Base line assessment for PPHAI at Health Facility Level

1. HTS_TST

Pediatric OPD/Pediatric Inpatient

Are providers oriented/ trained on pediatric HIV risk screening tool (if not please orient them
on the spot and show them how to complete the register)

Check the availability and utilization of the following support tools

- POPD & PIPD HMIS register

- Pediatric HIV risk screening register /form
- The national HIV testing algorithm
- Post test counselling poster
Review the number of children screened and tested in the last 5 months (Hamle 21,2014-
Hidar,2015)

# Seen____ Screened: ______Eligible_______ Tested________ Positive________

Linked_________ Initiated ART______

Check completeness of the Pediatric HIV risk screening register

Check whether all pediatric patients offered HIV test at Malnutrition and TB clinic

ICT(ART/PMTCT Clinic)

Are providers oriented/ trained on ICT (if not please orient them on the spot and show them
how to complete the register)

Check the availability and utilization of

- the latest version of ICT register

- ICT counseling script
- ICT flow chart
Check if there is line listing of untested biologic children in the past 5 months (Hamle 2014 -

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Hidar 2015

If line listed: #Line listed: ____ Tested: _______ Positive: _____ Linked: _____ Initiated
ART: _______

Check completeness of the ICT register

Is there a community partner actively working on ICT with your facility?

What does it look like the coordination system on ICT between your facility and the
community IPT?

Is there a proper documentation of referral to and from the community with written feedback?

EID

Are providers oriented/ trained on EID (if not please orient them on the spot and show them
how to collect the DBS)

Check the average TAT of the EID results

Check all DBS positive infants were initiated on ART

Check the availability and utilization of

- EID testing algorithm

- DBS register
Check the completeness of DBS register

HIV-ST in children ART Clinic (applicable only)

Are providers oriented/ trained on HIV-ST in children (if not please orient them on the spot
and show them how to complete the register)

Check the availability and utilization of

- HIV-ST register for children

- Social Harm screening desk top reference

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 - SOP, M&E flow chart
- Enlarged form of the HIV-ST insert poster
Check the HIV-ST cascades (Kit Distributed____ Screened +ve:____ Received Confirmed
test:_____ Concordance Rate:____ Initiated on ART: _____)

2. Pediatric care and treatment

Ped TX_Curr_______, # on 1L______,# on 2L_______, # on DTG_____, # on LPV/r________

Check for assigned provider for pediatric HIV care at ART clinic

Check for Ped tested positive for HIV in the past 12 months (Hidar, 21, 2014-Hidar 2015)

Linkage, ART Positive: ______ Started ART: ______ SD: _____ within 7days: _______ after 7 days: ______

initiation & Reasons for non-ART Initiated: __________________________________________________

optimization
Check for # of TX_New for the past six months_____________________________________

Check for TX_CURR trend in the past six months _______________________________

Check linkage from within facility and also from referrals of those tested outside of the facility.
____________________________________________________________________

Pediatric Tx _Curr (Hidar 2015)_____________, Total screened for TB_________, Screen

TB/HIV
positive________, LF-LAM done________,LF L;AM pos, xpert done_________, LF pos_____

Check for availability of INH 100 mg, 3HP, Pyrimidine

_____________________________________________________________________________
TPT
Pediatric Tx-Curr:______ TPT Initiated:________ TPT Completed:________

Ped TX_New in the past months________; Initiated TPT___________

MMD Pediatric Tx-Curr:______ <3MMD_______, 3MMD_____, 6MMD:______

AHD Check for trained provider on AHD

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 Check process for routine screening and management of AHD for children at ART clinic.

Check for availability of essential AHD supplies and provider support tools at the facility.

Check for complete documentation on PMTCT cohort register

PMTCT
Check for PMTCT cohort wall chart (Posted, documented, and updated)

Check for provision of routine VL monitoring (From Hidar 21,2014-Hidar 20,2015)

Line Listed: Eligible: ________ Tested for VL: ________, HVL___________, Started
EAC____, Re-suppressed ______, Switched to next level regimen______
VL
Check for attachment of returned VL result papers in client charts?
management
Check for process of notification of high viral load results to parents of children < 15 years of
age within a week of result received date?

Check for documentation on the provision of EAC for children with HVL results.

3. OTZ

#10-19 year: _____ # Fully Disclosed: ______ # Enrolled to OTZ/APSS: _______

How do you monitor the program?

_____________________________________________________________________________
OTZ/APSS What is the impact of the OTZ program on the facility’s performance?
_____________________________________________________________________________
What are the challenges faced in implementing OTZ?
_____________________________________________________________________________