivity Tests performed for STI, culture & sensitivity Tests performed for STI, culture & sensitivity Tests performed for STI, culture & sensitivity Tests performed for STI, culture & sensitivity Q4 What are the tests performed for STI? Culture & sensitivity Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests performed for STI, dark field microscopy Tests performed for STI, dark field microscopy Tests performed for STI, dark field microscopy Tests performed for STI, dark field microscopy Tests performed for STI, dark field microscopy Q4 What are the tests performed for STI? dark field microscopy Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Section score, 1 Section score, 1 Section score, 1 Section score, 1 Section score, 1 Score for this section (.../...)*100 Section grade, 1 Section grade, 1 Section grade, 1 Section grade, 1 Section grade, 1 Grade for this section Lab space adequate Lab space adequate Lab space adequate Lab space adequate Lab space adequate 5. Did you feel comfortable during your physical examination? 1 Yes 2 No Adequate water supply available Adequate water supply available Adequate water supply available Adequate water supply available Adequate water supply available Q5.1 Is adequate water supply available in the laboratory? Observation 1 Yes 2 No Access to a functioning autoclave Access to a functioning autoclave Access to a functioning autoclave Access to a functioning autoclave Access to a functioning autoclave Q5.2 Does the laboratory have access to a functioning autoclave? Observation No 2 -> Q5.5 1 Yes 2 No Autoclave on site Autoclave on site Autoclave on site Autoclave on site Autoclave on site Q5.3 If autoclaving is done, is there an autoclave on site? Observation Q5.2 = 1 1 Yes 2 No Standard procedures followed for autoclaving Standard procedures followed for autoclaving Standard procedures followed for autoclaving Standard procedures followed for autoclaving Standard procedures followed for autoclaving Q5.4 Are standard procedures followed for autoclaving? Q5.2 = 1 1 Yes 2 No Common way of sterilization of materials Common way of sterilization of materials Common way of sterilization of materials Common way of sterilization of materials Common way of sterilization of materials Q5.5 If there is no autoclave, how are materials sterilized usually, in last 7 days? Q5.2 = 2 1 Boiling 2 Hot air oven 3 Others Common way of sterilization of materials, other specific Common way of sterilization of materials, other specific Common way of sterilization of materials, other specific Common way of sterilization of materials, other specific Common way of sterilization of materials, other specific Q5.5 If there is no autoclave, how are materials sterilized usually, in last 7 days? Others, specify Q5.2 = 2 Access to functioning incinerator Access to functioning incinerator Access to functioning incinerator Access to functioning incinerator Access to functioning incinerator Q5.6 Does the laboratory have access to a functioning incinerator? Observation No 2 -> Q6.1 1 Yes 2 No Incinerator within reachable distance Incinerator within reachable distance Incinerator within reachable distance Incinerator within reachable distance Incinerator within reachable distance Q5.7 Is it within the reachable distance? Q5.6 = 1 1 Yes 2 No Subsection score, 2a Subsection score, 2a Subsection score, 2a Subsection score, 2a Subsection score, 2a Score for this subsection (.../...)*100 Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Grade for this subsection Microscope, presence Microscope, presence Microscope, presence Microscope, presence Microscope, presence Q6.1 Microscope, presence Observation 1 Yes 2 No Microscope, functioning Microscope, functioning Microscope, functioning Microscope, functioning Microscope, functioning Q6.1 Microscope, functioning Observation 1 Yes 2 No Sink for staining, presence Sink for staining, presence Sink for staining, presence Sink for staining, presence Sink for staining, presence Q6.2 Sink for staining, presence Observation 1 Yes 2 No Micropipettes, presence Micropipettes, presence Micropipettes, presence Micropipettes, presence Micropipettes, presence Q6.3 Micropipettes, presence Observation 1 Yes 2 No Micropipettes, functioning Micropipettes, functioning Micropipettes, functioning Micropipettes, functioning Micropipettes, functioning Q6.3 Micropipettes, functioning Observation 1 Yes 2 No ELISA washer, presence ELISA washer, presence ELISA washer, presence ELISA washer, presence ELISA washer, presence Q6.4 ELISA washer, presence Observation 1 Yes 2 No ELISA washer, functioning ELISA washer, functioning ELISA washer, functioning ELISA washer, functioning ELISA washer, functioning Q6.4 ELISA washer, functioning Observation 1 Yes 2 No Bunsen Burner/spirit lamp, presence Bunsen Burner/spirit lamp, presence Bunsen Burner/spirit lamp, presence Bunsen Burner/spirit lamp, presence Bunsen Burner/spirit lamp, presence Q6.7 Bunsen Burner/spirit lamp, presence Observation 1 Yes 2 No Bunsen Burner/spirit lamp, functioning Bunsen Burner/spirit lamp, functioning Bunsen Burner/spirit lamp, functioning Bunsen Burner/spirit lamp, functioning Bunsen Burner/spirit lamp, functioning Q6.7 Bunsen Burner/spirit lamp, functioning Observation 1 Yes 2 No Hot air oven, presence Hot air oven, presence Hot air oven, presence Hot air oven, presence Hot air oven, presence Q6.8 Hot air oven, presence Observation 1 Yes 2 No Hot air oven, functioning Hot air oven, functioning Hot air oven, functioning Hot air oven, functioning Hot air oven, functioning Q6.8 Hot air oven, functioning Observation 1 Yes 2 No Incubator, presence Incubator, presence Incubator, presence Incubator, presence Incubator, presence Q6.9 Incubator, presence Observation 1 Yes 2 No Incubator, functioning Incubator, functioning Incubator, functioning Incubator, functioning Incubator, functioning Q6.9 Incubator, functioning Observation 1 Yes 2 No Plate shaker, presence Plate shaker, presence Plate shaker, presence Plate shaker, presence Plate shaker, presence Q6.10 Plate shaker, presence Observation 1 Yes 2 No Plate shaker, functioning Plate shaker, functioning Plate shaker, functioning Plate shaker, functioning Plate shaker, functioning Q6.10 Plate shaker, functioning Observation 1 Yes 2 No CD4, presence CD4, presence CD4, presence CD4, presence CD4, presence Q6.11 CD4, presence Observation 1 Yes 2 No CD4, functioning CD4, functioning CD4, functioning CD4, functioning CD4, functioning Q6.11 CD4, functioning 1 Yes 2 No Refrigerator, presence Refrigerator, presence Refrigerator, presence Refrigerator, presence Refrigerator, presence Q6.12 Refrigerator, presence Observation 1 Yes 2 No Refrigerator, functioning Refrigerator, functioning Refrigerator, functioning Refrigerator, functioning Refrigerator, functioning Q6.12 Refrigerator, functioning Observation 1 Yes 2 No -20C freezer, presence -20C freezer, presence -20C freezer, presence -20C freezer, presence -20C freezer, presence Q6.13 -20C freezer, presence Observation 1 Yes 2 No -20C freezer, functioning -20C freezer, functioning -20C freezer, functioning -20C freezer, functioning -20C freezer, functioning Q6.13 -20C freezer, functioning Observation 1 Yes 2 No -70C freezer, presence -70C freezer, presence -70C freezer, presence -70C freezer, presence -70C freezer, presence Q6.14 -70C freezer, presence Observation 1 Yes 2 No -70C freezer, functioning -70C freezer, functioning -70C freezer, functioning -70C freezer, functioning -70C freezer, functioning Q6.14 -70C freezer, functioning Observation 1 Yes 2 No Number of refs adequate, presence Number of refs adequate, presence Number of refs adequate, presence Number of refs adequate, presence Number of refs adequate, presence Q6.15 Are the number of refrigerators (-20C and -70C) adequate for the need of this laboratory? Presence Observation 1 Yes 2 No Number of refs adequate, functioning Number of refs adequate, functioning Number of refs adequate, functioning Number of refs adequate, functioning Number of refs adequate, functioning Q6.15 Are the number of refrigerators (-20C and -70C) adequate for the need of this laboratory? Functioning Observation 1 Yes 2 No Computer Computer Computer Computer Computer Q6.16 Computer Observation 1 Yes 2 No Printer Printer Printer Printer Printer Q6.17 Printer Observation 1 Yes 2 No Sebsection score, 2b Sebsection score, 2b Sebsection score, 2b Sebsection score, 2b Sebsection score, 2b Score for this subsection (.../...)*100 Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Grade for this subsection Adequate reagents/kits for STI diagnosis available Adequate reagents/kits for STI diagnosis available Adequate reagents/kits for STI diagnosis available Adequate reagents/kits for STI diagnosis available Adequate reagents/kits for STI diagnosis available Q7.1 Does the laboratory have adequate reagents/kits for STI diagnosis available? Observation 1 Yes 2 No Adequate reagents/kits for HIV diagnosis available Adequate reagents/kits for HIV diagnosis available Adequate reagents/kits for HIV diagnosis available Adequate reagents/kits for HIV diagnosis available Adequate reagents/kits for HIV diagnosis available Q7.2 Does the laboratory have adequate reagents/kits for HIV diagnosis available? Observation 1 Yes 2 No Reagents/kits arrive in right condition Reagents/kits arrive in right condition Reagents/kits arrive in right condition Reagents/kits arrive in right condition Reagents/kits arrive in right condition Q7.3 Do the reagents/kits usually arrive in the reference laboratory in right conditions (e.g. temperature, intact packages, etc)? 1 Yes 2 No Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Q7.4 What does the laboratory do if the supplies do not arrive in right condition? 1 Discard 2 Returned 3 Reuse 99 Others Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Q7.4 What does the laboratory do if the supplies do not arrive in right condition? Others, specify Reagent/kit beyond expired date available Reagent/kit beyond expired date available Reagent/kit beyond expired date available Reagent/kit beyond expired date available Reagent/kit beyond expired date available Q7.5 Are any of the reagents/kits available at the facility beyond expired date? Observation No 2 -> Q7.7 1 Yes 2 No Action taken on expired reagent/kit Action taken on expired reagent/kit Action taken on expired reagent/kit Action taken on expired reagent/kit Action taken on expired reagent/kit Q7.6 What is done with the expired reagents/kits? Q7.5 = 1 1 Discard 2 Returned 3 Reuse 99 Others With the expired reagents/kits, other With the expired reagents/kits, other With the expired reagents/kits, other With the expired reagents/kits, other With the expired reagents/kits, other Q7.6 What is done with the expired reagents/kits? Others, specify Q7.5 = 1 Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Q7.7 Does the laboratory usually have adequate quantity of disinfectants for STI? Observation 1 Yes 2 No Disinfectants used: Sodium Hypochlorite solution Disinfectants used: Sodium Hypochlorite solution Disinfectants used: Sodium Hypochlorite solution Disinfectants used: Sodium Hypochlorite solution Disinfectants used: Sodium Hypochlorite solution Q7.8 What are the disinfectants used in the laboratory? Sodium Hypochlorite solution Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Disinfectants used: Savlon Disinfectants used: Savlon Disinfectants used: Savlon Disinfectants used: Savlon Disinfectants used: Savlon Q7.8 What are the disinfectants used in the laboratory? Savlon Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Disinfectants used: 70% ethanol Disinfectants used: 70% ethanol Disinfectants used: 70% ethanol Disinfectants used: 70% ethanol Disinfectants used: 70% ethanol Q7.8 What are the disinfectants used in the laboratory? 70% ethanol Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Subsection score, 2c Subsection score, 2c Subsection score, 2c Subsection score, 2c Subsection score, 2c Score for this subsection (.../...)*100 Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Grade for this subsection Supplies in lab: glassware Supplies in lab: glassware Supplies in lab: glassware Supplies in lab: glassware Supplies in lab: glassware Q7.9 Are following laboratory supplies available to perform the test? Glassware Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: tips Supplies in lab: tips Supplies in lab: tips Supplies in lab: tips Supplies in lab: tips Q7.9 Are following laboratory supplies available to perform the test? Tips Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: Eppendorf tube Supplies in lab: Eppendorf tube Supplies in lab: Eppendorf tube Supplies in lab: Eppendorf tube Supplies in lab: Eppendorf tube Q7.9 Are following laboratory supplies available to perform the test? Eppendorf tube Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: bucket Supplies in lab: bucket Supplies in lab: bucket Supplies in lab: bucket Supplies in lab: bucket Q7.9 Are following laboratory supplies available to perform the test? Bucket Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: disposable syringe Supplies in lab: disposable syringe Supplies in lab: disposable syringe Supplies in lab: disposable syringe Supplies in lab: disposable syringe Q7.9 Are following laboratory supplies available to perform the test? Disposable syringe Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: needle Supplies in lab: needle Supplies in lab: needle Supplies in lab: needle Supplies in lab: needle Q7.9 Are following laboratory supplies available to perform the test? Needle Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: mask Supplies in lab: mask Supplies in lab: mask Supplies in lab: mask Supplies in lab: mask Q7.9 Are following laboratory supplies available to perform the test? Mask Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Refrigerators adequate for the need of this laboratory functioning Refrigerators adequate for the need of this laboratory functioning Refrigerators adequate for the need of this laboratory functioning Refrigerators adequate for the need of this laboratory functioning Refrigerators adequate for the need of this laboratory functioning Q7.10 Is separate glassware, tips, transfer pipettes etc used for testing? Observation 1 Yes 2 No Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Q7.11 Was this facility ever out of stock of gloves in the last 12 months? 1 Yes 2 No Section score2b Section score2b Section score2b Section score2b Section score2b Section grade2b Section grade2b Section grade2b Section grade2b Section grade2b Virologist/Microbiologist in lab Virologist/Microbiologist in lab Virologist/Microbiologist in lab Virologist/Microbiologist in lab Virologist/Microbiologist in lab Q8.1 Is there a virologist/microbiologist is present in this laboratory now? Observation No 2 -> Q8.3 1 Yes 2 No Virologist had training on STI/HIV Virologist had training on STI/HIV Virologist had training on STI/HIV Virologist had training on STI/HIV Virologist had training on STI/HIV Q8.2 If yes, has she/he received training in STI/HIV? Q8.1 = 1 1 Yes 2 No Lab technologist in lab Lab technologist in lab Lab technologist in lab Lab technologist in lab Lab technologist in lab Q8.3 Is there any laboratory technologist is present in this laboratory now? Observation No 2 -> Q8.5 1 Yes 2 No Lab technologist had training on relevant tests conducted Lab technologist had training on relevant tests conducted Lab technologist had training on relevant tests conducted Lab technologist had training on relevant tests conducted Lab technologist had training on relevant tests conducted Q8.4 If yes, has she/he training on the relevant tests that s/he conducts? Q8.3 = 1 1 Yes 2 No Lab technician in lab Lab technician in lab Lab technician in lab Lab technician in lab Lab technician in lab Q8.5 Is there a laboratory technician is present in this laboratory now? (observation) Observation 1 Yes 2 No Lab technician had training on relevant tests conducted Lab technician had training on relevant tests conducted Lab technician had training on relevant tests conducted Lab technician had training on relevant tests conducted Lab technician had training on relevant tests conducted Q8.6 If yes, has she/he training on the relevant tests that s/he conducts? No 2 -> Q8.7 Q8.5 = 1 1 Yes 2 No Cleaner in facility Cleaner in facility Cleaner in facility Cleaner in facility Cleaner in facility Q8.7 Is there any cleaner/attendant available in this laboratory? Observation No 2 -> Q8.10 1 Yes 2 No Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Q8.8 Does the cleaner/attendant have to handle biohazard substances? Q8.7 = 1 1 Yes 2 No Measures for protection: gloves Measures for protection: gloves Measures for protection: gloves Measures for protection: gloves Measures for protection: gloves Q8.9 If yes, are measures taken for the individual's protection? Gloves Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q8.8 = 1 1 Yes 2 No Measures for protection: mask Measures for protection: mask Measures for protection: mask Measures for protection: mask Measures for protection: mask Q8.9 If yes, are measures taken for the individual's protection? Mask Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q8.8 = 1 1 Yes 2 No Measures for protection: apron Measures for protection: apron Measures for protection: apron Measures for protection: apron Measures for protection: apron Q8.9 If yes, are measures taken for the individual's protection? Apron Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q8.8 = 1 1 Yes 2 No Measures for protection: footwear Measures for protection: footwear Measures for protection: footwear Measures for protection: footwear Measures for protection: footwear Q8.9 If yes, are measures taken for the individual's protection? Footwear Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q8.8 = 1 1 Yes 2 No Measures for protection: other Measures for protection: other Measures for protection: other Measures for protection: other Measures for protection: other Q8.9 If yes, are measures taken for the individual's protection? Other Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q8.8 = 1 1 Yes 2 No Measures for protection: other specific Measures for protection: other specific Measures for protection: other specific Measures for protection: other specific Measures for protection: other specific Q8.9 If yes, are measures taken for the individual's protection? Others, specify Q8.8 = 1 Engineer available for equipment maintenance Engineer available for equipment maintenance Engineer available for equipment maintenance Engineer available for equipment maintenance Engineer available for equipment maintenance Q8.10 Is there an engineer available who is responsible for maintaining the equipment in this laboratory? Observation No 2 -> Q9.1 1 Yes 2 No Engineer with BS level of qualification Engineer with BS level of qualification Engineer with BS level of qualification Engineer with BS level of qualification Engineer with BS level of qualification Q8.11 If yes, does she/he have B.Sc level of qualification? Q8.10 = 1 1 Yes 2 No Section score, 3 Section score, 3 Section score, 3 Section score, 3 Section score, 3 Score for this section (.../...)