Client's first or given name

Client's family name or last name

The date and time of the client's visit

If client was referred for care

How the client was referred

Referred by the community level services

Referred by the health facility

Unique identifier generated for new clients or a universal ID, if used in the country

National unique identifier assigned to the client, if used in the country

National health unique identifier assigned to the client, if used in the country

National programme unique identifier assigned to the client, if used in the country

National health insurance unique identifier assigned to the client, if used in the country

Country where the client was born

The client's date of birth (DOB) if known

Is the client's DOB is unknown?

If DOB is unknown, enter the client's estimated age. Display client's age in number of years.

Calculated age (number of years) of the client based on date of birth

Gender of the client

Client identifies as female

Client identifies as male

Client identifies as transgender male

Client identifies as transgender female

Additional category

Additional category (please specify)

Sex of the client assigned at birth

Client identifies as female

Client identifies as male

Client identifies in non-binary way or as a sexual and gender minority (or minorities)

Client's home address or address which the client is consenting to disclose

Client's current marital status

Client does not have an active marriage contract

Client has never entered into a marriage contract

A current marriage contract is active

Client is in a polygamous union

Client is divorced, whereby marriage contract has been declared dissolved and inactive

Client's spouse has died

Client does not wish to disclose marital status

Client reports that they are in a domestic partnership

Client's marriage contract has been declared null and to have not existed

Client is legally separated from their spouse

Client is subject to an interlocutory decree

Client's telephone number (a landline or a mobile phone number)

This should be a context-specific list of administrative areas, such as villages, districts, etc. The purpose of this data element is to allow for grouping and flagging of client data to a particular facility's catchment area. This can be input into the system by the end user OR it can be automated in the database based on the end user's attributes.

Indication that client gave consent to be contacted

Whether client wants to receive text or other messages as follow-up for HIV services

How the client would like to receive family planning communications

The client would like to receive communications via Text message/SMS

Client would like to receive communications via voice call

Client's primary email account where the client can be contacted

Name of an alternate contact, which could be next of kin (e.g. partner, husband, mother, sibling, etc.). The alternate contact would be used in the case of an emergency situation.

Phone number of the alternate contact

Alternate contact's home address or address which the client is consenting to disclose

The alternate contact's relationship to the client (e.g. partner, husband, mother, sibling, etc.)

Reason for HIV testing services visit

First encounter for screening for human immunodeficiency virus

Retesting for human immunodeficiency virus

Client attending facility for HIV testing services visit

Client reported coming to the facility after receiving a provider-assisted referral or patient referral from a contact or partner

The client is a contact or partner of a person diagnosed with HIV (an index case)

The client is a contact or partner identified through partner or social network services, but is not known to be a partner of an index-case

Client's relationship to the person that referred the client for partner services or family services

Client is the biological child of the person that referred the client for family services

Client is a drug-injecting partner of the person that referred the client for partner services

Client is a sexual partner of the person that referred the client for partner services

Client is a social contact of the person that referred the client for social-network services

When the client is reported to have had suspected exposure to HIV

Date and time when the client had suspected exposure to HIV

Whether testing is happening in the community or at a facility

Testing is happening in the community, which includes mobile testing

Testing is happening at a facility

Specific point in the community where testing is happening

The client tested through mobile testing, such as through vans or temporary testing facilities

The client tested at a voluntary counselling and testing centre (not in a health facility setting)

The client tested through another type of community-based testing

Specific point where testing is happening at a facility

The client tested though provider-initiated HIV testing & counselling, which could be at an emergency facility

The client tested at an antenatal care clinic, including labour and delivery

The client tested through voluntary counselling and testing (within a health facility setting)

The client tested at a family planning clinic

The client tested at another type of facility

The client tested at a TB clinic

Client is currently pregnant

Gestational age in weeks and/or days depending on the source of gestational age

Expected date of delivery based on gestational age

Infant is being breastfed by mother

The HIV status of the client's partner.

Client's partner is HIV-positive

Client's partner is HIV-negative

Don't know HIV status - client does not know partner's HIV status

Client's partner is a member of a key population, that has an increased risk of HIV

Client's partner is a sex worker

Client's partner is a man who has sex with men

Client's partner identifies as trans and gender-diverse

Client's partner is a person who injects drugs

Client's partner lives in a prison or other closed setting

The client reported having used an HIV self-test before

Results from the reported HIV self-test

The HIV self-test was reactive

The HIV self-test was non-reactive

The HIV self-test was invalid

Date when the HIV self-test was conducted

Client is a member of a key population that has an increased risk of HIV

The type of key population that the client is included in

Client is a sex worker

Client is a man who has sex with men

Client identifies as trans and gender-diverse

Client is a person who injects drugs

Client lives in a prison or another closed setting

Calculated field based on age and gender, if client is 10 years or older and under 20 years old

Calculated field based on age and gender, if client is 20 years or older and under 25 years old

Client considered an orphan or vulnerable child

Client has been informed of their HIV test result

Date HIV test result returned to client

Ways in which the client was exposed to HIV

Occupational exposure to HIV

Non-occupational violent exposure to HIV

Exposure to HIV through non-occupational consensual sex

The date on which the client was diagnosed with HIV

The facility where the client received an HIV-positive diagnosis

Earliest date of HIV diagnosis determined according to the national HIV testing algorithm

The client's HIV serotype

The client has HIV-1

The client has HIV-2

Date diagnosis was returned to client

The date on which the client started or restarted antiretroviral therapy (ART)

The client's age (in years) when given an HIV diagnosis

Client's relationship to the contact identified for voluntary partner services or family services

Contact identified for family services is the biological child of the client

Contact identified for partner services is a drug-injecting partner of the client

Contact identified for partner services is a sexual partner of the client

Contact identified for social-network services is a social contact of the client

An HIV test of the client was ordered by the provider

An HIV test was performed on the client during the visit

Type of HIV test

Antibody test for HIV performed with a rapid diagnostic

Antibody test for HIV performed with an enzyme immunoassay

Virological test, which includes testing for early infant diagnosis

Antibody test for HIV and syphilis performed with a rapid diagnostic

Antibody test for HIV performed by self-tester using a rapid diagnostic

Date HIV specimen was sent to lab

The number of the assay (test kit) in the HIV testing strategy

A community outreach test-for-triage or self-test which is not included in the HIV testing strategy

The first test in the HIV testing strategy

The second test in the HIV testing strategy

The third test in the HIV testing strategy

The first test in the HIV testing strategy

The result of the first HIV assay in the testing strategy

The result of the HIV assay in the testing strategy was reactive

The result of the HIV assay in the testing strategy was non-reactive

The result of the HIV assay in the testing strategy was invalid

The result of the second HIV assay in the testing strategy

The result of the HIV assay in the testing strategy was reactive

The result of the HIV assay in the testing strategy was non-reactive

The result of the HIV assay in the testing strategy was invalid

The result of the third HIV assay in the testing strategy

The result of the HIV assay in the testing strategy was reactive

The result of the HIV assay in the testing strategy was non-reactive

The result of the HIV assay in the testing strategy was invalid

The result of the repeated first HIV assay in the testing strategy

The result of the HIV assay in the testing strategy was reactive

The result of the HIV assay in the testing strategy was non-reactive

The result of the HIV assay in the testing strategy was invalid

Date of the HIV test

The result from HIV testing after applying the testing algorithm

Test result is HIV-positive

Test result is HIV-negative

Test result is HIV-inconclusive

HIV status reported after applying the national HIV testing algorithm. No single HIV test can provide an HIV-positive diagnosis.

