Indicator/Question Probable Response

Are all HTS providers undertaking external quality assurance

1 Yes/Partly/No
through proficiency testing?

2 How many HTS copunsellors passed the most recent PT x/y

Is the HTS officer conversant with testing frequency for the

3 Yes/No
ddifferent sub population?

Does the HTS provider in ANC adhere to testing frequency for

4 Yes/No
ANC/L &D clients?

5 Does the facility offer index testing services? Yes/No

Is the facility HTS providers linking clients to combination

6 Yes/Partial/No
prevent?

7 Is Recency testing conducted as part of routine HIV testing? Yes/No

Once a client tests negative, are they linked to prevention
8 Yes/No
services?

Is this facility assigning NUPI for HTS PREP and clients seeking
9 YES/NO
other preventive services
 HTS

Verification/Observation

*Check the last Proficiency Testing (PT) results.

Yes if all HTS providers had PT; Partially if some and No if none

*Ask and also check to confirm from the HTS register or Facility QC log whether the last kit lot was tested using QC
Determine/First response and duo test kits
If new kit lot testing not done, score "No"
If new kit lot testing done, score "YES"

The answer is Yes if adhering to the HTS operational manual. Ask and Check in MOH 362 AYP for next appointme
TCA is longer
If yes – Ask HTS provider to explain and Check ANC/PNC register, no if not adhering.
The answer is Yes if adhering to the HTS operational manual. Ask and Check in ANC/PNC register for next appoin
TCA is longer
Check for client who tested HIV positive during the review period, verify if they were transferred into the aPNS regis
partner elicitation and follow up was done. If there is documentation of elicitation & follow-up - Score Yes If there is
of follow up on the aPNS register.
If yes verify in MOH 362 for linkage to prevention, Partial if some and No if none

Verify from the Recency Surveillance File

Check HTS register

Check Registers
 AYP
Indicator
Is the facility offering AYP-responsive services? Check
1 for clinic operation days, hours and equipment.
Have the service providers been trained on how to
2 manage AYPs?
Are adolescents and young people receiving HIV
combination prevention services?

3
Are psychosocial support services available for AYPs?

4
Are there peer educators/ young CHPs attached to the
5 facility to offer peer to peer services?
The facility providing ART has an adherence support
6 system for AYPs?

7 The facility has a disclosure support system for AYPs

Do service providers acquire consent before providing
8 services to adolescents?
 AYP
Probable response Verification

Y/N OPD/Clinic registers

Training logs indicating service providers trained on
Y/N AYFS/APOC
HTS register for services provided. Tick yes for 2
other services provided in addition to testing;
facility routinely provides risk reduction
counseling,lifeskills counselling,condoms, SRH
Y/N services,PrEP/PEP referrals,
Check on the OTZ register for the last meeting held
or any other registers indicating PSSGs, one on one
peer meetings, counselling register with AYPs seen
Y/N

Y/N service provider to give feedback

Y/N SOPs for adherence counselling

SOPs for disclosure counselling, disclosure
Y/N counselling notes

Y/N verify by checking for consent forms

 Probable
Indicator/Question Response
Has PrEP services been integrated to other services ? Yes /No
1
2 If Yes for no 1: Where is PrEP integrated? OPD, FP Clinic , ANC , CCC, Tick appropriate
Have all the service providers offering PrEP received a refresher training in the Score _ Yes/NO

3
Does the facility have PrEP Clinical encounter cards? Are they appropriately d Yes /Partial/ No

4
Does the facility routinely carry out Rapid Assessment Screening using the RAST tool
Score_ Yes/ No

5
6 Are client assessed for eligibility prior to PrEP initiation ? Score _ Yes/NO

7 Are clients on followup for PrEP offered HIV Testing ? Score_ Yes/ Par

8 Are clients on followup for PrEP assessesd for adverse drugs effects ? Score_Yes/Parti

9 Are clients on followup for PrEP assessesd for adherence and offered adherenceScore_Yes/Parti
10 Does the facility collect samples for drug resistance testing for clients who test Yes/ No /NA
 Verification/Observation
Tick as appropriate
Tick all that apply
Calculate the proportion of service providers who have received a
refresher training out of the total number offering PrEP. If 100%
tick Yes , if <100% tick no

Verify availability of clinical encounter card, , if available and

well documented score Yes, If available and not well documented
score partial If not available score No