*100 Section grade, 3 Section grade, 3 Section grade, 3 Section grade, 3 Section grade, 3 Grade for this section Staff aware of infection prevention: handwashing Staff aware of infection prevention: handwashing Staff aware of infection prevention: handwashing Staff aware of infection prevention: handwashing Staff aware of infection prevention: handwashing Q9.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Handwashing Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: gloving Staff aware of infection prevention: gloving Staff aware of infection prevention: gloving Staff aware of infection prevention: gloving Staff aware of infection prevention: gloving Q9.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Gloving Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes Staff aware of infection prevention: decontamination Staff aware of infection prevention: decontamination Staff aware of infection prevention: decontamination Staff aware of infection prevention: decontamination Staff aware of infection prevention: decontamination Q9.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Decontamination Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: cleaning Staff aware of infection prevention: cleaning Staff aware of infection prevention: cleaning Staff aware of infection prevention: cleaning Staff aware of infection prevention: cleaning Q9.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Cleaning Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: autoclaving Staff aware of infection prevention: autoclaving Staff aware of infection prevention: autoclaving Staff aware of infection prevention: autoclaving Staff aware of infection prevention: autoclaving Q9.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Sterilisation/Autoclaving Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: waste disposal Staff aware of infection prevention: waste disposal Staff aware of infection prevention: waste disposal Staff aware of infection prevention: waste disposal Staff aware of infection prevention: waste disposal Q9.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Waste Disposal Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: management of accidental injury Staff aware of infection prevention: management of accidental injury Staff aware of infection prevention: management of accidental injury Staff aware of infection prevention: management of accidental injury Staff aware of infection prevention: management of accidental injury Q9.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Management of accidental injury Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff had training on universal precaution Staff had training on universal precaution Staff had training on universal precaution Staff had training on universal precaution Staff had training on universal precaution Q9.2 Does the laboratory have access to a functioning autoclave? Observation No 2 -> Q9.5 1 Yes 2 No Rules of handwashing followed Rules of handwashing followed Rules of handwashing followed Rules of handwashing followed Rules of handwashing followed Q9.3 If autoclaving is done, is there an autoclave on site? Observation Q9.2 = 1 1 Yes 2 No Recent universal precaution guideline available Recent universal precaution guideline available Recent universal precaution guideline available Recent universal precaution guideline available Recent universal precaution guideline available Q9.4 Are standard procedures followed for autoclaving? Q9.2 = 1 1 Yes 2 No Gloves used while handling samples Gloves used while handling samples Gloves used while handling samples Gloves used while handling samples Gloves used while handling samples Q9.5 If there is no autoclave, how are materials sterilized usually, in last 7 days? 1 Yes 2 No Gloves used in lab while conducting HIV/STI tests Gloves used in lab while conducting HIV/STI tests Gloves used in lab while conducting HIV/STI tests Gloves used in lab while conducting HIV/STI tests Gloves used in lab while conducting HIV/STI tests Q9.6 Does the laboratory have access to a functioning incinerator? Observation No 2 -> Q10.1 1 Yes 2 No Lab coats worn while performing tests Lab coats worn while performing tests Lab coats worn while performing tests Lab coats worn while performing tests Lab coats worn while performing tests Q9.7 Is it within the reachable distance? Q9.6 = 1 1 Yes 2 No Mats placed on the testing area Mats placed on the testing area Mats placed on the testing area Mats placed on the testing area Mats placed on the testing area Q9.8 Are mats placed on the testing area? Observation 1 Yes 2 No PEP system in place PEP system in place PEP system in place PEP system in place PEP system in place Q9.9 Is there any PEP system in place? 1 Yes 2 No Subsection score, 4a Subsection score, 4a Subsection score, 4a Subsection score, 4a Subsection score, 4a Score for this subsection (.../...)*100 Subsection grade, 4a Subsection grade, 4a Subsection grade, 4a Subsection grade, 4a Subsection grade, 4a Grade for this subsection Common container of sharps disposal Common container of sharps disposal Common container of sharps disposal Common container of sharps disposal Common container of sharps disposal Q9.10 Where are the sharps disposed usually? Observation 1 Plastic bin 2 Safety box/sharp box 3 Bottle 99 Others Common container of sharps disposal, other specific Common container of sharps disposal, other specific Common container of sharps disposal, other specific Common container of sharps disposal, other specific Common container of sharps disposal, other specific Q9.10 Where are the sharps disposed usually? Others, specify Observation Clinical staff dispose needle and syringe appropriately Clinical staff dispose needle and syringe appropriately Clinical staff dispose needle and syringe appropriately Clinical staff dispose needle and syringe appropriately Clinical staff dispose needle and syringe appropriately Q9.11 Do all clinical staff dispose needle and syringe appropriately? 1 Yes 2 No Subsection score, 4b Subsection score, 4b Subsection score, 4b Subsection score, 4b Subsection score, 4b Score for this subsection (.../...)*100 Subsection grade, 4b Subsection grade, 4b Subsection grade, 4b Subsection grade, 4b Subsection grade, 4b Grade for this subsection Instruments decontaminated and sterilized after each use Instruments decontaminated and sterilized after each use Instruments decontaminated and sterilized after each use Instruments decontaminated and sterilized after each use Instruments decontaminated and sterilized after each use Q10.1 Microscope, presence Observation 1 Yes 2 No Hypochlorite solution/savlon used Hypochlorite solution/savlon used Hypochlorite solution/savlon used Hypochlorite solution/savlon used Hypochlorite solution/savlon used Q10.2 Sink for staining, presence Observation 1 Yes 2 No Length of time instruments are dipped Length of time instruments are dipped Length of time instruments are dipped Length of time instruments are dipped Length of time instruments are dipped Q10.3 ELISA reader, presence Observation 1 <10 mins 2 10 – 30 mins 3 >30 mins Frequency of hypochlorite solution/savlon preparation Frequency of hypochlorite solution/savlon preparation Frequency of hypochlorite solution/savlon preparation Frequency of hypochlorite solution/savlon preparation Frequency of hypochlorite solution/savlon preparation Q10.4 ELISA washer, presence Observation 1 Daily/whenever required 2 Once in 2 days 99 Others Frequency of hypochlorite solution/savlon preparation, other specific Frequency of hypochlorite solution/savlon preparation, other specific Frequency of hypochlorite solution/savlon preparation, other specific Frequency of hypochlorite solution/savlon preparation, other specific Frequency of hypochlorite solution/savlon preparation, other specific Q10.4 How frequently is the hypochlorite solution/savlon prepared? Others, specify Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Q10.5 Micropipettes, presence Observation 1 Yes 2 No Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Q10.6 Candle jar, presence Observation 1 Yes 2 No Subsection score, 4c Subsection score, 4c Subsection score, 4c Subsection score, 4c Subsection score, 4c Score for this subsection (.../...)*100 Subsection grade, 4c Subsection grade, 4c Subsection grade, 4c Subsection grade, 4c Subsection grade, 4c Grade for this subsection Established procedure for waste disposal Established procedure for waste disposal Established procedure for waste disposal Established procedure for waste disposal Established procedure for waste disposal Q11.1 Does the laboratory have adequate reagents/kits for STI diagnosis available? Observation 1 Yes 2 No Common way of sharps disposal Common way of sharps disposal Common way of sharps disposal Common way of sharps disposal Common way of sharps disposal Q11.2 Does the laboratory have adequate reagents/kits for HIV diagnosis available? Observation 1 Collected in hard closed bin and taken to deep pit burial 2 Collected in any bucket and taken to deep pit burial 99 Others Common way of sharps disposal, other specific Common way of sharps disposal, other specific Common way of sharps disposal, other specific Common way of sharps disposal, other specific Common way of sharps disposal, other specific Q11.2 How sharps are disposed usually? Others, specify Observation Common way of glasswares disposal Common way of glasswares disposal Common way of glasswares disposal Common way of glasswares disposal Common way of glasswares disposal Q11.3 Do the reagents/kits usually arrive in the reference laboratory in right conditions (e.g. temperature, intact packages, etc)? 1 Collected in hard closed bin and taken to deep pit burial 2 Collected in hard closed bin and reused after autoclaving 3 Collected in any bucket and taken to deep pit burial 4 Collected in any bucket and reused after autoclaving 99 Others Common way of glasswares disposal, other specific Common way of glasswares disposal, other specific Common way of glasswares disposal, other specific Common way of glasswares disposal, other specific Common way of glasswares disposal, other specific Q11.3 How glass wares are disposed usually? Others, specify Observation Common way of clinical waste disposal Common way of clinical waste disposal Common way of clinical waste disposal Common way of clinical waste disposal Common way of clinical waste disposal Q11.4 What does the laboratory do if the supplies do not arrive in right condition? 1 Decontaminated with disinfectant for 30 mins and lead to underground drainage 2 Lead to underground drainage 99 Others Common way of clinical waste disposal, other specific Common way of clinical waste disposal, other specific Common way of clinical waste disposal, other specific Common way of clinical waste disposal, other specific Common way of clinical waste disposal, other specific Q11.4 What does the laboratory do if the supplies do not arrive in right condition? Others, specify Separate buckets for contaminated waste disposal Separate buckets for contaminated waste disposal Separate buckets for contaminated waste disposal Separate buckets for contaminated waste disposal Separate buckets for contaminated waste disposal Q11.5 Are any of the reagents/kits available at the facility beyond expired date? Observation No 2 -> Q11.7 1 Yes 2 No Common way of infectious materials disposal Common way of infectious materials disposal Common way of infectious materials disposal Common way of infectious materials disposal Common way of infectious materials disposal Q11.6 What is done with the expired reagents/kits? Q11.5 = 1 1 Deep pit burial 2 Burnt 99 Others Common way of infectious materials disposal, other specific Common way of infectious materials disposal, other specific Common way of infectious materials disposal, other specific Common way of infectious materials disposal, other specific Common way of infectious materials disposal, other specific Q11.6 What is done with the expired reagents/kits? Others, specify Subsection score, 4d Subsection score, 4d Subsection score, 4d Subsection score, 4d Subsection score, 4d Score for this subsection (.../...)*100 Subsection grade, 4d Subsection grade, 4d Subsection grade, 4d Subsection grade, 4d Subsection grade, 4d Grade for this subsection Keeps records of samples tested for HIV Keeps records of samples tested for HIV Keeps records of samples tested for HIV Keeps records of samples tested for HIV Keeps records of samples tested for HIV Q12.1 Is there a virologist/microbiologist is present in this laboratory now? Observation No 2 -> Q12.3 1 Yes 2 No Kept records of samples tested for STI Kept records of samples tested for STI Kept records of samples tested for STI Kept records of samples tested for STI Kept records of samples tested for STI Q12.2 If yes, has she/he received training in STI/HIV? Q12.1 = 1 1 Yes 2 No Manner of recording of STI/HIV records: computerized Manner of recording of STI/HIV records: computerized Manner of recording of STI/HIV records: computerized Manner of recording of STI/HIV records: computerized Manner of recording of STI/HIV records: computerized Q12.3 How are the records of STI/HIV recorded? Computerized Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Manner of recording of STI/HIV records: register book Manner of recording of STI/HIV records: register book Manner of recording of STI/HIV records: register book Manner of recording of STI/HIV records: register book Manner of recording of STI/HIV records: register book Q12.3 How are the records of STI/HIV recorded? Register book Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Manner of recording of STI/HIV records: others Manner of recording of STI/HIV records: others Manner of recording of STI/HIV records: others Manner of recording of STI/HIV records: others Manner of recording of STI/HIV records: others Q12.3 How are the records of STI/HIV recorded? Others Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Manner of recording of STI/HIV records: other specific Manner of recording of STI/HIV records: other specific Manner of recording of STI/HIV records: other specific Manner of recording of STI/HIV records: other specific Manner of recording of STI/HIV records: other specific Q12.3 How are the records of STI/HIV recorded? Others, specify Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned Person responsible for maintaining the laboratory test record Person responsible for maintaining the laboratory test record Person responsible for maintaining the laboratory test record Person responsible for maintaining the laboratory test record Person responsible for maintaining the laboratory test record Q12.4 If yes, has she/he training on the relevant tests that s/he conducts? Q12.3 = 1 1 Yes 2 No Provide STI/HIV report to authority in timely manner Provide STI/HIV report to authority in timely manner Provide STI/HIV report to authority in timely manner Provide STI/HIV report to authority in timely manner Provide STI/HIV report to authority in timely manner Q12.5 Is there a laboratory technician is present in this laboratory now? (observation) Observation 1 Yes 2 No Section score, 5 Section score, 5 Section score, 5 Section score, 5 Section score, 5 Score for this section (.../...)