Client is HIV-positive

Client is HIV-negative

Client has unknown HIV status

Date patient received positive HIV test confirmation (with written documentation)

Name or identifier of health facility where HIV test was confirmed

Probable route(s) of transmission of HIV to client

Probable route of HIV transmission was through heterosexual sex

Probable route of HIV transmission was through sex between men

Probable route of HIV transmission was through unprotected intercourse during sex work

Probable route of HIV transmission was through injecting drug use with unsterile equipment

Probable route of HIV transmission was nosocomial

Probable route of HIV transmission to an infant was during pregnancy, labour, delivery and breastfeeding (vertical transmission)

Probable route of HIV transmission was other and may include needle accidents, blood transfusion, blood products or organ/tissue donations, tattoos, piercings, circumcision, or acupuncture.

If the client does not know the HIV status of the client's partner(s), offer to test and add results here

An HIV test for the client's partner has been ordered

Date of client's partner's HIV test

The HIV test result of the client's partner

Test result is HIV-positive

Test result is HIV-negative

Test result is HIV-inconclusive

The HIV status of a sexual or drug-injecting partner of the client, based on a confirmed test result

Client's partner is HIV-positive

Client's partner is HIV-negative

Client's partner HIV status is unknown

Partner of the client is on ART

ART and virally suppression status of a partner of the client

Whether counselling was provided to a client during the visit

Whether counselling was provided to a client who has been diagnosed with HIV

Whether counselling was provided to a client who has been diagnosed with hepatitis B

Whether counselling was provided to a client who has been diagnosed with hepatitis C

Whether counselling and treatment was provided to a client who has been diagnosed with syphilis. Additional testing (RPR test) recommended.

Linkage made from HIV testing to enrolment in care following an HIV diagnosis

Whether counselling for voluntary medical male circumcision (VMMC) was provided following an HIV-negative test

Offer or refer to prevention services

Offer male and female condoms and condom-compatible lubricants

Offer pre-exposure prophylaxis (PrEP) to people with substantial ongoing risk of HIV infection

Offer or refer client for PEP following suspected exposure

Offer referral for VMMC services

Offer or refer to harm reduction services for people who inject drugs (needle and syringe programmes, opioid substitution therapy, other drug-dependence treatment and opioid overdose prevention and management)

Offer or refer to behavioural interventions to support risk reduction, particularly for people with HIV and members of key populations

Offer voluntary testing for all partners and biological children of positive cases (includes partner services and index case testing), as welll as partners and social contacts of people from key populations, where appropriate

Offer voluntary testing for partners and social contacts of people from key populations, where appropriate

Offer or refer to sexual and reproductive health services

Offer contraception and family planning services

Check women's pregnancy status

Offer services for prevention of mother-to-child transmission (counselling)

Offer cervical cancer screening and treatment counselling and services

Offer services for anal cancer screening (for men who have sex with men)

Offer sexually transmitted infection (STI) testing and treatment services

Other clinical services offered or referrals given to the client

Assessment and provision of vaccinations, such as for people from key populations, pregnant women and infants; and, where appropriate, tetanus vaccination for adolescent boys and men receiving VMMC

Offer or refer for HBV and/or HCV testing and treatment

Offer or refer for co-trimoxazole chemoprophylaxis to prevent pneumocystis carinii pneumonia

Offer or refer for intensified TB case finding and linkage to TB treatment

Offer or refer for provision of isoniazid preventive therapy if person does not have TB

Offer or refer for malaria prevention (such as bed nets and prophylaxis), depending on epidemiology

Offer or refer for other support services

Offer or refer for mental health services

Offer or refer for psychosocial counselling, support and treatment adherence counselling

Offer or refer for support for disclosure and partner services

Offer or refer for legal and social services

Offer or refer for services for responding to violence against women, including first-line support and psychosocial support, post-rape care and other support services including shelters, legal services and women and child protection services

Whether a clinical enquiry for intimate partner violence was conducted

Result of medical inquiry for intimate partner violence

Client received treatment and/or counselling as needed

Client was referred to another provider/facility

No additional action was deemed necessary

Other intimate partner violence (IPV) result not described above

Other intimate partner violence (IPV) result not described above (specify)

Whether the client was offered voluntary partner services or family services

The quantity of contacts or partners given by a client that accepts social network-based/partner services for follow-up

Whether the client was offered social network-based partner services

Whether the client accepted social network-based partner services

First name of each contact given by the client to offer social network-based/partner services

Last or family name of each contact given by the client to offer social network-based/partner services

Type of follow-up appointment for testing services

Retesting follow-up appointment

Other reason for the follow-up appointment

Other reason for the follow-up appointment (specify)

Date the patient is to return for monitoring, re-supply or any other reason

Date when follow-up is recommended based on follow up requirements

Whether a voluntary medical male circumcision procedure was performed

Date on which a voluntary medical male circumcision procedure was performed

Whether an adverse event was reported associated with a voluntary medical male circumcision (VMMC) procedure

Complications from voluntary medical male circumcision (VMMC) procedure resulted in death or hospitalization within 30 days of the procedure or permanent disability

Severity of the adverse event associated with voluntary medical male circumcision (VMMC) procedure

Severity of the adverse event associated with VMMC procedure was moderate

Severity of the adverse event associated with VMMC procedure was severe

When the adverse event associated with VMMC procedure occurred

The adverse event associated with VMMC procedure occurred during the procedure

The adverse event associated with VMMC procedure occurred within the first 30 days after the procedure

Type of adverse event associated with voluntary medical male circumcision (VMMC) procedure

Client experienced abnormal pain

Client had anaesthesia-related effects

Client had bleeding

Client had damage to the penis

Client had difficulty urinating

Client experienced excessive bleeding

Client experienced excessive skin removal

Client experienced excessive swelling

Client experienced haematoma

Client experienced infection

Client experienced injury to glans

Client experienced scar or disfigurement

During VMMC procedure there was sharps injury to personnel

Client experienced wound disruption

Client experienced other adverse VMMC event

Client experienced other adverse VMMC event (specify)

HIV retest prior to starting ART conducted

Client is at elevated risk for HIV acquisition

Syndrome or STI for which client is diagnosed

Client diagnosed with urethral discharge syndrome

Client diagnosed with vaginal discharge syndrome

Client diagnosed with lower abdominal pain

Client diagnosed with genital ulcer disease syndrome

Client diagnosed with anorectal discharge

Specimen sent for testing

Other syndrome/STI diagnosed

Other syndrome/STI diagnosed (specify)

Was the client diagnosed with any of the five STI syndromes during this visit?