Sample 5 encounter card for clients for clients initiated on PrEP

during the review period verify documentation of risk
assessment . Indicate the number clients with assessment done
(numerator) total cards sampled (denominator)
If any risk parameter is ticked , Indicate Yes , if none Score No
Sample 5 encounter card for clients initiated on PrEP during the
review period verify documentation of eligibility status at
basesline. Indicate the number with eligibility assessment done
(numerator) total cards sampled (denominator) If all the
parameters for eligibility are indicated score Yes if any is
missing score No Parameters for eligibility: HIV Test Negative,
Screening for Kidney/Liver disease / No Contraindication to
TDF/FTC/3TC / Client willing to initiate PrEP )
Sample 5 client encounter cards, for clients who made a clinical
follow up visit during the review period.verify if they were tested
for HIV
Indicate the number with documented HIV results (numerator)
total cards sampled (denominator)
If all the clients were tested indicate Yes , If some indicate Partial
If none indicate No
Sample 5 client encounter cards, for clients who made a follow
up visit during the review period.verify if they were assessed for
adverse drugs events.
Indicate the number with documented screening for adverse
effects (numerator) total cards sampled (denominator)
If all the clients were assesed for adverse drug effects indicate Yes
, If some indicate Partial If none indicate No
Sample 5 client encounter cards, for clients who made a follow
up visit during the review period.verify if they were assessed for
adherence and offered adherence counselling.
Indicate the number with documented adherence assessment
(numerator) total cards sampled (denominator)
If all the clients were assessed for adherence indicate Yes , If
some indicate Partial If none indicate No
Verify from the PrEP register if there has been any client who
tested positive while on PrEP.
Verify if clients were offered DRT on the the specific client
encounter card or sample tracking log.
If sample collected or results available indicate Yes if no
documentation score No
If not client has ever tested positive while on PrEP indicate NA
 CARE & TREATMENT ( For adults and Paediatrics)

Indicator/Question Probable Response

1 Are clients screened for TB at every clinic visit? (Y/N) Y/N
2 · Is documentation done for clients who have completed TPT? Yes/No
(Y/N)
3 Are the HCW sensitized on the new recommendations for TPT? Yes/No
(Y/N)
4 · Does the facility have access to a functional CD4 testing lab (Y/N)
(either on site or referral)?
5 · Are the clients screened for baseline CD4 test? (Y/N) (Y/N)
6 · Are the healthcare workers sensitized on AHD categorization? (Y/N)
(Y/N)
7 Does the facility conduct Serum Cryptococcal Antigen (sCrAg) Y/N

8 2 Y/N

9 · Does the facility screen for NCDs in each visit? (BMI, RBS,
BP, CaCx)
10 Has the facility experienced stouckouts of VL commodities in Yes/Partial/No
the last three months? (consumables)
11 Is client categorization conducted at each visit? (Y/N) Yes/No
12 Is fast track model for ART refill available at the facility? Yes/No
13 Has the facility defined a clear CLIENT FLOW for fast track to Yes/No
ensure clients spend minimal time at facility <30min?
14 Does the facility have a system for assessment and management Yes/No
of clients with HVL?
15 Does the facility assign a case manager for clients failing Yes/No
treatment?
16 Does the facility have a defaulter tracking mechanism in place? Yes/No
17 Have the facility staff been trained ART 2022 guidelines Yes/No
training?
18 Do they conduct MDTs meetings? Yes/No
19 Does the facility receive bi-annual mentorship visits from their Yes/No
TWG mentors?
20 Does the facility have an EMR? (Y/N) Yes/No
21 Does the facility have USHAURI? Is it active? (Y/N) Yes/No
22 Is it linked to the EMR? (Y/N) Yes/No
Commodities
 1 Does the facility have a designated officer(s) to handle supply Yes/No
chain management of Antiretroviral (ARV)/Opportunistic
Infection (OI) medicines?
2 If yes, has the officer(s) been trained in Commodity Yes/No
Management?
3 Does the facility have manual/electronic stock control cards/Bin Yes/No
cards for ARVs and OI medicines?
4 If Yes, are the bin cards upto date? Yes/No

5 Which tool does the facility use for dispensing ART and OI Tick appropriately
medicines?

Pharmacovigilance
1a. Has this facility report Suspected Adverse Drug Reaction YES if the two are done;
(ADR) / Poor quality ARV/OI medicines? In the last three Partial if one is done
months and No if none is done

b. How was the reporting done electronically/ Manually

 Nutrition
1 Does this facility have a functional anthropometric equipments . YES/Partial/NO
Partially if available and
not functional

2 Does the facility have the following job Aids? Yes/No

3 Does the facility have a Nutritionist supporting Nutrition HIV Score -Y/N
services
4 Has the facility conducted an internal baby friendly hospital Score yes if
initiative (BFHI) assessment in the past one year? documentation is
availed. No if there is no
documentation availed

i)Did the facility qualify for an external BFHI assessment? Yes/No (Apply Skip
pattern for the next
question if the response
is NO)
ii)After the external assessment ,did the facility get accredited as Yes/No
a baby friendly Hospital?
5 Is there a community baby friendly initiative attached to the Yes/No
health facility?
CQI
1 Does this facility have quality committee that plans and oversees (Y/N)
quality activities for the facility?
2 Is client feedback incorporated? (Y/N)

3 How does the facility share information about the quality (Y/N)
activities and project results?
lts and Paediatrics)

Verification/Observation
Check if TB Screening was done at the last clinical
visit
Check in on
theTB4
MOH 257
register/ICF card

Training reports and minutes if OJT was done

(Check if CD4 and WHO staging at enrolment was

done and documented in MOH257
Sample some files for verification- Tease out
patients who have been newly enrolled in the last 6
CME minutes