*100 Section grade, 5 Section grade, 5 Section grade, 5 Section grade, 5 Section grade, 5 Grade for this section Has internal QC system for HIV/STI testing Has internal QC system for HIV/STI testing Has internal QC system for HIV/STI testing Has internal QC system for HIV/STI testing Has internal QC system for HIV/STI testing Q13.1 Is there an internal QC system for HIV/STI testing in this laboratory? Observation No 2 -> Q13.3 1 Yes 2 No Ever had internal QC system for HIV/STI testing Ever had internal QC system for HIV/STI testing Ever had internal QC system for HIV/STI testing Ever had internal QC system for HIV/STI testing Ever had internal QC system for HIV/STI testing Q13.2 Have staffs working in this laboratory received any training on universal precaution and waste disposal? 1 Yes 2 No Has external QC system for HIV/STI testing Has external QC system for HIV/STI testing Has external QC system for HIV/STI testing Has external QC system for HIV/STI testing Has external QC system for HIV/STI testing Q13.3 Is all laboratory staff following rules of hand washing? Ask to show the procedure 1 Yes 2 No Ever had external QC system for HIV/STI testing Ever had external QC system for HIV/STI testing Ever had external QC system for HIV/STI testing Ever had external QC system for HIV/STI testing Ever had external QC system for HIV/STI testing Q13.4 Is the recent universal precaution guideline available? Observation 1 Yes 2 No Has specific personnel for checking QC system Has specific personnel for checking QC system Has specific personnel for checking QC system Has specific personnel for checking QC system Has specific personnel for checking QC system Q13.5 Are gloves usually used in the laboratory while handling samples? Observation 1 Yes 2 No Conducted QC on samples received from other laboratories Conducted QC on samples received from other laboratories Conducted QC on samples received from other laboratories Conducted QC on samples received from other laboratories Conducted QC on samples received from other laboratories Q13.6 Are gloves usually used in the laboratory while conducting HIV/STI tests? 1 Yes 2 No QC done on a regular basis QC done on a regular basis QC done on a regular basis QC done on a regular basis QC done on a regular basis Q13.7 Are lab coats worn in laboratory while performing the tests? Observation 1 Yes 2 No Section score, 6 Section score, 6 Section score, 6 Section score, 6 Section score, 6 Score for this section (.../...)*100 Section grade, 6 Section grade, 6 Section grade, 6 Section grade, 6 Section grade, 6 Grade for this section Personnel understand the meaning of confidentiality Personnel understand the meaning of confidentiality Personnel understand the meaning of confidentiality Personnel understand the meaning of confidentiality Personnel understand the meaning of confidentiality Q14.1 Are the instruments decontaminated and sterilized after each use? 1 Yes 2 No Had break in confidentiality Had break in confidentiality Had break in confidentiality Had break in confidentiality Had break in confidentiality Q14.2 Is hypochlorite solution/savlon used in this facility? No 2 -> Q14.6 ->Q14.6 1 Yes 2 No Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Q14.3 If yes, how was this managed? Meeting with all staff Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q14.2 = 1 1 Yes 2 No Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Q14.3 If yes, how was this managed? Meeting with individual person Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q14.2 = 1 1 Yes 2 No Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Q14.3 If yes, how was this managed? Who breaks confidentiality Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q14.2 = 1 1 Yes 2 No Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Q14.3 If yes, how was this managed? Others Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q14.2 = 1 1 Yes 2 No Manage confidentiality break, other specifc Manage confidentiality break, other specifc Manage confidentiality break, other specifc Manage confidentiality break, other specifc Manage confidentiality break, other specifc Q14.3 If yes, how was this managed? Others, specify Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q14.2 = 1 Section score, 7 Section score, 7 Section score, 7 Section score, 7 Section score, 7 Score for this section (.../...)*100 Section grade, 7 Section grade, 7 Section grade, 7 Section grade, 7 Section grade, 7 Grade for this section Number of STI cases tested Number of STI cases tested Number of STI cases tested Number of STI cases tested Number of STI cases tested Q15.1 Is there any established procedure for waste disposal? Number of HIV cases tested Number of HIV cases tested Number of HIV cases tested Number of HIV cases tested Number of HIV cases tested Q15.2 How sharps are disposed usually? Observation Proportion of referral cases of STI among the tests performed Proportion of referral cases of STI among the tests performed Proportion of referral cases of STI among the tests performed Proportion of referral cases of STI among the tests performed Proportion of referral cases of STI among the tests performed Q15.3 How glass wares are disposed usually? Observation Proportion of referral cases of HIV among the tests performed Proportion of referral cases of HIV among the tests performed Proportion of referral cases of HIV among the tests performed Proportion of referral cases of HIV among the tests performed Proportion of referral cases of HIV among the tests performed Q15.4 How liquid clinical waste is disposed usually? Observation Section score, 8 Section score, 8 Section score, 8 Section score, 8 Section score, 8 Score for this section (.../...)*100 Section grade, 8 Section grade, 8 Section grade, 8 Section grade, 8 Section grade, 8 Grade for this section Unique key Unique key Unique key Unique key Unique key Unique key Recstatus Recstatus Recstatus Recstatus Recstatus Serial number of health facility Serial number of health facility Serial number of health facility Serial number of health facility Serial number of health facility Serial number of the health facility District District District District District District 1 Bumthang 2 Chukha 3 Dagana 4 Gasa 5 Ha 6 Lhuntse 7 Monggar 8 Paro 9 Pemagatshel 10 Punakha 11 Samdrup Jongkhar 12 Samtse 13 Sarpang 14 Thimphu 15 Trashigang 16 Trongsa 17 Tsirang 18 Wangdue Phodrang 19 Yangtsi 20 Zhemgang Gewog/town Gewog/town Gewog/town Gewog/town Gewog/town Interview completion status Interview completion status Interview completion status Interview completion status Interview completion status Interview completion status 1 Completed 2 Not completed Type of health facility Type of health facility Type of health facility Type of health facility Type of health facility Type of health facility 1 National Referral Hospital 2 Public Health Laboratory 3 Regional Referral Hospitals Specimens used for HIV testing Specimens used for HIV testing Specimens used for HIV testing Specimens used for HIV testing Specimens used for HIV testing 1. Was there a place for you to sit while you were waiting? 1 Serum 2 Plasma Algorithm followed for HIV testing Algorithm followed for HIV testing Algorithm followed for HIV testing Algorithm followed for HIV testing Algorithm followed for HIV testing 2. Was the prescriber knowledgeable? 1 Yes 2 No Algorithm Based on existing national guidelines Algorithm Based on existing national guidelines Algorithm Based on existing national guidelines Algorithm Based on existing national guidelines Algorithm Based on existing national guidelines 3. Did you feel comfortable when the prescriber asking questions? 1 Yes 2 No CD4 tests done for HIV positive patients CD4 tests done for HIV positive patients CD4 tests done for HIV positive patients CD4 tests done for HIV positive patients CD4 tests done for HIV positive patients 4. Did you feel the prescriber answer your questions fully? 1 Yes 2 No Tests conducted for STI, Syphilis Tests conducted for STI, Syphilis Tests conducted for STI, Syphilis Tests conducted for STI, Syphilis Tests conducted for STI, Syphilis Q5 What laboratory tests are conducted for STI? Syphilis Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests conducted for STI, Hepatitis B Tests conducted for STI, Hepatitis B Tests conducted for STI, Hepatitis B Tests conducted for STI, Hepatitis B Tests conducted for STI, Hepatitis B Q5 What laboratory tests are conducted for STI? Hepatitis B Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests conducted for STI, Hepatitis C Tests conducted for STI, Hepatitis C Tests conducted for STI, Hepatitis C Tests conducted for STI, Hepatitis C Tests conducted for STI, Hepatitis C Q5 What laboratory tests are conducted for STI? Hepatitis C Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Specimens used for STI testing, blood Specimens used for STI testing, blood Specimens used for STI testing, blood Specimens used for STI testing, blood Specimens used for STI testing, blood Q6 What specimens are used for STI testing? Blood Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Specimens used for STI testing, CSF Specimens used for STI testing, CSF Specimens used for STI testing, CSF Specimens used for STI testing, CSF Specimens used for STI testing, CSF Q6 What specimens are used for STI testing? Urethral swab (male) Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests performed for STI, TPHA Tests performed for STI, TPHA Tests performed for STI, TPHA Tests performed for STI, TPHA Tests performed for STI, TPHA Q7 What are the tests performed for STI? TPHA Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests performed for STI, RPR/VDRL Tests performed for STI, RPR/VDRL Tests performed for STI, RPR/VDRL Tests performed for STI, RPR/VDRL Tests performed for STI, RPR/VDRL Q7 What are the tests performed for STI? RPR/VRDL Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Section score, 1 Section score, 1 Section score, 1 Section score, 1 Section score, 1 Score for this section (.../...)*100 Section grade, 1 Section grade, 1 Section grade, 1 Section grade, 1 Section grade, 1 Grade for this section Lab space adequate Lab space adequate Lab space adequate Lab space adequate Lab space adequate 8. Did your prescriber clearly explain the meaning of your disease? 1 Yes 2 No Adequate water supply available Adequate water supply available Adequate water supply available Adequate water supply available Adequate water supply available Q9.1 Is adequate water supply available in the laboratory? Observation 1 Yes 2 No Access to a functioning autoclave Access to a functioning autoclave Access to a functioning autoclave Access to a functioning autoclave Access to a functioning autoclave Q9.2 Does the laboratory have access to a functioning autoclave? Observation No 2 -> Q9.5 1 Yes 2 No Autoclave on site Autoclave on site Autoclave on site Autoclave on site Autoclave on site Q9.3 If autoclaving is done, is there an autoclave on site? Observation Q9.2 = 1 1 Yes 2 No Standard procedures followed for autoclaving Standard procedures followed for autoclaving Standard procedures followed for autoclaving Standard procedures followed for autoclaving Standard procedures followed for autoclaving Q9.4 Are standard procedures followed for autoclaving? Q9.2 = 1 1 Yes 2 No Common way of sterilization of materials Common way of sterilization of materials Common way of sterilization of materials Common way of sterilization of materials Common way of sterilization of materials Q9.5 If there is no autoclave, how are materials sterilized usually, in last 7 days? 1 Boiling 2 Hot air oven 3 Others Common way of sterilization of materials, other specific Common way of sterilization of materials, other specific Common way of sterilization of materials, other specific Common way of sterilization of materials, other specific Common way of sterilization of materials, other specific Q9.5 If there is no autoclave, how are materials sterilized usually, in last 7 days? Others, specify Access to functioning incinerator Access to functioning incinerator Access to functioning incinerator Access to functioning incinerator Access to functioning incinerator Q9.6 Does the laboratory have access to a functioning incinerator? Observation No 2 -> Q10.1 1 Yes 2 No Incinerator within reachable distance Incinerator within reachable distance Incinerator within reachable distance Incinerator within reachable distance Incinerator within reachable distance Q9.7 Is it within the reachable distance? Q9.6 = 1 1 Yes 2 No Subsection score, 2a Subsection score, 2a Subsection score, 2a Subsection score, 2a Subsection score, 2a Score for this subsection (.../...)*100 Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Grade for this subsection ELISA reader, presence ELISA reader, presence ELISA reader, presence ELISA reader, presence ELISA reader, presence Q10.1 Microscope, presence Observation 1 Yes 2 No ELISA reader, functioning ELISA reader, functioning ELISA reader, functioning ELISA reader, functioning ELISA reader, functioning Q10.1 Microscope, functioning Observation 1 Yes 2 No ELISA washer, presence ELISA washer, presence ELISA washer, presence ELISA washer, presence ELISA washer, presence Q10.2 Sink for staining, presence Observation 1 Yes 2 No ELISA washer, functioning ELISA washer, functioning ELISA washer, functioning ELISA washer, functioning ELISA washer, functioning Q10.2 ELISA washer, functioning Observation 1 Yes 2 No Micropipettes, presence Micropipettes, presence Micropipettes, presence Micropipettes, presence Micropipettes, presence Q10.3 ELISA reader, presence Observation 1 Yes 2 No Micropipettes, functioning Micropipettes, functioning Micropipettes, functioning Micropipettes, functioning Micropipettes, functioning Q10.3 ELISA reader, functioning Observation 1 Yes 2 No Refrigerator, presence Refrigerator, presence Refrigerator, presence Refrigerator, presence Refrigerator, presence Q10.4 ELISA washer, presence Observation 1 Yes 2 No Refrigerator, functioning Refrigerator, functioning Refrigerator, functioning Refrigerator, functioning Refrigerator, functioning Q10.4 ELISA washer, functioning Observation 1 Yes 2 No -20C freezer, presence -20C freezer, presence -20C freezer, presence -20C freezer, presence -20C freezer, presence Q10.5 Micropipettes, presence Observation 1 Yes 2 No -20C freezer, functioning -20C freezer, functioning -20C freezer, functioning -20C freezer, functioning -20C freezer, functioning Q10.5 Micropipettes, functioning Observation 1 Yes 2 No -70C freezer, presence -70C freezer, presence -70C freezer, presence -70C freezer, presence -70C freezer, presence Q10.6 Candle jar, presence Observation 1 Yes 2 No -70C freezer, functioning -70C freezer, functioning -70C freezer, functioning -70C freezer, functioning -70C freezer, functioning Q10.6 Candle jar, functioning Observation 1 Yes 2 No Number of refs adequate, presence Number of refs adequate, presence Number of refs adequate, presence Number of refs adequate, presence Number of refs adequate, presence Q10.7 Bunsen Burner/spirit lamp, presence Observation 1 Yes 2 No Number of refs adequate, functioning Number of refs adequate, functioning Number of refs adequate, functioning Number of refs adequate, functioning Number of refs adequate, functioning Q10.7 Bunsen Burner/spirit lamp, functioning Observation 1 Yes 2 No Computer Computer Computer Computer Computer Q10.8 Hot air oven, presence Observation 1 Yes 2 No Printer Printer Printer Printer Printer Q10.9 Incubator, presence Observation 1 Yes 2 No Sebsection score, 2b Sebsection score, 2b Sebsection score, 2b Sebsection score, 2b Sebsection score, 2b Score for this subsection (.../...)*100 Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Grade for this subsection Adequate reagents/kits for STI diagnosis available Adequate reagents/kits for STI diagnosis available Adequate reagents/kits for STI diagnosis available Adequate reagents/kits for STI diagnosis available Adequate reagents/kits for STI diagnosis available Q11.1 Does the laboratory have adequate reagents/kits for STI diagnosis available? Observation 1 Yes 2 No Adequate reagents/kits for HIV diagnosis available Adequate reagents/kits for HIV diagnosis available Adequate reagents/kits for HIV diagnosis available Adequate reagents/kits for HIV diagnosis available Adequate reagents/kits for HIV diagnosis available Q11.2 Does the laboratory have adequate reagents/kits for HIV diagnosis available? Observation 1 Yes 2 No Reagents/kits arrive in right condition Reagents/kits arrive in right condition Reagents/kits arrive in right condition Reagents/kits arrive in right condition Reagents/kits arrive in right condition Q11.3 Do the reagents/kits usually arrive in the reference laboratory in right conditions (e.g. temperature, intact packages, etc)? 1 Yes 2 No Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Q11.4 What does the laboratory do if the supplies do not arrive in right condition? 