Date on which the STI test was conducted

STI for which the client was tested

Client tested for Neisseria gonorrhoeae

Client tested for Chlamydia trachomatis

Client tested for Trichomonas vaginalis

Client tested for Syphilis (treponema pallidum)

Client tested for herpes simplex virus (HSV1, HSV2)

Client tested for Mycoplasma genitalium

Client tested for Mpox

Client tested for Hepatitis B

Client tested for Hepatitis C

Client tested for other STI

Client tested for other STI (specify)

Date of syphilis test

Result from syphilis test

Test result is positive for syphilis

Test result is negative for syphilis

Test result is inconclusive

Date of initiation of syphilis treatment

Date of Gonorrhoea test

Result from Gonorrhoea test

Test result is positive for Neisseria gonorrhoeae

Test result is negative for Neisseria gonorrhoeae

Test result is inconclusive

Date of initiation of Gonorrhoea treatment

Type of specimen to be collected

Blood specimen to be collected

Urine specimen to be collected

Cervical or vaginal swab to be collected

Urethral or penile swab to be collected

Rectal swab to be collected

Other specimen type to be collected

Other specimen type to be collected (specify)

Type of diagnostic test used for syphilis (treponema pallidum)

Treponemal test used

Non-treponemal test used

Point-of-care (POC) test used

Nucleic Acid Amplification Test (NAAT) used

Other test used

Other test used (specify)

Type of diagnostic test used for Neisseria gonorrhoeae

Nucleic Acid Amplification Test (NAAT) used

Point-of-care (POC) test used

Culture test used

Microscopy test used

Other type of test used

Other type of test used (specify)

Point-of-care (POC) test used for Neisseria gonorrhoeae (specify)

Type of diagnostic test used for Chlamydia trachomatis

Nucleic Acid Amplification Test (NAAT) used

Point-of-care (POC) test used

Culture test used

ELISA test used

Microscopy test used

Other type of test used

Other type of test used for Chlaymdia (specify)

Point-of-care (POC) test used for Chlamydia (specify)

Type of diagnostic test used for Trichomonas vaginalis

Nucleic Acid Amplification Test (NAAT) used

Point-of-care (POC) test used

Culture test used

Microscopy test used

Other type of test used

Other type of test used (specify)

Point-of-care (POC) test used (specify)

Type of diagnostic test used for herpes simplex virus (HSV)

Nucleic Acid Amplification Test (NAAT) used

Antibody test used

Other type of test used

Other type of test used for Herpes simplex virus (HSV) test (specify)

Type of diagnostic test used for Mycoplasma genitalium

Nucleic Acid Amplification Test (NAAT) used

Microscopy test used

Other type of test used

Other type of test used for Mycoplasma genitalium test (specify)

Test type used for the other specified STI

Result from STI test

Test result is positive

Test result is negative

Test result is inconclusive

Date of STI confirmatory test

Type of test ued for confirmatory syphilis test

Treponemal test used

Non-treponemal test used

Point-of-care (POC) test used

Nucleic Acid Amplification Test (NAAT) used

Other test used

Other test used for confirmatory syphilis test (specify)

Confirmatory test type for other STI

Result from confirmatory STI test

Test result is positive

Test result is negative

Test result is inconclusive

Date STI treatment was prescribed to the client

Date STI treatment dispensed to the client

STI treatment dispensed to the client

Client's reason for the prevention visit

The client is interested in discussing pre-exposure prophylaxis (PrEP) for the first time

Client is at a follow-up or refill pre-exposure prophylaxis (PrEP) appointment

Client has previously taken pre-exposure prophylaxis (PrEP) and may like to restart taking it

Counselling on post-exposure prophylaxis (PEP)

Patient visit for management of side effects related to PrEP

Client is visiting for the recommended 3-month pre-exposure prophylaxis (PrEP) visit

The client had suspected or known exposure to HIV

When the suspect exposure to HIV took place

The client is currently taking PrEP. Oral pre-exposure prophylaxis (PrEP) of HIV is the use of ARV drugs by people who are not infected with HIV to block the acquisition of HIV.

Way in which pre-exposure prophylaxis (PrEP) is taken (daily or event-driven)

Pre-exposure prophylaxis (PrEP) is taken every day

Event-driven pre-exposure prophylaxis (PrEP) is taken on an even-driven basis (2+1+1)

Other PrEP dosing type

Other PrEP dosing type (specify)

Client reports taking ED-PrEP for at risk exposures over a 3-month period

HIV pre-exposure prophylaxis (PrEP) regimen

Treated with tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) pre-exposure prophylaxis (PrEP) regimen (oral PrEP)

Treated with single-agent tenofovir disoproxil fumarate (TDF) pre-exposure prophylaxis (PrEP) regimen (oral PrEP)

Treated with tenofovir disoproxil fumarate (TDF) and lamivudine (3TC) pre-exposure prophylaxis (PrEP) regimen (oral PrEP)

Treated with other tenofovir disoproxil fumarate (TDF)-based regimen (oral PrEP)

Dapivirine vaginal ring (DVR) for HIV prevention

Long-acting injectable cabotegravir

The client's experience in taking PrEP

The client has never used pre-exposure prophylaxis (PrEP) before (naive)

The client has used PrEP before and is continuing to use PrEP

The client is restarting PrEP following a period of not taking PrEP

The date on which the client started or restarted pre-exposure prophylaxis (PrEP)

Client stopped taking pre-exposure prophylaxis (PrEP)

Date client stopped taking pre-exposure prophylaxis (PrEP)

The client's history in taking post-exposure prophylaxis (PEP) for HIV prevention

The client has never used post-exposure prophylaxis (PEP) before

The client has used post-exposure prophylaxis (PEP) before

Dates when the client previously used post-exposure prophylaxis (PEP)

Date client completes PEP course

Signs the client is at a substantial risk of HIV infection

Recent vaginal or anal sexual intercourse without a condom with more than one partner

A recent history (in the last 6 months) of a sexually transmitted infection (STI ) by laboratory testing, self-report or syndromic STI treatment

A recent sex partner of the client had HIV risk factors

Client is requesting PrEP, reflecting a decision-making process has already taken place and suggesting of substantial risk of HIV

Client's intention or desire in the next year to either become pregnant or prevent a future pregnancy (in serodiscordant partnerships)

Client intends to become pregnant

Client is not intending to become pregnant, but would not be adverse to becoming pregnant

Client does not intend to become pregnant

Client is unsure or undecided about her pregnancy intentions

Symptoms that could suggest an acute HIV infection

Client's symptoms include a fever

Client's symptoms include a sore throat

Client's symptoms include aches

Client's symptoms include pains

Client's symptoms include swollen glands

Client's symptoms include a mouth sores

Client's symptoms include a headaches

Client's symptoms include a rash

Treatment adherence of client's sex partner for partners that are HIV-positive

Sex partner is HIV-positive and not on ART

Sex partner is HIV-positive and is on ART less than 6 months. ART may take up to 6 months to suppress viral load. In studies of serodiscordant couples, pre-exposure prophylaxis (PrEP) has provided a useful bridge to full viral suppression by the partner during that time.

Sex partner is HIV-positive and is suspected to have low adherence to ART. There have been gaps in the partner's treatment adherence or the couple is not communicating openly about treatment adherence and viral load test results.

Sex partner is HIV-positive and not virally suppressed

Sex partner is HIV-positive and virally suppressed with 6 months or more on ART

The client is suitable for PrEP

After being evaluated as suitable for PrEP, the client was offered PrEP

Listing of tests for clients on or starting pre-exposure prophylaxis (PrEP) that may be recommended or should be considered

Test serum creatinine to identify pre-existing renal disease (estimated creatinine clearance less than 60 ml/min)

Hepatitis B test recommended for client

Hepatitis C test recommended for client

Syphilis test recommended for client

Other STI screening recommended for client

Pregnancy testing for client

Review vaccination history recommended for client

Test serum creatinine to identify pre-existing renal disease (estimated creatinine clearance less than 60 ml/min)

Test serum creatinine to identify pre-existing renal disease (estimated creatinine clearance less than 60 ml/min).