Verify from sampled patient files for all adults and

adolescents with a CD4 count ≤ 200 cells/mm3.
This should be done as reflex testing by the
laboratory

Verify from urine results of a sample of patient files

for adults and adolescents and children > 5 years,
with a CD4 count ≤ 200 cells/ mm3 and in
children less than 5 years if CD4% < 25%

Sample client files and check for completeness of

all the NCD parameters indicated in MOH257
Check the linelist of clients who are due for VL in
that month and compare with the consumables
available
This is to indicate the DSD models of care to
decongest facilities andofoffer
Check for availability quick and
completed efficient
client categorization checklist in files
Check for availability of a defined patient flow for
model
These are clients who have a 2nd VL of >1000
copies/ml after 3 consecutive EACs
Check for EAC records and the dates

Check for defaulter tracking register

This will check on the ART 2022 guidelines
training
Evidence based through train smart or minutes for
the meeting)
Indicate which rTWG and show proof of
attendance
These are systems used in the facility to capture
patient levelondata
Check box the EMRs available
Check on the proportion of clients enrolled on
USHAURI
Ask for Training Log/ Certificates

Check for any 5 electronic or physical bincards

Select the electronic or Physical TLD bin card and

check if most recent delivery from KEMSA/MEDS
or S11 from Central site is updated on the bin
card).

Check if the tool is available and in use.

Have a multiple check box for these tools:

i) Daily Activity Register (DAR) Version 2019
ii) Web ADT (Version 4.02)

iii) Any other (Older version DAR, older version

Web ADT, any other electronic ADT)

Insert comment to describe the others.

Two steps of handling Severe Drug Reaction:

a) Review the client and manage accordingly

(reassure/ switch medication)
b) Report to PPB using electronic or hard copy
yellow form.
The Healthcare provider should mention the
following:

a) Quarantine the product.

b) Inform the immediate
supervisor/KEMSA&MEDS/NASCOP (Check for
evidence of a report to
supervisor/KEMSA&MEDS/NASCOP; -
letter/email)

c) Report to Pharmacy and Poisons Board (PPB)

using electronic or hard copy pink forms.

Adult MUAC tapes

Child MUAC tapes
BMI Calculator(Wheel/Chart)

Provide a check box ticking the available job Aids:

BMI reference Chart

Nutrition &HIV guidelines 2019

Nutrition &HIV guidelines 2019

Nutrition HIV Toolkit2019

Abridged version of the guideline 2019

Nutrition HIV Counselling Card 2019

MIYCN Policy Statement 2019

Verbal response
(Look at documented minutes) If no include a skip
pattern for the two questions highlighted in yellow

(Check out for any documentation that shows the

assessment was done)

(Observe whether accreditation poster is placed on

the wall)
(Look out for minutes or documentation done in
regards to BFCI), Observe whether accreditation
poster is placed within the community
Check for most recent available QI Meeting
minutes, Member TOR
Observe for available feedback mechanisms. Eg.
Suggestion box available and in use, Client exit
interviews done

Observe for applied QI tools hanged on the walls

eg. Root cause analysis Chart, Patient flow chart,
signage
 STI

Indicator/Question Probable Response

1 Does the facility have National Guidelines on Yes/No
Prevention ,Management and Control of Sexually Transmittted
infections (2018 guidelines)?
2 Are the healthcare workers sensitized on National Guidelines on (Y/N)
Prevention ,Management and Control of Sexually Transmittted
infections (2018 guidelines)? (Y/N)

3 Does the facility test for STI ie (syphilis, Neisseria Gonorrrhoea Y/N
and chlamydia )per client presentation

4 Are clients with STI symptoms treated? (Y/N) Y/N

5 Does the facility have the required STI commodities? Y/N
Verification/Observation
Check for version 2018 of the
guidelines

CME minutes

Check within CCC

Check if filled in STI treatment clinic visit

form,enrolment form and clinicstock
Stock cards,bin cards,physical visit count. Check for Dual Test Kit HIV/Syphilis, BPG, Benzathine Penicilin 2.4MU
enzathine Penicilin 2.4MU, Azithromizine 500mg, Cefriaxone 1gm, Cefixime 400mg
 VIRAL HEPATITIS

Indicator/Question Probable Response

1 Does the facility have National Guidelines on Control and Yes/No
Management of Viral Hepatitis (2018 Guidelines)?
2 Are the healthcare workers sensitized on National Guidelines on (Y/N)
Control and Management of Viral Hepatitis (2018 Guidelines) ?

3 Does the facility start clients on VH Rx for the PCR confirmed Yes/No
clients?
4 Is documentation done for clients who have completed VH C? Yes/No

5 Does the facility have the required VH commodities. Yes/No

IS

Verification/Observation
Check for 2018 HV guidelines
CME minutes

Clinic Visit form

Clinic visit form

Stock cards,bin cards,physical stock count; Check

for RDTs, PCR commodities if on-site testing is
done and Treatment therapies
(Sofosbuvir/Ledipasvir and Sofosbuvir-velpatasvir
FOR VH C), (Tenofovir with Emtricitabine for HV
B)