1 Discard 2 Returned 3 Reuse 99 Others Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Q11.4 What does the laboratory do if the supplies do not arrive in right condition? Others, specify Reagent/kit beyond expired date available Reagent/kit beyond expired date available Reagent/kit beyond expired date available Reagent/kit beyond expired date available Reagent/kit beyond expired date available Q11.5 Are any of the reagents/kits available at the facility beyond expired date? Observation No 2 -> Q11.7 1 Yes 2 No Action taken on expired reagent/kit Action taken on expired reagent/kit Action taken on expired reagent/kit Action taken on expired reagent/kit Action taken on expired reagent/kit Q11.6 What is done with the expired reagents/kits? Q11.5 = 1 1 Discard 2 Returned 3 Reuse 99 Others Action taken on expired reagent/kit, other specific Action taken on expired reagent/kit, other specific Action taken on expired reagent/kit, other specific Action taken on expired reagent/kit, other specific Action taken on expired reagent/kit, other specific Q11.6 What is done with the expired reagents/kits? Others, specify Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Q11.7 Does the laboratory usually have adequate quantity of disinfectants for STI? Observation 1 Yes 2 No Disinfectants used: Sodium Hypochlorite solution Disinfectants used: Sodium Hypochlorite solution Disinfectants used: Sodium Hypochlorite solution Disinfectants used: Sodium Hypochlorite solution Disinfectants used: Sodium Hypochlorite solution Q11.8 What are the disinfectants used in the laboratory? Sodium Hypochlorite solution Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Disinfectants used: Savlon Disinfectants used: Savlon Disinfectants used: Savlon Disinfectants used: Savlon Disinfectants used: Savlon Q11.8 What are the disinfectants used in the laboratory? Savlon Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Disinfectants used: 70% ethanol Disinfectants used: 70% ethanol Disinfectants used: 70% ethanol Disinfectants used: 70% ethanol Disinfectants used: 70% ethanol Q11.8 What are the disinfectants used in the laboratory? 70% ethanol Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Subsection score, 2c Subsection score, 2c Subsection score, 2c Subsection score, 2c Subsection score, 2c Score for this subsection (.../...)*100 Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Grade for this subsection Supplies in lab: glassware Supplies in lab: glassware Supplies in lab: glassware Supplies in lab: glassware Supplies in lab: glassware Q11.9 Are following laboratory supplies available to perform the test? Glassware Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: tips Supplies in lab: tips Supplies in lab: tips Supplies in lab: tips Supplies in lab: tips Q11.9 Are following laboratory supplies available to perform the test? Tips Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: Eppendorf tube Supplies in lab: Eppendorf tube Supplies in lab: Eppendorf tube Supplies in lab: Eppendorf tube Supplies in lab: Eppendorf tube Q11.9 Are following laboratory supplies available to perform the test? Eppendorf tube Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: bucket Supplies in lab: bucket Supplies in lab: bucket Supplies in lab: bucket Supplies in lab: bucket Q11.9 Are following laboratory supplies available to perform the test? Bucket Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: disposable syringe Supplies in lab: disposable syringe Supplies in lab: disposable syringe Supplies in lab: disposable syringe Supplies in lab: disposable syringe Q11.9 Are following laboratory supplies available to perform the test? Disposable syringe Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: needle Supplies in lab: needle Supplies in lab: needle Supplies in lab: needle Supplies in lab: needle Q11.9 Are following laboratory supplies available to perform the test? Needle Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: mask Supplies in lab: mask Supplies in lab: mask Supplies in lab: mask Supplies in lab: mask Q11.9 Are following laboratory supplies available to perform the test? Mask Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Refrigerators adequate for the need of this laboratory functioning Refrigerators adequate for the need of this laboratory functioning Refrigerators adequate for the need of this laboratory functioning Refrigerators adequate for the need of this laboratory functioning Refrigerators adequate for the need of this laboratory functioning Q11.10 Is separate glassware, tips, transfer pipettes etc used for testing? Observation 1 Yes 2 No Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Q11.11 Was this facility ever out of stock of gloves in the last 12 months? 1 Yes 2 No Section score2b Section score2b Section score2b Section score2b Section score2b Section grade2b Section grade2b Section grade2b Section grade2b Section grade2b Virologist/Microbiologist in lab Virologist/Microbiologist in lab Virologist/Microbiologist in lab Virologist/Microbiologist in lab Virologist/Microbiologist in lab Q12.1 Is there a virologist/microbiologist is present in this laboratory now? Observation No 2 -> Q12.3 1 Yes 2 No Virologist had training on STI/HIV Virologist had training on STI/HIV Virologist had training on STI/HIV Virologist had training on STI/HIV Virologist had training on STI/HIV Q12.2 If yes, has she/he received training in STI/HIV? Q12.1 = 1 1 Yes 2 No Lab technologist in lab Lab technologist in lab Lab technologist in lab Lab technologist in lab Lab technologist in lab Q12.3 Is there any laboratory technologist is present in this laboratory now? Observation No 2 -> Q12.5 1 Yes 2 No Lab technologist had training on relevant tests conducted Lab technologist had training on relevant tests conducted Lab technologist had training on relevant tests conducted Lab technologist had training on relevant tests conducted Lab technologist had training on relevant tests conducted Q12.4 If yes, has she/he training on the relevant tests that s/he conducts? Q12.3 = 1 1 Yes 2 No Lab technician in lab Lab technician in lab Lab technician in lab Lab technician in lab Lab technician in lab Q12.5 Is there a laboratory technician is present in this laboratory now? (observation) Observation 1 Yes 2 No Lab technician had training on relevant tests conducted Lab technician had training on relevant tests conducted Lab technician had training on relevant tests conducted Lab technician had training on relevant tests conducted Lab technician had training on relevant tests conducted Q12.6 If yes, has she/he training on the relevant tests that s/he conducts? No 2 -> Q12.7 Q12.5 = 1 1 Yes 2 No Cleaner in facility Cleaner in facility Cleaner in facility Cleaner in facility Cleaner in facility Q12.7 Is there any cleaner/attendant available in this laboratory? Observation No 2 -> Q12.10 1 Yes 2 No Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Q12.8 Does the cleaner/attendant have to handle biohazard substances? Q12.7 = 1 1 Yes 2 No Measures for protection: gloves Measures for protection: gloves Measures for protection: gloves Measures for protection: gloves Measures for protection: gloves Q12.9 If yes, are measures taken for the individual's protection? Gloves Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q12.8 = 1 1 Yes 2 No Measures for protection: mask Measures for protection: mask Measures for protection: mask Measures for protection: mask Measures for protection: mask Q12.9 If yes, are measures taken for the individual's protection? Mask Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q12.8 = 1 1 Yes 2 No Measures for protection: apron Measures for protection: apron Measures for protection: apron Measures for protection: apron Measures for protection: apron Q12.9 If yes, are measures taken for the individual's protection? Apron Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q12.8 = 1 1 Yes 2 No Measures for protection: footwear Measures for protection: footwear Measures for protection: footwear Measures for protection: footwear Measures for protection: footwear Q12.9 If yes, are measures taken for the individual's protection? Footwear Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q12.8 = 1 1 Yes 2 No Measures for protection: other Measures for protection: other Measures for protection: other Measures for protection: other Measures for protection: other Q12.9 If yes, are measures taken for the individual's protection? Other Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q12.8 = 1 1 Yes 2 No Measures for protection: other specific Measures for protection: other specific Measures for protection: other specific Measures for protection: other specific Measures for protection: other specific Q12.9 If yes, are measures taken for the individual's protection? Others, specify Q12.8 = 1 1 Yes 2 No Engineer available for equipment maintenance Engineer available for equipment maintenance Engineer available for equipment maintenance Engineer available for equipment maintenance Engineer available for equipment maintenance Q12.10 Is there an engineer available who is responsible for maintaining the equipment in this laboratory? Observation No 2 -> Q13.1 ->Q13.1 1 Yes 2 No Engineer with BS level of qualification Engineer with BS level of qualification Engineer with BS level of qualification Engineer with BS level of qualification Engineer with BS level of qualification Q12.11 If yes, does she/he have B.Sc level of qualification? Q12.10 = 1 1 Yes 2 No Section score, 3 Section score, 3 Section score, 3 Section score, 3 Section score, 3 Score for this section (.../...)*100 Section grade, 3 Section grade, 3 Section grade, 3 Section grade, 3 Section grade, 3 Grade for this section Staff aware of infection prevention: handwashing Staff aware of infection prevention: handwashing Staff aware of infection prevention: handwashing Staff aware of infection prevention: handwashing Staff aware of infection prevention: handwashing Q13.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Handwashing Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: gloving Staff aware of infection prevention: gloving Staff aware of infection prevention: gloving Staff aware of infection prevention: gloving Staff aware of infection prevention: gloving Q13.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Gloving Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes Staff aware of infection prevention: decontamination Staff aware of infection prevention: decontamination Staff aware of infection prevention: decontamination Staff aware of infection prevention: decontamination Staff aware of infection prevention: decontamination Q13.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Decontamination Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: cleaning Staff aware of infection prevention: cleaning Staff aware of infection prevention: cleaning Staff aware of infection prevention: cleaning Staff aware of infection prevention: cleaning Q13.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Cleaning Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: autoclaving Staff aware of infection prevention: autoclaving Staff aware of infection prevention: autoclaving Staff aware of infection prevention: autoclaving Staff aware of infection prevention: autoclaving Q13.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Sterilisation/Autoclaving Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: waste disposal Staff aware of infection prevention: waste disposal Staff aware of infection prevention: waste disposal Staff aware of infection prevention: waste disposal Staff aware of infection prevention: waste disposal Q13.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Waste Disposal Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: management of accidental injury Staff aware of infection prevention: management of accidental injury Staff aware of infection prevention: management of accidental injury Staff aware of infection prevention: management of accidental injury Staff aware of infection prevention: management of accidental injury Q13.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Management of accidental injury Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff had training on universal precaution Staff had training on universal precaution Staff had training on universal precaution Staff had training on universal precaution Staff had training on universal precaution Q13.2 Have staffs working in this laboratory received any training on universal precaution and waste disposal? 1 Yes 2 No Rules of handwashing followed Rules of handwashing followed Rules of handwashing followed Rules of handwashing followed Rules of handwashing followed Q13.3 Is all laboratory staff following rules of hand washing? Ask to show the procedure 1 Yes 2 No Recent universal precaution guideline available Recent universal precaution guideline available Recent universal precaution guideline available Recent universal precaution guideline available Recent universal precaution guideline available Q13.4 Is the recent universal precaution guideline available? Observation 1 Yes 2 No Gloves used while handling samples Gloves used while handling samples Gloves used while handling samples Gloves used while handling samples Gloves used while handling samples Q13.5 Are gloves usually used in the laboratory while handling samples? Observation 1 Yes 2 No Gloves used in lab while conducting HIV/STI tests Gloves used in lab while conducting HIV/STI tests Gloves used in lab while conducting HIV/STI tests Gloves used in lab while conducting HIV/STI tests Gloves used in lab while conducting HIV/STI tests Q13.6 Are gloves usually used in the laboratory while conducting HIV/STI tests? 1 Yes 2 No Lab coats worn while performing tests Lab coats worn while performing tests Lab coats worn while performing tests Lab coats worn while performing tests Lab coats worn while performing tests Q13.7 Are lab coats worn in laboratory while performing the tests? Observation 1 Yes 2 No Mats placed on the testing area Mats placed on the testing area Mats placed on the testing area Mats placed on the testing area Mats placed on the testing area Q13.8 Are mats placed on the testing area? Observation 1 Yes 2 No PEP system in place PEP system in place PEP system in place PEP system in place PEP system in place Q13.9 Is there any PEP system in place? 1 Yes 2 No Subsection score, 4a Subsection score, 4a Subsection score, 4a Subsection score, 4a Subsection score, 4a Score for this subsection (.../...)*100 Subsection grade, 4a Subsection grade, 4a Subsection grade, 4a Subsection grade, 4a Subsection grade, 4a Grade for this subsection Common container of sharps disposal Common container of sharps disposal Common container of sharps disposal Common container of sharps disposal Common container of sharps disposal Q13.10 Where are the sharps disposed usually? Observation 1 Plastic bin 2 Safety box/sharp box 3 Bottle 99 Others Common container of sharps disposal, other specific Common container of sharps disposal, other specific Common container of sharps disposal, other specific Common container of sharps disposal, other specific Common container of sharps disposal, other specific Q13.10 Where are the sharps disposed usually? Others, specify Observation Clinical staff dispose needle and syringe appropriately Clinical staff dispose needle and syringe appropriately Clinical staff dispose needle and syringe appropriately Clinical staff dispose needle and syringe appropriately Clinical staff dispose needle and syringe appropriately Q13.11 Do all clinical staff dispose needle and syringe appropriately? 1 Yes 2 No Subsection score, 4b Subsection score, 4b Subsection score, 4b Subsection score, 4b Subsection score, 4b Score for this subsection (.../...)*100 Subsection grade, 4b Subsection grade, 4b Subsection grade, 4b Subsection grade, 4b Subsection grade, 4b Grade for this subsection Instruments decontaminated and sterilized after each use Instruments decontaminated and sterilized after each use Instruments decontaminated and sterilized after each use Instruments decontaminated and sterilized after each use Instruments decontaminated and sterilized after each use Q14.1 Are the instruments decontaminated and sterilized after each use? 1 Yes 2 No Hypochlorite solution/savlon used Hypochlorite solution/savlon used Hypochlorite solution/savlon used Hypochlorite solution/savlon used Hypochlorite solution/savlon used Q14.2 Is hypochlorite solution/savlon used in this facility? No 2 -> Q14.6 ->Q14.6 1 Yes 2 No Length of time instruments are dipped Length of time instruments are dipped Length of time instruments are dipped Length of time instruments are dipped Length of time instruments are dipped Q14.3 If yes, for how long the instruments are dipped? Q14.2 = 1 1 <10 mins 2 10 – 30 mins 3 >30 mins Frequency of hypochlorite solution/savlon preparation Frequency of hypochlorite solution/savlon preparation Frequency of hypochlorite solution/savlon preparation Frequency of hypochlorite solution/savlon preparation Frequency of hypochlorite solution/savlon preparation Q14.4 How frequently is the hypochlorite solution/savlon prepared? 