Date the client was dispensed medications

Date the client was prescribed medications

Medications the client was prescribed

Client was prescribed pre-exposure prophylaxis (PrEP) for HIV prevention

Client was prescribed post-exposure prophylaxis (PEP) for HIV prevention

Client was prescribed other medications

Client was prescribed other medications (specify)

PrEP product that the client was prescribed

Client was prescribed oral PrEP

Client was prescribed dapivirine vaginal ring (DVR)

Client was prescribed long-acting cabotegravir (CAB-LA)

Client was prescribed other PrEP product

Client was prescribed other PrEP product (specify)

Date client was prescribed PrEP, including initial prescription and repeats

Date client was dispensed PrEP

Volume of PrEP product the client was prescribed or dispensed (for example, number of pills, number of devices)

Date the client was prescribed PEP

Date client completes PEP course

Preferred backbone regimen for PEP

Preferred backbone containing tenofovir disoproxil fumarate and lamivudine

Preferred backbone containing tenofovir disoproxil fumarate and emtricitabine

Preferred backbone containing zidovudine and lamivudine

Alternative backbone regimen for PEP

Alternative backbone containing abacavir and lamivudine

Alternative backbone containing tenofovir disoproxil fumarate and lamivudine

Alternative backbone containing tenofovir disoproxil fumarate and emtricitabine

Preferred third drug for PEP

Preferred third drug of dolutegravir

Alternative third drug for PEP

Alternative third drug of atazanavir/ritonavir (ATV/r)

Alternative third drug of darunavir/ritonavir (DRV/r)

Alternative third drug of lopinavir/ritonavir (LPV/r)

Alternative third drug of raltegravir (RAL)

Estimated creatinine clearance of the client returned from lab in mL/min

Value used for gender for calculating creatinine clearance if required. For transgender populations, the sex at birth is used in the Cockcroft-Gault equation if the person is not using hormone therapy; among transgender populations using hormone therapy for more than three months, the current gender can be used.

Male client

Female client

If the laboratory does not have the capacity to estimate creatinine clearance, the provider can use the Cockcroft–Gault equation to calculate estimated creatinine clearance based on measured serum creatinine, the client’s sex at birth, age and estimated lean body weight.

Date when the specimen was collected

Listing of contraindications to pre-exposure prophylaxis (PrEP)

Allergy to pre-exposure prophylaxis (PrEP) tenofovir disoproxil fumarate (TDF)

Client is HIV-positive

Estimated creatinine clearance of less than 60 ml/min (if known)

Symptoms that could suggest an acute HIV infection

When the client is reported to have had probable recent exposure to HIV

Client has another allergy or contraindication to a medicine in the pre-exposure prophylaxis (PrEP) regimen

Client has another allergy or contraindication to a medicine in the pre-exposure prophylaxis (PrEP) regimen (specify)

Client was prescribed pre-exposure prophylaxis (PrEP) on a first visit

Days of medication client has been prescribed

HIV pre-exposure prophylaxis (PrEP) regimen prescribed

Whether adherence counselling was provided

Date the client is to return for monitoring, re-supply, or any other reason

Type of follow-up appointment for testing services

Retesting follow-up appointment

Retesting follow-up appointment

Other reason for the follow-up appointment

Other reason for the follow-up appointment (specify)

Linkage made from HIV testing to enrolment in care following an HIV diagnosis

Offer or refer to prevention services

Offer male and female condoms and condom-compatible lubricants

Offer referral for VMMC services

Offer or refer to harm reduction for people who inject drugs (needle and syringe programmes, opioid substitution therapy, other drug-dependence treatment and opioid overdose prevention and management) services

Offer or refer to services for behavioural interventions to support risk reduction, particularly for people with HIV and members of key populations

Date client was provided with condoms

Number of condoms given to the client, if any were distributed

Type of condom provided to client

Male condoms were provided to the client

Female condoms were provided to the client

Whether any HIV self-test kits were given to the client

Number of HIV self-test kits distributed to the client

Whom the client plans to give the HIV self-test kit (self, sexual partner, social contact, etc.)

Client plans to use the self-test kit

Client plans to give the self-test kit to a family member to use

Client plans to give the self-test kit to a drug-injecting partner

Client plans to give the self-test kit to a sexual partner

Client plans to give the self-test kit to a social contact

Offer or refer to sexual and reproductive health services

Offer contraception and family planning services

Check woman's pregnancy status

Offer services (counselling) to help prevent of mother-to-child transmission

Offer cervical cancer screening and treatment services

Offer anal cancer screening (for men who have sex with men) services

Offer STI testing and treatment services

Offer testing for all partners and biological children of positive cases (includes partner services and index case testing), as well as partners and social contacts of people from key populations, where appropriate

Other clinical services offered or referrals given to the client

Assessment and provision of vaccinations, such as for people from key populations, pregnant women and infants; and, where appropriate, tetanus vaccination for adolescent boys and men receiving VMMC

Offer or refer for HBV testing and vaccination and HCV testing and treatment

Offer or refer for co-trimoxazole chemoprophylaxis to prevent pneumocystis carinii pneumonia

Offer or refer for TB case finding and linkage to TB treatment

Offer or refer for provision of isoniazid preventive therapy if person does not have TB

Offer or refer for malaria prevention (such as bed nets and prophylaxis), depending on epidemiology

Offer or refer for other support services

Offer or refer for mental health services

Offer or refer for psychosocial counselling, support and treatment adherence counselling

Offer or refer for support for disclosure and partner services

Offer or refer for legal and social services

Offer or refer for services for responding to violence against women, including first-line support and psychosocial support, post-rape care and other support services including shelters, legal services and women and child protection services

Whether visit was scheduled or unscheduled, clinical only, or for ARV drug pick-up

The client's first appointment for clinical care by a provider at the facility

Appointment for clinical care by a provider

Appointment for initiation of ART

Appointment for an antiretroviral drug pick up

Visit to address issues and concerns

Appointment for a post-treatment follow-up visit for cervical precancer lesions or invasive cervical cancer

Is this is a scheduled visit?

Temperature of the client in Celsius

The number of breaths per minute

The number of heartbeats per minute

The client's height in centimetres

The client's current weight in kilograms

Systolic blood pressure (SBP) in mmHg

Diastolic blood pressure (DBP) in mmHg

If the client's blood pressure cannot be taken, this should be indicated here. Otherwise, blood pressure should be measured.

Signs that may indicate the client has a serious illness and needs triage or an emergency referral

Client has a fever with a measured temperature of 102.2 F/39 C or greater

Heart rate above a rate per minute based on age

Respiratory rate above a number of breaths per minute based on age

Client is not able to walk without help

Client is exhibiting lethargy as a sign of serious illness

Client is currently unconscious

Client is convulsing

Child is not able to drink

Infant or child is not able to breastfeed

Client is repeatedly vomiting

Client is exhibiting a headache

Client is exhibiting another sign of a serious illness

Client is exhibiting another sign of a serious illness (specify)

Client is currently pregnant

Client is giving infant breast milk

Total number of times the woman has been pregnant (gravida)

Total number of pregnancies lost/ended due to miscarriages and/or abortions before 22 weeks/5 months

Total number of live births after 22 weeks

Calculated parity is the total number of live and stillbirths

Client's HIV status is different from a current partner's HIV status

Client is currently taking ART

The date on which the client started or restarted ART

Client stopped taking ART

Date on which client stopped ART

Is the client successfully established on ART?