1 Daily/whenever required 2 Once in 2 days 99 Others Frequency of hypochlorite solution/savlon preparation, other specific Frequency of hypochlorite solution/savlon preparation, other specific Frequency of hypochlorite solution/savlon preparation, other specific Frequency of hypochlorite solution/savlon preparation, other specific Frequency of hypochlorite solution/savlon preparation, other specific Q14.4 How frequently is the hypochlorite solution/savlon prepared? Others, specify Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Q14.5 After dipping in hypochlorite solution/savlon, are the instruments washed by continuous flow of water? 1 Yes 2 No Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Q14.6 After cleaning, are instruments autoclaved? 1 Yes 2 No Subsection score, 4c Subsection score, 4c Subsection score, 4c Subsection score, 4c Subsection score, 4c Score for this subsection (.../...)*100 Subsection grade, 4c Subsection grade, 4c Subsection grade, 4c Subsection grade, 4c Subsection grade, 4c Grade for this subsection Established procedure for waste disposal Established procedure for waste disposal Established procedure for waste disposal Established procedure for waste disposal Established procedure for waste disposal Q15.1 Is there any established procedure for waste disposal? 1 Yes 2 No Common way of sharps disposal Common way of sharps disposal Common way of sharps disposal Common way of sharps disposal Common way of sharps disposal Q15.2 How sharps are disposed usually? Observation 1 Collected in hard closed bin and taken to deep pit burial 2 Collected in any bucket and taken to deep pit burial 99 Others Common way of sharps disposal, other specific Common way of sharps disposal, other specific Common way of sharps disposal, other specific Common way of sharps disposal, other specific Common way of sharps disposal, other specific Q15.2 How sharps are disposed usually? Others, specify Observation Common way of glasswares disposal Common way of glasswares disposal Common way of glasswares disposal Common way of glasswares disposal Common way of glasswares disposal Q15.3 How glass wares are disposed usually? Observation 1 Collected in hard closed bin and taken to deep pit burial 2 Collected in hard closed bin and reused after autoclaving 3 Collected in any bucket and taken to deep pit burial 4 Collected in any bucket and reused after autoclaving 99 Others Common way of glasswares disposal, other specific Common way of glasswares disposal, other specific Common way of glasswares disposal, other specific Common way of glasswares disposal, other specific Common way of glasswares disposal, other specific Q15.3 How glass wares are disposed usually? Others specify Observation Common way of clinical waste disposal Common way of clinical waste disposal Common way of clinical waste disposal Common way of clinical waste disposal Common way of clinical waste disposal Q15.4 How liquid clinical waste is disposed usually? Observation 1 Decontaminated with disinfectant for 30 mins and lead to underground drainage 2 Lead to underground drainage 99 Others Common way of clinical waste disposal, other specific Common way of clinical waste disposal, other specific Common way of clinical waste disposal, other specific Common way of clinical waste disposal, other specific Common way of clinical waste disposal, other specific Q15.4 How liquid clinical waste is disposed usually? Others, specify Observation Separate buckets for contaminated waste disposal Separate buckets for contaminated waste disposal Separate buckets for contaminated waste disposal Separate buckets for contaminated waste disposal Separate buckets for contaminated waste disposal Q15.5 Are there separate buckets for disposal of contaminated waste (e.g. swab), instruments (e.g. forceps)? Observation 1 Yes 2 No Common way of infectious materials disposal Common way of infectious materials disposal Common way of infectious materials disposal Common way of infectious materials disposal Common way of infectious materials disposal Q15.6 How are infectious materials disposed (e.g. blood, used cotton, gauge) usually? Observation 1 Deep pit burial 2 Burnt 99 Others Common way of infectious materials disposal, other specific Common way of infectious materials disposal, other specific Common way of infectious materials disposal, other specific Common way of infectious materials disposal, other specific Common way of infectious materials disposal, other specific Q15.6 How infectious materials are disposed (e.g. blood, used cotton, gauge) usually? Observation Subsection score, 4d Subsection score, 4d Subsection score, 4d Subsection score, 4d Subsection score, 4d Score for this subsection (.../...)*100 Subsection grade, 4d Subsection grade, 4d Subsection grade, 4d Subsection grade, 4d Subsection grade, 4d Grade for this subsection Keeps records of samples tested for HIV Keeps records of samples tested for HIV Keeps records of samples tested for HIV Keeps records of samples tested for HIV Keeps records of samples tested for HIV Q16.1 Does the laboratory keep records of samples that were tested for HIV? Observation 1 Yes 2 No Kept records of samples tested for STI Kept records of samples tested for STI Kept records of samples tested for STI Kept records of samples tested for STI Kept records of samples tested for STI Q16.2 Has the laboratory kept records of samples that were tested for STI? Observation 1 Yes 2 No Manner of recording of STI/HIV records: computerized Manner of recording of STI/HIV records: computerized Manner of recording of STI/HIV records: computerized Manner of recording of STI/HIV records: computerized Manner of recording of STI/HIV records: computerized Q16.3 How are the records of STI/HIV recorded? Computerized Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Manner of recording of STI/HIV records: register book Manner of recording of STI/HIV records: register book Manner of recording of STI/HIV records: register book Manner of recording of STI/HIV records: register book Manner of recording of STI/HIV records: register book Q16.3 How are the records of STI/HIV recorded? Register book Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Manner of recording of STI/HIV records: others Manner of recording of STI/HIV records: others Manner of recording of STI/HIV records: others Manner of recording of STI/HIV records: others Manner of recording of STI/HIV records: others Q16.3 How are the records of STI/HIV recorded? Others Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Manner of recording of STI/HIV records: other specific Manner of recording of STI/HIV records: other specific Manner of recording of STI/HIV records: other specific Manner of recording of STI/HIV records: other specific Manner of recording of STI/HIV records: other specific Q16.3 How are the records of STI/HIV recorded? Others, specify Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned Person responsible for maintaining the laboratory test record Person responsible for maintaining the laboratory test record Person responsible for maintaining the laboratory test record Person responsible for maintaining the laboratory test record Person responsible for maintaining the laboratory test record Q16.4 Is there any person responsible for maintaining the laboratory test record? Observation 1 Yes 2 No Provide STI/HIV report to authority in timely manner Provide STI/HIV report to authority in timely manner Provide STI/HIV report to authority in timely manner Provide STI/HIV report to authority in timely manner Provide STI/HIV report to authority in timely manner Q16.5 Does the facility provide STI and HIV report to the authority in a timely manner? (observation) Observation 1 Yes 2 No Section score, 5 Section score, 5 Section score, 5 Section score, 5 Section score, 5 Score for this section (.../...)*100 Section grade, 5 Section grade, 5 Section grade, 5 Section grade, 5 Section grade, 5 Grade for this section Has internal QC system for HIV/STI testing Has internal QC system for HIV/STI testing Has internal QC system for HIV/STI testing Has internal QC system for HIV/STI testing Has internal QC system for HIV/STI testing Q17.1 Is there an internal QC system for HIV/STI testing in this laboratory? Observation No 2 -> Q17.3 1 Yes 2 No Ever had internal QC system for HIV/STI testing Ever had internal QC system for HIV/STI testing Ever had internal QC system for HIV/STI testing Ever had internal QC system for HIV/STI testing Ever had internal QC system for HIV/STI testing Q17.2 If there is none now, was there ever an internal QC system in the laboratory? Q17.1 = 2 1 Yes 2 No Has external QC system for HIV/STI testing Has external QC system for HIV/STI testing Has external QC system for HIV/STI testing Has external QC system for HIV/STI testing Has external QC system for HIV/STI testing Q17.3 Is there an external QC system for HIV/STI testing in this laboratory? Observation No 2 -> Q17.5 1 Yes 2 No Ever had external QC system for HIV/STI testing Ever had external QC system for HIV/STI testing Ever had external QC system for HIV/STI testing Ever had external QC system for HIV/STI testing Ever had external QC system for HIV/STI testing Q17.4 If there is none now, was there ever an external QC system in the laboratory? Q17.3 = 2 1 Yes 2 No Has specific personnel for checking QC system Has specific personnel for checking QC system Has specific personnel for checking QC system Has specific personnel for checking QC system Has specific personnel for checking QC system Q17.5 Is there any specific personnel for checking the QC system in the laboratory? 1 Yes 2 No Conducted QC on samples received from other laboratories Conducted QC on samples received from other laboratories Conducted QC on samples received from other laboratories Conducted QC on samples received from other laboratories Conducted QC on samples received from other laboratories Q17.6 Has the laboratory ever conducted any QC on any samples received from other laboratories? No 2 -> Q18.1 1 Yes 2 No QC done on a regular basis QC done on a regular basis QC done on a regular basis QC done on a regular basis QC done on a regular basis Q17.7 If yes, is this done on a regular basis? Q17.6 = 1 1 Yes 2 No Section score, 6 Section score, 6 Section score, 6 Section score, 6 Section score, 6 Score for this section (.../...)*100 Section grade, 6 Section grade, 6 Section grade, 6 Section grade, 6 Section grade, 6 Grade for this section Personnel understand the meaning of confidentiality Personnel understand the meaning of confidentiality Personnel understand the meaning of confidentiality Personnel understand the meaning of confidentiality Personnel understand the meaning of confidentiality Q18.1 Do all laboratory personnel understand the meaning of confidentiality? Ask the meaning of confidentiality 1 Yes 2 No Had break in confidentiality Had break in confidentiality Had break in confidentiality Had break in confidentiality Had break in confidentiality Q18.2 Have you had any break in confidentiality in this facility? Yes 1 -> Q18.3 No 2 -> Q19.1 ->Q19.1 1 Yes 2 No Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Q18.3 If yes, how was this managed? Meeting with all staff Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q18.2 = 1 1 Yes 2 No Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Q18.3 If yes, how was this managed? Meeting with individual person Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q18.2 = 1 1 Yes 2 No Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Q18.3 If yes, how was this managed? Who breaks confidentiality Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q18.2 = 1 1 Yes 2 No Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Q18.3 If yes, how was this managed? Others Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q18.2 = 1 1 Yes 2 No Manage confidentiality break, other specifc Manage confidentiality break, other specifc Manage confidentiality break, other specifc Manage confidentiality break, other specifc Manage confidentiality break, other specifc Q18.3 If yes, how was this managed? Others, specify Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q18.2 = 1 Section score, 7 Section score, 7 Section score, 7 Section score, 7 Section score, 7 Score for this section (.../...)*100 Section grade, 7 Section grade, 7 Section grade, 7 Section grade, 7 Section grade, 7 Grade for this section Number of STI cases tested Number of STI cases tested Number of STI cases tested Number of STI cases tested Number of STI cases tested Q19.1 How many of STI cases tested in the last 12 months? Observation Number of HIV cases tested Number of HIV cases tested Number of HIV cases tested Number of HIV cases tested Number of HIV cases tested Q19.2 How many of HIV cases tested in the last 12 months? (observation) Observation Proportion of referral cases of STI among the tests performed Proportion of referral cases of STI among the tests performed Proportion of referral cases of STI among the tests performed Proportion of referral cases of STI among the tests performed Proportion of referral cases of STI among the tests performed Q19.3 Proportion of referral cases of STI among the tests performed in the last 12 months? Observation Proportion of referral cases of HIV among the tests performed Proportion of referral cases of HIV among the tests performed Proportion of referral cases of HIV among the tests performed Proportion of referral cases of HIV among the tests performed Proportion of referral cases of HIV among the tests performed Q19.4 Proportion of referral cases of HIV among the tests performed in the last 12 months? Observation Section score, 8 Section score, 8 Section score, 8 Section score, 8 Section score, 8 Score for this section (.../...)*100 Section grade, 8 Section grade, 8 Section grade, 8 Section grade, 8 Section grade, 8 Grade for this section Unique key Unique key Unique key Unique key Unique key Unique key Recstatus Recstatus Recstatus Recstatus Recstatus Serial number of health facility Serial number of health facility Serial number of health facility Serial number of health facility Serial number of health facility Serial number of the health facility District District District District District District 1 Bumthang 2 Chukha 3 Dagana 4 Gasa 5 Ha 6 Lhuntse 7 Monggar 8 Paro 9 Pemagatshel 10 Punakha 11 Samdrup Jongkhar 12 Samtse 13 Sarpang 14 Thimphu 15 Trashigang 16 Trongsa 17 Tsirang 18 Wangdue Phodrang 19 Yangtsi 20 Zhemgang Gewog/town Gewog/town Gewog/town Gewog/town Gewog/town Interview completion status Interview completion status Interview completion status Interview completion status Interview completion status Interview completion status 1 Completed 2 Not completed Type of health facility Type of health facility Type of health facility Type of health facility Type of health facility Type of health facility 1 National Referral Hospital 2 Public Health Laboratory 3 Regional Referral Hospitals Specimens used for HIV testing Specimens used for HIV testing Specimens used for HIV testing Specimens used for HIV testing Specimens used for HIV testing 1. Was there a place for you to sit while you were waiting? 1 Serum 2 Plasma Algorithm followed for HIV testing Algorithm followed for HIV testing Algorithm followed for HIV testing Algorithm followed for HIV testing Algorithm followed for HIV testing 2. Was the prescriber knowledgeable? 1 Yes 2 No Algorithm Based on existing national guidelines Algorithm Based on existing national guidelines Algorithm Based on existing national guidelines Algorithm Based on existing national guidelines Algorithm Based on existing national guidelines 3. Did you feel comfortable when the prescriber asking questions? 1 Yes 2 No CD4 tests done for HIV positive patients CD4 tests done for HIV positive patients CD4 tests done for HIV positive patients CD4 tests done for HIV positive patients CD4 tests done for HIV positive patients 4. Did you feel the prescriber answer your questions fully? 1 Yes 2 No Tests conducted for STI, Gonorrhoea Tests conducted for STI, Gonorrhoea Tests conducted for STI, Gonorrhoea Tests conducted for STI, Gonorrhoea Tests conducted for STI, Gonorrhoea Q5 What laboratory tests are conducted for STI? Gonorrhoea Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests conducted for STI, Chlamydia Tests conducted for STI, Chlamydia Tests conducted for STI, Chlamydia Tests conducted for STI, Chlamydia Tests conducted for STI, Chlamydia Q5 What laboratory tests are conducted for STI? Chlamydia Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests conducted for STI, Syphilis Tests conducted for STI, Syphilis Tests conducted for STI, Syphilis Tests conducted for STI, Syphilis Tests conducted for STI, Syphilis Q5 What laboratory tests are conducted for STI? Syphilis Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests conducted for STI, Hepatitis B Tests conducted for STI, Hepatitis B Tests conducted for STI, Hepatitis B Tests conducted for STI, Hepatitis B Tests conducted for STI, Hepatitis B Q5 What laboratory tests are conducted for STI? Hepatitis B Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests conducted for STI, Hepatitis C Tests conducted for STI, Hepatitis C Tests conducted for STI, Hepatitis C Tests conducted for STI, Hepatitis C Tests conducted for STI, Hepatitis C Q5 What laboratory tests are conducted for STI? Hepatitis C Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Specimens used for STI testing, blood Specimens used for STI testing, blood Specimens used for STI testing, blood Specimens used for STI testing, blood Specimens used for STI testing, blood Q6 What specimens are used for STI testing? Blood Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Specimens used for STI testing, urethral swab (male) Specimens used for STI testing, urethral swab (male) Specimens used for STI testing, urethral swab (male) Specimens used for STI testing, urethral swab (male) Specimens used for STI testing, urethral swab (male) Q6 What specimens are used for STI testing? Urethral swab (male) Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Specimens used for STI testing, vaginal swab (female) Specimens used for STI testing, vaginal swab (female) Specimens used for STI testing, vaginal swab (female) Specimens used for STI testing, vaginal swab (female) Specimens used for STI testing, vaginal swab (female) Q6 What specimens are used for STI testing? Vaginal swab (female) Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Specimens used for STI testing, urine (male/female) Specimens used for STI testing, urine (male/female) Specimens used for STI testing, urine (male/female) Specimens used for STI testing, urine (male/female) Specimens used for STI testing, urine (male/female) Q6 What specimens are used for STI testing? Urine (male/female) Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests performed for STI, gram stain Tests performed for STI, gram stain Tests performed for STI, gram stain Tests performed for STI, gram stain Tests performed for STI, gram stain Q7 What are the tests performed for STI? Gram stain Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests performed for STI, culture & sensitivity Tests performed for STI, culture & sensitivity Tests performed for STI, culture & sensitivity Tests performed for STI, culture & sensitivity Tests performed for STI, culture & sensitivity Q7 What are the tests performed for STI? Culture & sensitivity Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests performed for STI, dark field microscopy Tests performed for STI, dark field microscopy Tests performed for STI, dark field microscopy Tests performed for STI, dark field microscopy Tests performed for STI, dark field microscopy Q7 What are the tests performed for STI? dark field microscopy Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests performed for STI, TPHA Tests performed for STI, TPHA Tests performed for STI, TPHA Tests performed for STI, TPHA Tests performed for STI, TPHA Q7 What are the tests performed for STI? TPHA Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Tests performed for STI, RPR/VDRL Tests performed for STI, RPR/VDRL Tests performed for STI, RPR/VDRL Tests performed for STI, RPR/VDRL Tests performed for STI, RPR/VDRL Q7 What are the tests performed for STI? RPR/VRDL Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Section score, 1 Section score, 1 Section score, 1 Section score, 1 Section score, 1 Score for this section (.../...)*100 Section grade, 1 Section grade, 1 Section grade, 1 Section grade, 1 Section grade, 1 Grade for this section Lab space adequate Lab space adequate Lab space adequate Lab space adequate Lab space adequate 8. Did your prescriber clearly explain the meaning of your disease? 1 Yes 2 No Adequate water supply available Adequate water supply available Adequate water supply available Adequate water supply available Adequate water supply available Q9.1 Is adequate water supply available in the laboratory? Observation 1 Yes 2 No Access to a functioning autoclave Access to a functioning autoclave Access to a functioning autoclave Access to a functioning autoclave Access to a functioning autoclave Q9.2 Does the laboratory have access to a functioning autoclave? Observation No 2 -> Q9.5 1 Yes 2 No Autoclave on site Autoclave on site Autoclave on site Autoclave on site Autoclave on site Q9.3 If autoclaving is done, is there an autoclave on site? Observation Q9.2 = 1 1 Yes 2 No Standard procedures followed for autoclaving Standard procedures followed for autoclaving Standard procedures followed for autoclaving Standard procedures followed for autoclaving Standard procedures followed for autoclaving Q9.4 Are standard procedures followed for autoclaving? Q9.2 = 1 1 Yes 2 No Common way of sterilization of materials Common way of sterilization of materials Common way of sterilization of materials Common way of sterilization of materials Common way of sterilization of materials Q9.5 If there is no autoclave, how are materials sterilized usually, in last 7 days? 1 Boiling 2 Hot air oven 3 Others Common way of sterilization of materials, other specific Common way of sterilization of materials, other specific Common way of sterilization of materials, other specific Common way of sterilization of materials, other specific Common way of sterilization of materials, other specific Q9.5 If there is no autoclave, how are materials sterilized usually, in last 7 days? Others, specify Access to functioning incinerator Access to functioning incinerator Access to functioning incinerator Access to functioning incinerator Access to functioning incinerator Q9.6 Does the laboratory have access to a functioning incinerator? Observation No 2 -> Q10.1 1 Yes 2 No Incinerator within reachable distance Incinerator within reachable distance Incinerator within reachable distance Incinerator within reachable distance Incinerator within reachable distance Q9.7 Is it within the reachable distance? Q9.6 = 1 1 Yes 2 No Subsection score, 2a Subsection score, 2a Subsection score, 2a Subsection score, 2a Subsection score, 2a Score for this subsection (.../...)*100 Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Subsection grade, 2a Grade for this subsection Microscope, presence Microscope, presence Microscope, presence Microscope, presence Microscope, presence Q10.1 Microscope, presence Observation 1 Yes 2 No Microscope, functioning Microscope, functioning Microscope, functioning Microscope, functioning Microscope, functioning Q10.1 Microscope, functioning Observation 1 Yes 2 No Sink for staining, presence Sink for staining, presence Sink for staining, presence Sink for staining, presence Sink for staining, presence Q10.2 Sink for staining, presence Observation 1 Yes 2 No ELISA reader, presence ELISA reader, presence ELISA reader, presence ELISA reader, presence ELISA reader, presence Q10.3 ELISA reader, presence Observation 1 Yes 2 No ELISA reader, functioning ELISA reader, functioning ELISA reader, functioning ELISA reader, functioning ELISA reader, functioning Q10.3 ELISA reader, functioning Observation 1 Yes 2 No ELISA washer, presence ELISA washer, presence ELISA washer, presence ELISA washer, presence ELISA washer, presence Q10.4 ELISA washer, presence Observation 1 Yes 2 No ELISA washer, functioning ELISA washer, functioning ELISA washer, functioning ELISA washer, functioning ELISA washer, functioning Q10.4 ELISA washer, functioning Observation 1 Yes 2 No Micropipettes, presence Micropipettes, presence Micropipettes, presence Micropipettes, presence Micropipettes, presence Q10.5 Micropipettes, presence Observation 1 Yes 2 No Micropipettes, functioning Micropipettes, functioning Micropipettes, functioning Micropipettes, functioning Micropipettes, functioning Q10.5 Micropipettes, functioning Observation 1 Yes 2 No Candle jar, presence Candle jar, presence Candle jar, presence Candle jar, presence Candle jar, presence Q10.6 Candle jar, presence Observation 1 Yes 2 No Candle jar, functioning Candle jar, functioning Candle jar, functioning Candle jar, functioning Candle jar, functioning Q10.6 Candle jar, functioning Observation 1 Yes 2 No Bunsen Burner/spirit lamp, presence Bunsen Burner/spirit lamp, presence Bunsen Burner/spirit lamp, presence Bunsen Burner/spirit lamp, presence Bunsen Burner/spirit lamp, presence Q10.7 Bunsen Burner/spirit lamp, presence Observation 1 Yes 2 No Bunsen Burner/spirit lamp, functioning Bunsen Burner/spirit lamp, functioning Bunsen Burner/spirit lamp, functioning Bunsen Burner/spirit lamp, functioning Bunsen Burner/spirit lamp, functioning Q10.7 Bunsen Burner/spirit lamp, functioning Observation 1 Yes 2 No Hot air oven, presence Hot air oven, presence Hot air oven, presence Hot air oven, presence Hot air oven, presence Q10.8 Hot air oven, presence Observation 1 Yes 2 No Hot air oven, functioning Hot air oven, functioning Hot air oven, functioning Hot air oven, functioning Hot air oven, functioning Q10.8 Hot air oven, functioning Observation 1 Yes 2 No Incubator, presence Incubator, presence Incubator, presence Incubator, presence Incubator, presence Q10.9 Incubator, presence Observation 1 Yes 2 No Incubator, functioning Incubator, functioning Incubator, functioning Incubator, functioning Incubator, functioning Q10.9 Incubator, functioning Observation 1 Yes 2 No Plate shaker, presence Plate shaker, presence Plate shaker, presence Plate shaker, presence Plate shaker, presence Q10.10 Plate shaker, presence Observation 1 Yes 2 No Plate shaker, functioning Plate shaker, functioning Plate shaker, functioning Plate shaker, functioning Plate shaker, functioning Q10.10 Plate shaker, functioning Observation 1 Yes 2 No CD4, presence CD4, presence CD4, presence CD4, presence CD4, presence Q10.11 CD4, presence Observation 1 Yes 2 No CD4, functioning CD4, functioning CD4, functioning CD4, functioning CD4, functioning Q10.11 CD4, functioning Observation 1 Yes 2 No Refrigerator, presence Refrigerator, presence Refrigerator, presence Refrigerator, presence Refrigerator, presence Q10.12 Refrigerator, presence Observation 1 Yes 2 No Refrigerator, functioning Refrigerator, functioning Refrigerator, functioning Refrigerator, functioning Refrigerator, functioning Q10.12 Refrigerator, functioning Observation 1 Yes 2 No -20C freezer, presence -20C freezer, presence -20C freezer, presence -20C freezer, presence -20C freezer, presence Q10.13 -20C freezer, presence Observation 1 Yes 2 No -20C freezer, functioning -20C freezer, functioning -20C freezer, functioning -20C freezer, functioning -20C freezer, functioning Q10.13 -20C freezer, functioning Observation 1 Yes 2 No -70C freezer, presence -70C freezer, presence -70C freezer, presence -70C freezer, presence -70C freezer, presence Q10.14 -70C freezer, presence Observation 1 Yes 2 No -70C freezer, functioning -70C freezer, functioning -70C freezer, functioning -70C freezer, functioning -70C freezer, functioning Q10.14 -70C freezer, functioning Observation 1 Yes 2 No Number of refs adequate, presence Number of refs adequate, presence Number of refs adequate, presence Number of refs adequate, presence Number of refs adequate, presence Q10.15 Are the number of refrigerators (-20C and -70C) adequate for the need of this laboratory? Presence Observation 1 Yes 2 No Number of refs adequate, functioning Number of refs adequate, functioning Number of refs adequate, functioning Number of refs adequate, functioning Number of refs adequate, functioning Q10.15 Are the number of refrigerators (-20C and -70C) adequate for the need of this laboratory? Functioning Observation 1 Yes 2 No Computer Computer Computer Computer Computer Q10.16 Computer Observation 1 Yes 2 No Printer Printer Printer Printer Printer Q10.17 Printer Observation 1 Yes 2 No Sebsection score, 2b Sebsection score, 2b Sebsection score, 2b Sebsection score, 2b Sebsection score, 2b Score for this subsection (.../...)*100 Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Subsection grade, 2b Grade for this subsection Adequate reagents/kits for STI diagnosis available Adequate reagents/kits for STI diagnosis available Adequate reagents/kits for STI diagnosis available Adequate reagents/kits for STI diagnosis available Adequate reagents/kits for STI diagnosis available Q11.1 Does the laboratory have adequate reagents/kits for STI diagnosis available? Observation 1 Yes 2 No Adequate reagents/kits for HIV diagnosis available Adequate reagents/kits for HIV diagnosis available Adequate reagents/kits for HIV diagnosis available Adequate reagents/kits for HIV diagnosis available Adequate reagents/kits for HIV diagnosis available Q11.2 Does the laboratory have adequate reagents/kits for HIV diagnosis available? Observation 1 Yes 2 No Reagents/kits arrive in right condition Reagents/kits arrive in right condition Reagents/kits arrive in right condition Reagents/kits arrive in right condition Reagents/kits arrive in right condition Q11.3 Do the reagents/kits usually arrive in the reference laboratory in right conditions (e.g. temperature, intact packages, etc)? 1 Yes 2 No Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Action taken on reagents/kits not in right condition Q11.4 What does the laboratory do if the supplies do not arrive in right condition? 1 Discard 2 Returned 3 Reuse 99 Others Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Action taken on reagents/kits not in right condition, other specific Q11.4 What does the laboratory do if the supplies do not arrive in right condition? Others, specify Reagent/kit beyond expired date available Reagent/kit beyond expired date available Reagent/kit beyond expired date available Reagent/kit beyond expired date available Reagent/kit beyond expired date available Q11.5 Are any of the reagents/kits available at the facility beyond expired date? Observation No 2 -> Q11.7 1 Yes 2 No Action taken on expired reagent/kit Action taken on expired reagent/kit Action taken on expired reagent/kit Action taken on expired reagent/kit Action taken on expired reagent/kit Q11.6 What is done with the expired reagents/kits? Q11.5 = 1 1 Discard 2 Returned 3 Reuse 99 Others Action taken on expired reagent/kit, other specific Action taken on expired reagent/kit, other specific Action taken on expired reagent/kit, other specific Action taken on expired reagent/kit, other specific Action taken on expired reagent/kit, other specific Q11.6 What is done with the expired reagents/kits? Others, specify Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Adequate quantity of disinfectants Q11.7 Does the laboratory usually have adequate quantity of disinfectants for STI? Observation 1 Yes 2 No Disinfectants used: Sodium Hypochlorite solution Disinfectants used: Sodium Hypochlorite solution Disinfectants used: Sodium Hypochlorite solution Disinfectants used: Sodium Hypochlorite solution Disinfectants used: Sodium Hypochlorite solution Q11.8 What are the disinfectants used in the laboratory? Sodium Hypochlorite solution Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Disinfectants used: Savlon Disinfectants used: Savlon Disinfectants used: Savlon Disinfectants used: Savlon Disinfectants used: Savlon Q11.8 What are the disinfectants used in the laboratory? Savlon Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Disinfectants used: 70% ethanol Disinfectants used: 70% ethanol Disinfectants used: 70% ethanol Disinfectants used: 70% ethanol Disinfectants used: 70% ethanol Q11.8 What are the disinfectants used in the laboratory? 70% ethanol Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Disinfectants used: Other Disinfectants used: Other Disinfectants used: Other Disinfectants used: Other Disinfectants used: Other Q11.8d What are the disinfectants used in the laboratory? Other 1 Yes 2 No Subsection score, 2c Subsection score, 2c Subsection score, 2c Subsection score, 2c Subsection score, 2c Score for this subsection (.../...)*100 Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Subsection grade, 2c Grade for this subsection Supplies in lab: glassware Supplies in lab: glassware Supplies in lab: glassware Supplies in lab: glassware Supplies in lab: glassware Q11.9 Are following laboratory supplies available to perform the test? Glassware Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: tips Supplies in lab: tips Supplies in lab: tips Supplies in lab: tips Supplies in lab: tips Q11.9 Are following laboratory supplies available to perform the test? Tips Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: Eppendorf tube Supplies in lab: Eppendorf tube Supplies in lab: Eppendorf tube Supplies in lab: Eppendorf tube Supplies in lab: Eppendorf tube Q11.9 Are following laboratory supplies available to perform the test? Eppendorf tube Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: bucket Supplies in lab: bucket Supplies in lab: bucket Supplies in lab: bucket Supplies in lab: bucket Q11.9 Are following laboratory supplies available to perform the test? Bucket Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: disposable syringe Supplies in lab: disposable syringe Supplies in lab: disposable syringe Supplies in lab: disposable syringe Supplies in lab: disposable syringe Q11.9 Are following laboratory supplies available to perform the test? Disposable syringe Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: needle Supplies in lab: needle Supplies in lab: needle Supplies in lab: needle Supplies in lab: needle Q11.9 Are following laboratory supplies available to perform the test? Needle Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Supplies in lab: mask Supplies in lab: mask Supplies in lab: mask Supplies in lab: mask Supplies in lab: mask Q11.9 Are following laboratory supplies available to perform the test? Mask Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Refrigerators adequate for the need of this laboratory functioning Refrigerators adequate for the need of this laboratory functioning Refrigerators adequate for the need of this laboratory functioning Refrigerators adequate for the need of this laboratory functioning Refrigerators adequate for the need of this laboratory functioning Q11.10 Is separate glassware, tips, transfer pipettes etc used for testing? Observation 1 Yes 2 No Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Gloves out of stock last year Q11.11 Was this facility ever out of stock of gloves in the last 12 months? 