Whether the client is ART naive or is restarting ART

Client is ART naive, having never taken ART to treat HIV before

Client is restarting ART after stopping treatment for any reason

The date on which the client was first initiated on ART

Time the client has been on ART since starting or restarting it in years and months

Date(s) client restarted ART after stopping (intentionally interrupting) for any number of reasons (see 'Reason ART stopped')

Month and year client originally started ART (documented) at a health facility in the system. The cohort is a group of patients who started ART in the same month (or quarter) and year, whose status is followed over time, using the ART register.

Client is transferring in with records or known ART drugs and ART start date

Date client presented at facility (with transfer/referral slip) from another facility (and on ART) within the system

Name of health facility client was transferred from

Date client first enrols in HIV care at the facility. Begins when a person with a confirmed HIV diagnosis presents to a facility where HIV care is provided and a medical record, patient card, file or chart is opened for the first time. This could be at an HIV care/ART, MNCH or TB clinic.

Client's age when the client was enrolled in ART care

Facility where the client first enrolled in HIV care

Whether or not the client received ARV drugs prior to enrolling into HIV care

Client received no prior ARVs

Client received ARVs prior without records/documentation

Client received ARVs during pregnancy or breastfeeding

Client received ARVs for post-exposure prophylaxis (PEP) or PrEP

Client received ARV prophylaxis for an HIV-exposed infant

Date ARV drugs were started prior to enrolment into HIV care/ART

Health facility (or other location) where ARV drugs were received prior to enrolment into HIV care/ART

ARV drug regimen received prior to enrolment into HIV care/ART

Does the client have any current chronic health conditions or problems?

Client does not have chronic diseases or any past health conditions

Client does not know whether she has any chronic diseases or past health conditions

Client has diabetes of other or unspecified type

Client has pre-existing type 1 diabetes mellitus

Client has pre-existing type 2 diabetes mellitus

High blood pressure

Other health conditions not included in the list

Other health conditions not included in the list (specify)

Original full, first-line ARV drug regimen patient started on at this facility

The current ART regimen the client is taking

The date on which the client started taking the current ART regimen

The preferred first-line ART regimen for the client according to WHO (or national) guidelines

The alternative first-line ART regimen for the client according to WHO (or national) guidelines

The first-line ART regimen for the client under special circumstances according to WHO (or national) guidelines

The preferred second-line ART regimen for the client according to WHO (or national) guidelines

The alternative second-line ART regimen for the client according to WHO (or national) guidelines

The optimal regimen for transition to DTG-based regimens for children established on ART

ART regimen for treating clients living with HIV, based on national guidance

First-line ART regimen for adults and adolescents living with HIV

First-line ART regimen for children living with HIV

First-line ART regimen for neonates living with HIV

Second-line ART regimen for adults and adolescents living with HIV

Second-line ART regimen for children living with HIV

Third-line ART regimen for people living with HIV (Not defined by WHO. National programmes should develop policies for third-line ART)

List of ART regimens

Regimen containing abacavir, lamivudine, and atazanavir/ritonavir

Regimen containing abacavir, lamivudine, and dolutegravir

Regimen containing abacavir, lamivudine, and efavarinez

Regimen containing abacavir, lamivudine, and lopinavir/ritonavir

Regimen containing abacavir, lamivudine, and nevirapine

Regimen containing abacavir, lamivudine, and raltegravir

Regimen containing zidovudine, lamivudine, and atazanavir/ritonavir

Regimen containing zidovudine, lamivudine, and darunavir/ritonavir

Regimen containing zidovudine, lamivudine, and dolutegravir

Regimen containing zidovudine, lamivudine, and efavirenz

Regimen containing zidovudine, lamivudine, and efavirenz 600 mg

Regimen containing zidovudine, lamivudine, and lopinavir/ritonavir

Regimen containing zidovudine, lamivudine, and nevirapine

Regimen containing zidovudine, lamivudine, and raltegravir

Regimen containing tenofovir alafenamide, lamivudine, and dolutegravir

Regimen containing tenofovir alafenamide, emtricitabine, and dolutegravir

Regimen containing tenofovir disoproxil fumarate, lamivudine, and atazanavir/ritonavir

Regimen containing tenofovir disoproxil fumarate, lamivudine, and darunavir/ritonavir

Regimen containing tenofovir disoproxil fumarate, lamivudine, and dolutegravir

Regimen containing tenofovir disoproxil fumarate, lamivudine, and efavirenz

Regimen containing tenofovir disoproxil fumarate, lamivudine, and efavirenz (400 mg)

Regimen containing tenofovir disoproxil fumarate, lamivudine, and efavirenz (600 mg)

Regimen containing tenofovir disoproxil fumarate, lamivudine, and lopinavir/ritonavir

Regimen containing tenofovir disoproxil fumarate, lamivudine, and nevirapine

Regimen containing tenofovir disoproxil fumarate, lamivudine, and a boosted protease inhibitor

Regimen containing tenofovir disoproxil fumarate, lamivudine, and raltegravir

Regimen containing tenofovir disoproxil fumarate, emtricitabine, and atazanavir/ritonavir

Regimen containing tenofovir disoproxil fumarate, emtricitabine, and darunavir/ritonavir

Regimen containing tenofovir disoproxil fumarate, emtricitabine, and dolutegravir

Regimen containing tenofovir disoproxil fumarate, emtricitabine, and efavirenz

Regimen containing tenofovir disoproxil fumarate, emtricitabine, and efavirenz (600 mg)

Regimen containing tenofovir disoproxil fumarate, emtricitabine, and lopinavir/ritonavir

Regimen containing tenofovir disoproxil fumarate, emtricitabine, and nevirapine

Regimen containing tenofovir disoproxil fumarate, emtricitabine, and a boosted protease inhibitor

Regimen containing tenofovir disoproxil fumarate, emtricitabine, and raltegravir

Other regimen based upon WHO recommendations

Other regimen based upon WHO recommendations (specify)

Drug composition of client's current ART regimen

Treated with abacavir (ABC)

Treated with emtricitabine (FTC)

Treated with lamivudine (3TC)

Treated with zidovudine (AZT)

Treated with didanosine (DDI)

Treated with stavudine (D4T)

Treated with tenofovir (TDF)

Treated with efavirenz (EFV)

Treated with etravirine (ETV)

Treated with nevirapine (NVP)

Treated with rilpivirine (RIL)

Treated with atazanavir/ritonavir (ATV/r)

Treated with lopinavir/ritonavir (LPV/r)

Treated with darunavir/ritonavir (DRV/r)

Treated with ritonavir (RTV)

Treated with dolutegravir (DTG)

Treated with raltegravir (RAL)

Drug class of current ART regimen

Treated with nucleoside reverse transcriptase inhibitors (NRTIs)

Treated with nucleotide reverse-transcriptase inhibitors (NtRTIs)

Treated with non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Treated with protease inhibitors (PIs)

Treated with integrase strand transfer inhibitors (INSTIs)

Offer or refer for prevention services

Offer male and female condoms and condom-compatible lubricants

Offer or refer people who inject drugs to harm reduction services (needle and syringe programmes, opioid substitution therapy, other drug-dependence treatment and opioid overdose prevention and management)

Offer or refer to services for behavioural interventions to support risk reduction, particularly for people with HIV and members of key populations

Offer or refer to sexual and reproductive health services

Offer contraception and family planning services

Check woman's pregnancy status

Offer prevention of mother-to-child transmission services (counselling)

Offer STI testing and treatment services

Date client was tested for hepatitis B virus (HBV)

Hepatitis B virus test result (HBsAg)

HBsAg test result was positive

HBsAg test result was negative

HBsAg test result was indeterminate

Date HBV test result (HBsAG) was returned to client

Date when client started treatment (TDF) for hepatitis B virus (HBV)

Hepatitis B virus treatment regimen prescribed

Date client was tested for hepatitis C virus (HCV antibody, HCV RNA or HCV core antigen)

Hepatitis C virus test result (HCV antibody, HCV RNA or HCV core antigen)

HCV test result was positive

HCV test result was negative

HCV test result was indeterminate

Date HCV test result was returned to client

Date when client started treatment for hepatitis C virus (HCV)

Date when client completed treatment for hepatitis C virus (HCV)

Hepatitis C virus treatment regimen prescribed

Hepatitis C viral load test date

Hepatitis C viral load test result (qualitative)

HCV was detected

HCV was not detected

Type of medicine client is prescribed

Client is prescribed interferon

Client is prescribed direct acting antivirals

Client is currently on TDF-based ART regimen

WHO clinical stage of client based on signs and symptoms. WHO clinical staging is a way to categorize HIV disease severity based on new or recurrent clinical events. There are 4 WHO clinical stages that range from mild symptoms (WHO clinical stage 1) to severe symptoms (WHO clinical stage 4).

Client is currently assessed to be at a clinical stage 1, based on clinical assessment and diagnostics

Client is currently assessed to be at a clinical stage 2, based on clinical assessment and diagnostics

Client is currently assessed to be at a clinical stage 3, based on clinical assessment and diagnostics

Client is currently assessed to be at a clinical stage 4, based on clinical assessment and diagnostics

Number of doses of antiretroviral therapy (ART) the client missed since the last visit, used for monitoring adherence

Client received results from viral load test

The date on which the client received results from viral load test

Date and time when the sample was collected to test the client's HIV viral load

Expected date when client's viral load test results will be returned and reviewed

Date of client's ART interruption (ART stop or missed drug pick-up)

Reason why client was not adherent

Client reported not being adherent because they forgot

Client reported not being adherent because of toxicity/side effects

Client reported not being adherent because they were busy

Client reported not being adherent because of a change of routine

Client reported not being adherent because of travel cost

Client reported not being adherent because of distance to clinic

Client reported not being adherent because client lost/ran out of pills

Client reported not being adherent because of a stock-out

Client reported not being adherent because of being too ill

Client reported not being adherent because of the pill burden

Client reported not being adherent because they felt well

Client reported not being adherent because of depression

Client reported not being adherent because of alcohol use

Client reported not being adherent because of substance use (i.e. drugs)

Client reported not being adherent because of stigma/disclosure concerns

Client reported not being adherent because of a lack of food

Client reported not being adherent because of poor palatability

Client reported not being adherent because of other reason for nonadherence

Client reported not being adherent because of other reason for nonadherence (specify)

Reason client intentionally stopped ART

Client stopped ART because of toxicity/side effects

Client stopped ART because of severe illness, hospitalization

Client stopped ART because drugs were out of stock

Client stopped ART because of lack of finances

Client stopped ART because HIV infection in infant was excluded

Client stopped ART because of other reason

Client stopped ART because of other reason (specify)

ART treatment failure

New or recurrent clinical event indicating severe immunodeficiency in adults or advanced or severe immunodeficiency in children

CD4 count at or below 250 cells/mm3 following clinical failure

The inability to achieve or maintain viral suppression below a certain threshold indicated by viral load above 1000 copies/mL based on two consecutive viral load measurements in 3 months, with adherence support following the first viral load test

General care activities to be performed during the care visit

Determine WHO clinical stage based on past and current HIV-related conditions

Determine if client is in an advanced stage of HIV, as a special package of services may be provided

Prepare client new to ART

Prepare, assess and support adherence

Manage current medications being taken by the client

Check woman's pregnancy status

Provide family planning and contraception counselling

Support disclosure and partner notification

Counsel on risk reduction and combination HIV prevention approaches

Assess, prevent and manage noncommunicable diseases

Screen for and manage mental health problems

Screen for and manage and substance use issues

Provide psychosocial counselling and support

Manage pain and symptoms client is experiencing

Conduct a nutritional assessment and counsel on nutrition

Conduct a growth and development assessment

Provide support on infant and child feeding to mother or care giver

Coinfection prevention and treatment activities performed during the care visit

Provide co-trimoxazole prophylaxis for clients new to ART or identified as taking it

Offer or refer for intensified TB case finding and linkage to TB treatment

Provide isoniazid preventive therapy

Screen for cryptococcal infection and fungal prophylaxis

Screen for hepatitis B virus

Screen for hepatitis C virus

Prevent malaria including with insecticide-treated bed-nets and prophylaxis

Screen for STIs

Prevent and screen for cervical cancer

Offer anal cancer screening (for men who have sex with men)

Assessment and provision of vaccinations, such as for people from key populations, pregnant women and infants; and, where appropriate, tetanus vaccination for adolescent boys and men receiving VMMC

Signs and symptoms of opportunistic infections or other comorbidities experienced by client

Client's comorbidities or coinfections or symptoms of these include oral candidiasis (after the first 6-8 weeks of life)

Client's comorbidities or coinfections or symptoms of these include vaginal candidiasis

Client's comorbidities or coinfections or symptoms of these include cough

Client's comorbidities or coinfections or symptoms of these include prolonged fever

Client's comorbidities or coinfections or symptoms of these include night sweats

Client's comorbidities or coinfections or symptoms of these include weight loss

Client's comorbidities or coinfections or symptoms of these include difficulty breathing

Client's comorbidities or coinfections or symptoms of these include pneumonia

Client's comorbidities or coinfections or symptoms of these include urethral discharge

Client's comorbidities or coinfections or symptoms of these include syphilis

Client's comorbidities or coinfections or symptoms of these include pelvic inflammatory disease

Client's comorbidities or coinfections or symptoms of these include ulcers - skin

Client's comorbidities or coinfections or symptoms of these include ulcers - mouth or other

Client's comorbidities or coinfections or symptoms of these include ulcers - male genital

Client's comorbidities or coinfections or symptoms of these include vaginal discharge

Client's comorbidities or coinfections or symptoms of these include malaria

Client's comorbidities or coinfections or symptoms of these include chronic obstructive pulmonary disease

Client's comorbidities or coinfections or symptoms of these include hypertension

Client's comorbidities or coinfections or symptoms of these include diabetes

Client's comorbidities or coinfections or symptoms of these include gestational diabetes

Client's comorbidities or coinfections or symptoms of these include mental health disorders (including depression, dementia, encephalitis, seizures)