1 Yes 2 No Section score2b Section score2b Section score2b Section score2b Section score2b Section grade2b Section grade2b Section grade2b Section grade2b Section grade2b Virologist/Microbiologist in lab Virologist/Microbiologist in lab Virologist/Microbiologist in lab Virologist/Microbiologist in lab Virologist/Microbiologist in lab Q12.1 Is there a virologist/microbiologist is present in this laboratory now? Observation No 2 -> Q12.3 1 Yes 2 No Virologist had training on STI/HIV Virologist had training on STI/HIV Virologist had training on STI/HIV Virologist had training on STI/HIV Virologist had training on STI/HIV Q12.2 If yes, has she/he received training in STI/HIV? Q12.1 = 1 1 Yes 2 No Lab technologist in lab Lab technologist in lab Lab technologist in lab Lab technologist in lab Lab technologist in lab Q12.3 Is there any laboratory technologist is present in this laboratory now? Observation No 2 -> Q12.5 1 Yes 2 No Lab technologist had training on relevant tests conducted Lab technologist had training on relevant tests conducted Lab technologist had training on relevant tests conducted Lab technologist had training on relevant tests conducted Lab technologist had training on relevant tests conducted Q12.4 If yes, has she/he training on the relevant tests that s/he conducts? Q12.3 = 1 1 Yes 2 No Lab technician in lab Lab technician in lab Lab technician in lab Lab technician in lab Lab technician in lab Q12.5 Is there a laboratory technician is present in this laboratory now? (observation) Observation 1 Yes 2 No Lab technician had training on relevant tests conducted Lab technician had training on relevant tests conducted Lab technician had training on relevant tests conducted Lab technician had training on relevant tests conducted Lab technician had training on relevant tests conducted Q12.6 If yes, has she/he training on the relevant tests that s/he conducts? No 2 -> Q12.7 Q12.5 = 1 1 Yes 2 No Cleaner in facility Cleaner in facility Cleaner in facility Cleaner in facility Cleaner in facility Q12.7 Is there any cleaner/attendant available in this laboratory? Observation No 2 -> Q12.10 1 Yes 2 No Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Cleaner has to handle biohazard substances Q12.8 Does the cleaner/attendant have to handle biohazard substances? Q12.7 = 1 1 Yes 2 No Measures for protection: gloves Measures for protection: gloves Measures for protection: gloves Measures for protection: gloves Measures for protection: gloves Q12.9 If yes, are measures taken for the individual's protection? Gloves Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q12.8 = 1 1 Yes 2 No Measures for protection: mask Measures for protection: mask Measures for protection: mask Measures for protection: mask Measures for protection: mask Q12.9 If yes, are measures taken for the individual's protection? Mask Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q12.8 = 1 1 Yes 2 No Measures for protection: apron Measures for protection: apron Measures for protection: apron Measures for protection: apron Measures for protection: apron Q12.9 If yes, are measures taken for the individual's protection? Apron Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q12.8 = 1 1 Yes 2 No Measures for protection: footwear Measures for protection: footwear Measures for protection: footwear Measures for protection: footwear Measures for protection: footwear Q12.9 If yes, are measures taken for the individual's protection? Footwear Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q12.8 = 1 1 Yes 2 No Measures for protection: other Measures for protection: other Measures for protection: other Measures for protection: other Measures for protection: other Q12.9 If yes, are measures taken for the individual's protection? Other Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q12.8 = 1 1 Yes 2 No Measures for protection: other specific Measures for protection: other specific Measures for protection: other specific Measures for protection: other specific Measures for protection: other specific Q12.9 If yes, are measures taken for the individual's protection? Others, specify Q12.8 = 1 1 Yes 2 No Engineer available for equipment maintenance Engineer available for equipment maintenance Engineer available for equipment maintenance Engineer available for equipment maintenance Engineer available for equipment maintenance Q12.10 Is there an engineer available who is responsible for maintaining the equipment in this laboratory? Observation No 2 -> Q13.1 ->Q13.1 1 Yes 2 No Engineer with BS level of qualification Engineer with BS level of qualification Engineer with BS level of qualification Engineer with BS level of qualification Engineer with BS level of qualification Q12.11 If yes, does she/he have B.Sc level of qualification? Q12.10 = 1 1 Yes 2 No Section score, 3 Section score, 3 Section score, 3 Section score, 3 Section score, 3 Score for this section (.../...)*100 Section grade, 3 Section grade, 3 Section grade, 3 Section grade, 3 Section grade, 3 Grade for this section Staff aware of infection prevention: handwashing Staff aware of infection prevention: handwashing Staff aware of infection prevention: handwashing Staff aware of infection prevention: handwashing Staff aware of infection prevention: handwashing Q13.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Handwashing Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: gloving Staff aware of infection prevention: gloving Staff aware of infection prevention: gloving Staff aware of infection prevention: gloving Staff aware of infection prevention: gloving Q13.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Gloving Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes Staff aware of infection prevention: decontamination Staff aware of infection prevention: decontamination Staff aware of infection prevention: decontamination Staff aware of infection prevention: decontamination Staff aware of infection prevention: decontamination Q13.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Decontamination Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: cleaning Staff aware of infection prevention: cleaning Staff aware of infection prevention: cleaning Staff aware of infection prevention: cleaning Staff aware of infection prevention: cleaning Q13.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Cleaning Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: autoclaving Staff aware of infection prevention: autoclaving Staff aware of infection prevention: autoclaving Staff aware of infection prevention: autoclaving Staff aware of infection prevention: autoclaving Q13.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Sterilisation/Autoclaving Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: waste disposal Staff aware of infection prevention: waste disposal Staff aware of infection prevention: waste disposal Staff aware of infection prevention: waste disposal Staff aware of infection prevention: waste disposal Q13.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Waste Disposal Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff aware of infection prevention: management of accidental injury Staff aware of infection prevention: management of accidental injury Staff aware of infection prevention: management of accidental injury Staff aware of infection prevention: management of accidental injury Staff aware of infection prevention: management of accidental injury Q13.1 Are staffs at the laboratory aware of the importance of infection prevention and basic measures necessary? Management of accidental injury Multiple response Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Staff had training on universal precaution Staff had training on universal precaution Staff had training on universal precaution Staff had training on universal precaution Staff had training on universal precaution Q13.2 Have staffs working in this laboratory received any training on universal precaution and waste disposal? 1 Yes 2 No Rules of handwashing followed Rules of handwashing followed Rules of handwashing followed Rules of handwashing followed Rules of handwashing followed Q13.3 Is all laboratory staff following rules of hand washing? Ask to show the procedure 1 Yes 2 No Recent universal precaution guideline available Recent universal precaution guideline available Recent universal precaution guideline available Recent universal precaution guideline available Recent universal precaution guideline available Q13.4 Is the recent universal precaution guideline available? Observation 1 Yes 2 No Gloves used while handling samples Gloves used while handling samples Gloves used while handling samples Gloves used while handling samples Gloves used while handling samples Q13.5 Are gloves usually used in the laboratory while handling samples? Observation 1 Yes 2 No Gloves used in lab while conducting HIV/STI tests Gloves used in lab while conducting HIV/STI tests Gloves used in lab while conducting HIV/STI tests Gloves used in lab while conducting HIV/STI tests Gloves used in lab while conducting HIV/STI tests Q13.6 Are gloves usually used in the laboratory while conducting HIV/STI tests? 1 Yes 2 No Lab coats worn while performing tests Lab coats worn while performing tests Lab coats worn while performing tests Lab coats worn while performing tests Lab coats worn while performing tests Q13.7 Are lab coats worn in laboratory while performing the tests? Observation 1 Yes 2 No Mats placed on the testing area Mats placed on the testing area Mats placed on the testing area Mats placed on the testing area Mats placed on the testing area Q13.8 Are mats placed on the testing area? Observation 1 Yes 2 No PEP system in place PEP system in place PEP system in place PEP system in place PEP system in place Q13.9 Is there any PEP system in place? 1 Yes 2 No Subsection score, 4a Subsection score, 4a Subsection score, 4a Subsection score, 4a Subsection score, 4a Score for this subsection (.../...)*100 Subsection grade, 4a Subsection grade, 4a Subsection grade, 4a Subsection grade, 4a Subsection grade, 4a Grade for this subsection Common container of sharps disposal Common container of sharps disposal Common container of sharps disposal Common container of sharps disposal Common container of sharps disposal Q13.10 Where are the sharps disposed usually? Observation 1 Plastic bin 2 Safety box/sharp box 3 Bottle 99 Others Common container of sharps disposal, other specific Common container of sharps disposal, other specific Common container of sharps disposal, other specific Common container of sharps disposal, other specific Common container of sharps disposal, other specific Q13.10 Where are the sharps disposed usually? Others, specify Observation 99 others Clinical staff dispose needle and syringe appropriately Clinical staff dispose needle and syringe appropriately Clinical staff dispose needle and syringe appropriately Clinical staff dispose needle and syringe appropriately Clinical staff dispose needle and syringe appropriately Q13.11 Do all clinical staff dispose needle and syringe appropriately? 1 Yes 2 No Subsection score, 4b Subsection score, 4b Subsection score, 4b Subsection score, 4b Subsection score, 4b Score for this subsection (.../...)*100 Subsection grade, 4b Subsection grade, 4b Subsection grade, 4b Subsection grade, 4b Subsection grade, 4b Grade for this subsection Instruments decontaminated and sterilized after each use Instruments decontaminated and sterilized after each use Instruments decontaminated and sterilized after each use Instruments decontaminated and sterilized after each use Instruments decontaminated and sterilized after each use Q14.1 Are the instruments decontaminated and sterilized after each use? 1 Yes 2 No Hypochlorite solution/savlon used Hypochlorite solution/savlon used Hypochlorite solution/savlon used Hypochlorite solution/savlon used Hypochlorite solution/savlon used Q14.2 Is hypochlorite solution/savlon used in this facility? No 2 -> Q14.6 ->Q14.6 1 Yes 2 No Length of time instruments are dipped Length of time instruments are dipped Length of time instruments are dipped Length of time instruments are dipped Length of time instruments are dipped Q14.3 If yes, for how long the instruments are dipped? Q14.2 = 1 1 <10 mins 2 10 – 30 mins 3 >30 mins Frequency of hypochlorite solution/savlon preparation Frequency of hypochlorite solution/savlon preparation Frequency of hypochlorite solution/savlon preparation Frequency of hypochlorite solution/savlon preparation Frequency of hypochlorite solution/savlon preparation Q14.4 How frequently is the hypochlorite solution/savlon prepared? 1 Daily/whenever required 2 Once in 2 days 99 Others Frequency of hypochlorite solution/savlon preparation, other specific Frequency of hypochlorite solution/savlon preparation, other specific Frequency of hypochlorite solution/savlon preparation, other specific Frequency of hypochlorite solution/savlon preparation, other specific Frequency of hypochlorite solution/savlon preparation, other specific Q14.4 How frequently is the hypochlorite solution/savlon prepared? Others, specify Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Instruments washed in countinuous flow of water Q14.5 After dipping in hypochlorite solution/savlon, are the instruments washed by continuous flow of water? 1 Yes 2 No Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Instruments autoclaved after cleaning Q14.6 After cleaning, are instruments autoclaved? 1 Yes 2 No Subsection score, 4c Subsection score, 4c Subsection score, 4c Subsection score, 4c Subsection score, 4c Score for this subsection (.../...)*100 Subsection grade, 4c Subsection grade, 4c Subsection grade, 4c Subsection grade, 4c Subsection grade, 4c Grade for this subsection Established procedure for waste disposal Established procedure for waste disposal Established procedure for waste disposal Established procedure for waste disposal Established procedure for waste disposal Q15.1 Is there any established procedure for waste disposal? 1 Yes 2 No Common way of sharps disposal Common way of sharps disposal Common way of sharps disposal Common way of sharps disposal Common way of sharps disposal Q15.2 How sharps are disposed usually? Observation 1 Collected in hard closed bin and taken to deep pit burial 2 Collected in any bucket and taken to deep pit burial 99 Others Common way of sharps disposal, other specific Common way of sharps disposal, other specific Common way of sharps disposal, other specific Common way of sharps disposal, other specific Common way of sharps disposal, other specific Q15.2 How sharps are disposed usually? Others, specify Observation Common way of glasswares disposal Common way of glasswares disposal Common way of glasswares disposal Common way of glasswares disposal Common way of glasswares disposal Q15.3 How glass wares are disposed usually? Observation 1 Collected in hard closed bin and taken to deep pit burial 2 Collected in hard closed bin and reused after autoclaving 3 Collected in any bucket and taken to deep pit burial 4 Collected in any bucket and reused after autoclaving 99 Others Common way of glasswares disposal, other specific Common way of glasswares disposal, other specific Common way of glasswares disposal, other specific Common way of glasswares disposal, other specific Common way of glasswares disposal, other specific Q15.3 How glass wares are disposed usually? Others specify Observation Common way of clinical waste disposal Common way of clinical waste disposal Common way of clinical waste disposal Common way of clinical waste disposal Common way of clinical waste disposal Q15.4 How liquid clinical waste is disposed usually? Observation 1 Decontaminated with disinfectant for 30 mins and lead to underground drainage 2 Lead to underground drainage 99 Others Common way of clinical waste disposal, other specific Common way of clinical waste disposal, other specific Common way of clinical waste disposal, other specific Common way of clinical waste disposal, other specific Common way of clinical waste disposal, other specific Q15.4 How liquid clinical waste is disposed usually? Others, specify Observation Separate buckets for contaminated waste disposal Separate buckets for contaminated waste disposal Separate buckets for contaminated waste disposal Separate buckets for contaminated waste disposal Separate buckets for contaminated waste disposal Q15.5 Are there separate buckets for disposal of contaminated waste (e.g. swab), instruments (e.g. forceps)? Observation 1 Yes 2 No Common way of infectious materials disposal Common way of infectious materials disposal Common way of infectious materials disposal Common way of infectious materials disposal Common way of infectious materials disposal Q15.6 How are infectious materials disposed (e.g. blood, used cotton, gauge) usually? Observation 1 Deep pit burial 2 Burnt 99 Others Common way of infectious materials disposal, other specific Common way of infectious materials disposal, other specific Common way of infectious materials disposal, other specific Common way of infectious materials disposal, other specific Common way of infectious materials disposal, other specific Q15.6 How infectious materials are disposed (e.g. blood, used cotton, gauge) usually? Observation Subsection score, 4d Subsection score, 4d Subsection score, 4d Subsection score, 4d Subsection score, 4d Score for this subsection (.../...)*100 Subsection grade, 4d Subsection grade, 4d Subsection grade, 4d Subsection grade, 4d Subsection grade, 4d Grade for this subsection Keeps records of samples tested for HIV Keeps records of samples tested for HIV Keeps records of samples tested for HIV Keeps records of samples tested for HIV Keeps records of samples tested for HIV Q16.1 Does the laboratory keep records of samples that were tested for HIV? Observation 1 Yes 2 No Kept records of samples tested for STI Kept records of samples tested for STI Kept records of samples tested for STI Kept records of samples tested for STI Kept records of samples tested for STI Q16.2 Has the laboratory kept records of samples that were tested for STI? Observation 1 Yes 2 No Manner of recording of STI/HIV records: computerized Manner of recording of STI/HIV records: computerized Manner of recording of STI/HIV records: computerized Manner of recording of STI/HIV records: computerized Manner of recording of STI/HIV records: computerized Q16.3 How are the records of STI/HIV recorded? Computerized Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Manner of recording of STI/HIV records: register book Manner of recording of STI/HIV records: register book Manner of recording of STI/HIV records: register book Manner of recording of STI/HIV records: register book Manner of recording of STI/HIV records: register book Q16.3 How are the records of STI/HIV recorded? Register book Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Manner of recording of STI/HIV records: others Manner of recording of STI/HIV records: others Manner of recording of STI/HIV records: others Manner of recording of STI/HIV records: others Manner of recording of STI/HIV records: others Q16.3 How are the records of STI/HIV recorded? Others Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned 1 Yes 2 No Manner of recording of STI/HIV records: other specific Manner of recording of STI/HIV records: other specific Manner of recording of STI/HIV records: other specific Manner of recording of STI/HIV records: other specific Manner of recording of STI/HIV records: other specific Q16.3 How are the records of STI/HIV recorded? Others, specify Observation Multiple response possible Circle 1 if mentioned Circle 2 if not mentioned Person responsible for maintaining the laboratory test record Person responsible for maintaining the laboratory test record Person responsible for maintaining the laboratory test record Person responsible for maintaining the laboratory test record Person responsible for maintaining the laboratory test record Q16.4 Is there any person responsible for maintaining the laboratory test record? Observation 1 Yes 2 No Provide STI/HIV report to authority in timely manner Provide STI/HIV report to authority in timely manner Provide STI/HIV report to authority in timely manner Provide STI/HIV report to authority in timely manner Provide STI/HIV report to authority in timely manner Q16.5 Does the facility provide STI and HIV report to the authority in a timely manner? (observation) Observation 1 Yes 2 No Section score, 5 Section score, 5 Section score, 5 Section score, 5 Section score, 5 Score for this section (.../...)*100 Section grade, 5 Section grade, 5 Section grade, 5 Section grade, 5 Section grade, 5 Grade for this section Has internal QC system for HIV/STI testing Has internal QC system for HIV/STI testing Has internal QC system for HIV/STI testing Has internal QC system for HIV/STI testing Has internal QC system for HIV/STI testing Q17.1 Is there an internal QC system for HIV/STI testing in this laboratory? Observation No 2 -> Q17.3 1 Yes 2 No Ever had internal QC system for HIV/STI testing Ever had internal QC system for HIV/STI testing Ever had internal QC system for HIV/STI testing Ever had internal QC system for HIV/STI testing Ever had internal QC system for HIV/STI testing Q17.2 If there is none now, was there ever an internal QC system in the laboratory? Q17.1 = 2 1 Yes 2 No Has external QC system for HIV/STI testing Has external QC system for HIV/STI testing Has external QC system for HIV/STI testing Has external QC system for HIV/STI testing Has external QC system for HIV/STI testing Q17.3 Is there an external QC system for HIV/STI testing in this laboratory? Observation No 2 -> Q17.5 1 Yes 2 No Ever had external QC system for HIV/STI testing Ever had external QC system for HIV/STI testing Ever had external QC system for HIV/STI testing Ever had external QC system for HIV/STI testing Ever had external QC system for HIV/STI testing Q17.4 If there is none now, was there ever an external QC system in the laboratory? Q17.3 = 2 1 Yes 2 No Has specific personnel for checking QC system Has specific personnel for checking QC system Has specific personnel for checking QC system Has specific personnel for checking QC system Has specific personnel for checking QC system Q17.5 Is there any specific personnel for checking the QC system in the laboratory? 1 Yes 2 No Conducted QC on samples received from other laboratories Conducted QC on samples received from other laboratories Conducted QC on samples received from other laboratories Conducted QC on samples received from other laboratories Conducted QC on samples received from other laboratories Q17.6 Has the laboratory ever conducted any QC on any samples received from other laboratories? No 2 -> Q18.1 1 Yes 2 No QC done on a regular basis QC done on a regular basis QC done on a regular basis QC done on a regular basis QC done on a regular basis Q17.7 If yes, is this done on a regular basis? Q17.6 = 1 1 Yes 2 No Section score, 6 Section score, 6 Section score, 6 Section score, 6 Section score, 6 Score for this section (.../...)*100 Section grade, 6 Section grade, 6 Section grade, 6 Section grade, 6 Section grade, 6 Grade for this section Personnel understand the meaning of confidentiality Personnel understand the meaning of confidentiality Personnel understand the meaning of confidentiality Personnel understand the meaning of confidentiality Personnel understand the meaning of confidentiality Q18.1 Do all laboratory personnel understand the meaning of confidentiality? Ask the meaning of confidentiality 1 Yes 2 No Had break in confidentiality Had break in confidentiality Had break in confidentiality Had break in confidentiality Had break in confidentiality Q18.2 Have you had any break in confidentiality in this facility? Yes 1 -> Q18.3 No 2 -> Q19.1 ->Q19.1 1 Yes 2 No Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Manage confidentiality break, meet with staff Q18.3 If yes, how was this managed? Meeting with all staff Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q18.2 = 1 1 Yes 2 No Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Manage confidentiality break, meet with individual Q18.3 If yes, how was this managed? Meeting with individual person Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q18.2 = 1 1 Yes 2 No Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Manage confidentiality break, confidentiality breaker Q18.3 If yes, how was this managed? Who breaks confidentiality Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q18.2 = 1 1 Yes 2 No Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Manage confidentiality break, other Q18.3 If yes, how was this managed? Others Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q18.2 = 1 1 Yes 2 No Manage confidentiality break, other specifc Manage confidentiality break, other specifc Manage confidentiality break, other specifc Manage confidentiality break, other specifc Manage confidentiality break, other specifc Q18.3 If yes, how was this managed? Others, specify Multiple response Circle 1 if mentioned Circle 2 if not mentioned Q18.2 = 1 Section score, 7 Section score, 7 Section score, 7 Section score, 7 Section score, 7 Score for this section (.../...)*100 Section grade, 7 Section grade, 7 Section grade, 7 Section grade, 7 Section grade, 7 Grade for this section Number of STI cases tested Number of STI cases tested Number of STI cases tested Number of STI cases tested Number of STI cases tested Q19.1 How many of STI cases tested in the last 12 months? Observation Number of HIV cases tested Number of HIV cases tested Number of HIV cases tested Number of HIV cases tested Number of HIV cases tested Q19.2 How many of HIV cases tested in the last 12 months? (observation) Observation Proportion of referral cases of STI among the tests performed Proportion of referral cases of STI among the tests performed Proportion of referral cases of STI among the tests performed Proportion of referral cases of STI among the tests performed Proportion of referral cases of STI among the tests performed Q19.3 Proportion of referral cases of STI among the tests performed in the last 12 months? Observation Proportion of referral cases of HIV among the tests performed Proportion of referral cases of HIV among the tests performed Proportion of referral cases of HIV among the tests performed Proportion of referral cases of HIV among the tests performed Proportion of referral cases of HIV among the tests performed Q19.4 Proportion of referral cases of HIV among the tests performed in the last 12 months? Observation Section score, 8 Section score, 8 Section score, 8 Section score, 8 Section score, 8 Score for this section (.../...)*100 Section grade, 8 Section grade, 8 Section grade, 8 Section grade, 8 Section grade, 8 Grade for this section Unique key Unique key Unique key Unique key Unique key Unique key Recstatus Recstatus Recstatus Recstatus Recstatus Serial number of health facility Serial number of health facility Serial number of health facility Serial number of health facility Serial number of health facility Serial number of the health facility Serial number of patient Serial number of patient Serial number of patient Serial number of patient Serial number of patient Serial number of the patient District District District District District District 1 Bumthang 2 Chukha 3 Dagana 4 Gasa 5 Ha 6 Lhuntse 7 Monggar 8 Paro 9 Pemagatshel 10 Punakha 11 Samdrup Jongkhar 12 Samtse 13 Sarpang 14 Thimphu 15 Trashigang 16 Trongsa 17 Tsirang 18 Wangdue Phodrang 19 Yangtsi 20 Zhemgang Gewog/town Gewog/town Gewog/town Gewog/town Gewog/town Gewog/Town Interview completion status Interview completion status Interview completion status Interview completion status Interview completion status Interview completion status 1 Completed 2 Not completed 3 Refused 4 None available Cause of refusal Cause of refusal Cause of refusal Cause of refusal Cause of refusal If refused, ask the respondent what is the possible cause of refusal? 1 Not interested 2 No time 3 Others Type of health facility Type of health facility Type of health facility Type of health facility Type of health facility Type of health facility 1 National Referral Hospital 2 Regional Referral Hospital 3 District Hospitals 4 BHU-I 5 BHU-II Place to sit while waiting Place to sit while waiting Place to sit while waiting Place to sit while waiting Place to sit while waiting 1. Was there a place for you to sit while you were waiting? 1 Yes 2 No Prescriber knowledgeable Prescriber knowledgeable Prescriber knowledgeable Prescriber knowledgeable Prescriber knowledgeable 2. Was the prescriber knowledgeable? 1 Yes 2 No 3 Not sure Comfortable when prescriber was asking questions Comfortable when prescriber was asking questions Comfortable when prescriber was asking questions Comfortable when prescriber was asking questions Comfortable when prescriber was asking questions 3. Did you feel comfortable when the prescriber asking questions? 1 Yes 2 No Prescriber answers questions fully Prescriber answers questions fully Prescriber answers questions fully Prescriber answers questions fully Prescriber answers questions fully 4. Did you feel the prescriber answer your questions fully? 1 Yes 2 No Comfortable during physical examination Comfortable during physical examination Comfortable during physical examination Comfortable during physical examination Comfortable during physical examination 5. Did you feel comfortable during your physical examination? 1 Yes 2 No 3 Not applicable Comfortable when samples were collected Comfortable when samples were collected Comfortable when samples were collected Comfortable when samples were collected Comfortable when samples were collected 6. Did you feel comfortable when samples were collected? 1 Yes 2 No 3 Not applicable Prescriber appeared friendly Prescriber appeared friendly Prescriber appeared friendly Prescriber appeared friendly Prescriber appeared friendly 7. Was the prescriber appeared to be friendly to you? 1 Yes 2 No Prescriber clearly explained of disease Prescriber clearly explained of disease Prescriber clearly explained of disease Prescriber clearly explained of disease Prescriber clearly explained of disease 8. Did your prescriber clearly explain the meaning of your disease? 1 Yes 2 No Intends to discuss results with partner Intends to discuss results with partner Intends to discuss results with partner Intends to discuss results with partner Intends to discuss results with partner 9. Do you intend to discuss your test results with your partner? 1 Yes 2 No 3 Not applicable Staff members helpful and supportive Staff members helpful and supportive Staff members helpful and supportive Staff members helpful and supportive Staff members helpful and supportive 10. Were staff members helpful and supportive? 1 Yes 2 No Services you received at this facility satisfactory Services you received at this facility satisfactory Services you received at this facility satisfactory Services you received at this facility satisfactory Services you received at this facility satisfactory 11. Overall, were the services you received at this facility satisfactory? 1 Yes 2 No Intend to tell others about facility Intend to tell others about facility Intend to tell others about facility Intend to tell others about facility Intend to tell others about facility 12. Do you intend to tell others about this facility? 1 Yes 2 No Clear idea of how to protect self and/or partner from HIV/STI Clear idea of how to protect self and/or partner from HIV/STI Clear idea of how to protect self and/or partner from HIV/STI Clear idea of how to protect self and/or partner from HIV/STI Clear idea of how to protect self and/or partner from HIV/STI 13. Do you have a clear idea of how to protect yourself and/or your partner from HIV/STI now? 1 Yes 2 No Prescriber who examined wear gloves Prescriber who examined wear gloves Prescriber who examined wear gloves Prescriber who examined wear gloves Prescriber who examined wear gloves 14. Did the prescriber who examined wear gloves? 1 Yes 2 No Laboratory test for HIV/STI conducted in visit Laboratory test for HIV/STI conducted in visit Laboratory test for HIV/STI conducted in visit Laboratory test for HIV/STI conducted in visit Laboratory test for HIV/STI conducted in visit 15. Has any laboratory test for HIV/STI conducted for you in this visit? 1 Yes 2 No 3 Refer Received HIV/STI result Received HIV/STI result Received HIV/STI result Received HIV/STI result Received HIV/STI result 16. If yes, have you received the result? 1 Yes 2 No Expected time given to get result Expected time given to get result Expected time given to get result Expected time given to get result Expected time given to get result 17. If no, what is the date (expected time) they gave you to get the result? 1 1-2 days 2 >2 days Suggestion 1 Suggestion 1 Suggestion 1 Suggestion 1 Suggestion 1 Do you have any suggestion to improve quality of services in the facility? Suggestion 2 Suggestion 2 Suggestion 2 Suggestion 2 Suggestion 2 Do you have any suggestion to improve quality of services in the facility? Suggestion 3 Suggestion 3 Suggestion 3 Suggestion 3 Suggestion 3 Do you have any suggestion to improve quality of services in the facility? Suggestion 4 Suggestion 4 Suggestion 4 Suggestion 4 Suggestion 4 Do you have any suggestion to improve quality of services in the facility?