Client's comorbidities or coinfections or symptoms of these include diarrhoea or abdominal pain

Client's comorbidities or coinfections or symptoms of these include presumptive TB

Client's comorbidities or coinfections or symptoms of these include severe or complicated malnutrition

Client's comorbidities or coinfections or symptoms of these include poor growth or development

Client's comorbidities or coinfections or symptoms of these include oedema

Client has previously been treated for tuberculosis (TB)

Other comorbidities or coinfection signs or symptoms

Other comorbidities or coinfection signs or symptoms (specify)

New or recurrent clinical events used to categorize HIV disease severity based at baseline and follow up

No HIV-related symptoms reported and no clinical signs on examination

Persistent enlarged lymph nodes >1 cm at two or more non-contiguous sites (excluding inguinal) without known cause

Moderate unexplained weight loss (<10% of presumed or measured body weight)

Client's symptoms include recurrent respiratory tract infections including sinusitis, tonsillitis, otitis media or pharyngitis

Client's symptoms include unexplained persistent hepatosplenomegaly

Client's symptoms include herpes zoster

Client's symptoms include angular cheilitis

Client's symptoms include linear gingival erythema

Client's symptoms include recurrent oral ulceration

Client's symptoms include papular pruritic eruption

Client's symptoms include fungal nail infections

Client's symptoms include seborrhoeic dermatitis

Client's symptoms include extensive wart virus infection

Client's symptoms include extensive molluscum contagiosum

Client's symptoms include unexplained persistent parotid enlargement

Unexplained severe weight loss (>10% of presumed or measured body weight)

Defined as weight-for-height < - 2 z-score or mid-upper arm circumference 115 mm to <125 mm. For children younger than five years of age: stunting is defined as severe acute malnutrition - either weight for height < -3 z-score or mid-upper arm circumference <115 mm or the presence of oedema.

Client's symptoms include unexplained chronic diarrhoea for longer than 1 month

Client's symptoms include unexplained persistent diarrhoea (14 days or more)

Client's symptoms include unexplained persistent fever (above 37.5 C, intermittent or constant, for longer than one 1 month)

Client's symptoms include persistent oral candidiasis

Client has fine white small linear or corrugated lesions on lateral borders of the tongue that do not scrape off

Client's symptoms include pulmonary TB

Client's symptoms include lymph node TB

Client's symptoms include severe bacterial infections (such as pneumonia, empyema, pyomyositis, bone or joint infection, meningitis, bacteraemia)

Client's symptoms include severe recurrent bacterial pneumonia

Client's symptoms include acute necrotizing ulcerative stomatitis

Client's symptoms include acute necrotizing ulcerative gingivitis

Client's symptoms include acute necrotizing ulcerative periodontitis

Client's symptoms include unexplained anaemia (<8 g/dL)

Client's symptoms include neutropaenia (<0.5 x 10^9/L)

Client's symptoms include chronic thrombocytopaenia (<50 x 10^9/L)

Client's symptoms include symptomatic lymphoid interstitial pneumonitis

Client's symptoms include chronic HIV-associated lung disease, including bronchiectasis

Unexplained involuntary weight loss (>10% baseline body weight), with obvious wasting or body mass index <18.5; PLUS EITHER unexplained chronic reported for longer than one month; OR reports of fever or night sweats for more than one month without other cause and lack of response to antibiotics or antimalarial agents; malaria must be excluded in malarious areas.

Client has unexplained severe wasting not responding to standard therapy . For under 5 years old, defined as weight-for-height < -3 z-score

Client has unexplained stunting not responding to standard therapy . For under 5 years old, defined as length-for- age/height-for-age < -2 z-score

Client has unexplained severe malnutrition not responding to standard therapy . For under 5 years old, weight for height < -3 z-score or mid-upper arm circumference <115 mm or the presence of oedema

Client's symptoms include pneumocystis (jirovecii) pneumonia

Client's symptoms include recurrent severe bacterial pneumonia

Client's symptoms include recurrent severe bacterial infections (such as empyema, pyomyositis, bone or joint infection, meningitis, but excluding pneumonia)

Client's symptoms include recurrent empyema

Client's symptoms include recurrent pyomyositis

Client's symptoms include recurrent bone or joint infections

Client's symptoms include recurrent meningitis

Client's symptoms include chronic herpes simplex infection (orolabial or cutaneous of more than 1 month duration or visceral at any site)

Client's symptoms include chronic herpes simplex infection (orolabial, genital or anorectal of more than one month in duration or visceral at any site)

Client's symptoms include oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs)

Client's symptoms include extrapulmonary tuberculosis

Client's symptoms include Kaposi sarcoma

Client's symptoms include cytomegalovirus infection (retinitis or infection of other organs)

Client's symptoms include central nervous system toxoplasmosis

Client's symptoms include HIV encephalopathy

Client's symptoms include extrapulmonary cryptococcosis, including meningitis

Client's symptoms include disseminated nontuberculous mycobacterial infection

Client's symptoms include progressive multifocal leukoencephalopathy

Client's symptoms include chronic cryptosporidiosis

Client's symptoms include chronic cryptosporidiosis (with diarrhoea)

Client's symptoms include chronic isosporiasis

Client's symptoms include disseminated mycosis (extrapulmonary histoplasmosis, coccidioidomycosis)

Client's symptoms include disseminated endemic mycosis (extrapulmonary histoplasmosis, coccidioidomycosis, penicilliosis)

Client's symptoms include cerebral lymphoma

Client's symptoms include b-cell non-Hodgkin lymphoma

Client's symptoms include HIV- associated nephropathy or cardiomyopathy

Client's symptoms include recurrent bacteraemia (septicaemia) (including nontyphoidal salmonella)

Client's symptoms include invasive cervical carcinoma

Client's symptoms include atypical disseminated leishmaniasis

Client's symptoms include neutropenia, an abnormally low count of a type of white blood cell (neutrophils)

WHO clinical stage of client based on signs and symptoms at start of ART

Client is assessed to be at a clinical stage of 1 at the time of starting ART, based on clinical assessment and diagnostics

Client is assessed to be at a clinical stage of 2 at the time of starting ART, based on clinical assessment and diagnostics

Client is assessed to be at a clinical stage of 3 at the time of starting ART, based on clinical assessment and diagnostics

Client is assessed to be at a clinical stage of 4 at the time of starting ART, based on clinical assessment and diagnostics

Date on which the client's WHO HIV clinical stage changed, including the date when the client's stage is first determined

CD4 cell count in cells/mm^3

CD4 cell percentage

Date and time when CD4 count test was conducted

CD4 count performed at HIV diagnosis

Date and time when baseline CD4 count test was conducted

Client had late ART initiation. That is, the client's first CD4 count from baseline CD4 test performed (such as at HIV diagnosis) was a count of <200 cells/mm3

Reason why ART was not initiated at diagnosis or within 7 days of diagnosis

Client did not initiate ART at diagnosis or within 7 days of diagnosis because client self-reported as not ready/willing

Client did not initiate ART at diagnosis or within 7 days of diagnosis because client had not completed education, support and preparation for ART

Client did not initiate ART at diagnosis or within 7 days of diagnosis because of client's fear of disclosure

Client did not initiate ART at diagnosis or within 7 days of diagnosis because client lacks finances

Client did not initiate ART at diagnosis or within 7 days of diagnosis because client initiated on TB treatment

Client did not initiate ART at diagnosis or within 7 days of diagnosis because client initiated on treatment for TB meningitis

Client did not initiate ART at diagnosis or within 7 days of diagnosis because client diagnosed with cryptococcal meningitis

Client did not initiate ART at diagnosis or within 7 days of diagnosis because client diagnosed with histoplasmosis

Client did not initiate ART at diagnosis or within 7 days of diagnosis because client critically/severely ill

Client did not initiate ART at diagnosis or within 7 days of diagnosis because of other reason

Client did not initiate ART at diagnosis or within 7 days of diagnosis because of other reason (specify)

Client initiated ART within 7 days of diagnosis

Time from HIV diagnosis to when client started ART

Client started ART within 7 days

Client started ART within 30 days of ART initiation (but over 7 days)

Client started ART within 90 days of ART initiation (but over 30 days)

Result from the viral load test in number of copies/mL

The client is virally suppressed for HIV, based on the client's most recent viral load test result being less than 1000 copies/mL

Date the viral load test result was received from the lab or completed in the facility

Date on which the client tested as becoming virally suppressed, as indicated by a viral load test result under 1000 copies/mL

Whether the viral load is being tested for routine monitoring on a set schedule or for targeted monitoring for suspected treatment failure

Routine refers to viral load tests obtained at standard intervals following ART initiation to monitor viral load response to ART

Targeted refers to viral load tests obtained based on a specific clinical indication (such as concern about disease progression or failure to respond to ART)

The first viral load test of the client

A follow-up viral load test within 3-6 months after enhanced adherence counselling after client received a high viral load test result

Hepatitis B test is required

Hepatitis C test is recommended or should be considered

Syphilis test is required

Name of examinations, test and results for any relevant investigations carried out for client

Provider ordered a Haemoglobin (Hb) test, number in g/dL test

Provider ordered a pregnancy test for client

Provider ordered a syphilis test

Provider ordered a chest X-ray (CXR)

Provider ordered sputum or culture for TB

Provider ordered an HBsAg test (HBV) test

Provider ordered an HIV viral load test

Scheduled an HIV viral load test with client

Provider ordered a CD4 cell count

Scheduled a CD4 test with client

Provider ordered a cryptococcal antigen test

Provider ordered a histoplasmosis antigen test

Scheduled cervical cancer screening with client

Date of scheduled monitoring examination

Hepatitis C test has been ordered

Syphilis test has been ordered

Client received results from viral load test

The date on which the client received results from a viral load test

Reason why a substitution was made to the antiretroviral (ARV) drug regimen

A substitution was made to the regimen because of toxicity/side effects

A substitution was made to the regimen because of a drug-drug interaction

A substitution was made to the regimen because of pregnancy

A substitution was made to the regimen because of new tuberculosis (TB)

A substitution was made to the regimen because a new drug was available

A substitution was made to the regimen because drug was out of stock

A substitution was made for another reason

A substitution was made for another reason (specify)

A switch to second-line ART regimen is recommended

A switch to third-line ART regimen is recommended

Provider has made a regimen switch

Reason why a switch to a second- or third-line regimen was made

A switch was made to the regimen because of clinical treatment failure

A switch was made to the regimen because of immunological failure

A switch was made to the regimen because of virological failure

A switch was made to the regimen for another reason

A switch was made to the regimen for another reason (specify)

A drug substitution is recommended

A dosage change is recommended

Provider has made a regimen substitution

Date co-trimoxazole prophylaxis prescribed to client

Completion date of co-trimoxazole prophylaxis prescribed to client

Dose of co-trimoxazole prophylaxis prescribed to client

Number of days of co-trimoxazole prophylaxis prescribed to client

Client has been on ART, but has stopped taking it or a treatment failure is suspected

INCLUDE VALUE SETS OF REGIMENS

Client is experiencing antiretroviral drug (ARV) toxicity

Clients status of coinfections at the time when ART was initiated

Client was hepatitis B positive at the start of ART

Client was hepatitis C positive at the start of ART

ART status of women to prevent mother-to-child transmission

Client was pregnant when ART was initiated

Client was postpartum when ART was initiated

Client initiated ART at labour and delivery

Client was breastfeeding when ART was initiated

Date of delivery/birth of infant if breastfeeding at ART start

Client living with HIV was in an ongoing sexual relationship with an HIV-negative partner when ART was started

The date on which the client started taking the current ART regimen

Name or regimen code of all other medications prescribed during the visit

Date the medications were prescribed

Number of doses (quantity taken at a single point in time) of drugs prescribed/dispensed

Number of days supply of each medication or regimen prescribed during the visit

Any other medications that were dispensed to client, including preventive treatment

Number of days supply of each medication or regimen dispensed during the visit

Prescribed dosage of the medication

Prescribed frequency for taking the medication

Counselling was carried out during visit

Type of treatment-limiting toxicity experienced by client. Treatment-limiting toxicity is defined as a serious adverse drug reaction that results in drug discontinuation or substitution. In addition, any reaction that leads to treatment interruption or requires changing the drug or regimen because of an adverse drug reaction is also considered a serious adverse drug reaction.

Treatment-limiting toxicity due to GI issues (nausea, diarrhoea, abdominal pain, vomiting)

Treatment-limiting toxicity due to skin issues (rash, hypersensitivity reaction)

Treatment-limiting toxicity due to peripheral neuropathy (burning/numbness/ tingling)

Treatment-limiting toxicity due to central nervous system symptoms (dizzy, anxiety, nightmare, depression, seizures)

Treatment-limiting toxicity due to weight gain

Treatment-limiting toxicity due to hepatic dysfunction (jaundice)

Treatment-limiting toxicity due to haematological (anaemia, neutropenia) disorders

Treatment-limiting toxicity due to fatigue

Treatment-limiting toxicity due to headache

Treatment-limiting toxicity due to bone dysfunction (fractures, osteopenia)

Treatment-limiting toxicity due to metabolic symptoms (body fat changes, hyperglycaemia, dyslipidaemia)

Treatment-limiting toxicity due to kidney dysfunction (nephrolithiasis, renal insufficiency)

Client experienced an unexpected adverse drug reaction

Specify the type of unexpected adverse drug reaction the client experienced

Date on which ARV drug regimen (one or more drugs) for client was changed within the first-line regimen (substitution)

Reason(s) why one ore more drugs in client's first-line ARV drug regimen was changed (substituted)

New antiretroviral (ARV) drugs after client changed regimen within the first-line regimen

Date client was changed from a first-line to second-line ARV drug regimen (switch)

New ART regimen after switch to second-line ART regimen

Reason why client was switched from first- to second-line ARV drug regimen (see 'Reason for regimen switch' for levels)

Date on which ARV drug regimen for client was changed within the second-line regimen (substitution)

Reason(s) why client changed drug regimen (within the second-line)

New ARV drugs after client changed regimen within the second- line regimen

Date client was changed from a second- to third-line ARV drug regimen (switch)

New ART regimen after switch to third-line ART regimen

Reason why client was switched from second- to third-line ARV drug regimen (see 'Reason for regimen switch' for levels)

Date on which ARV drug regimen for client was changed within the third-line (substitution)

Reason(s) why client changed drug regimen (within the third-line)

New ARV drugs after client changed regimen within the third-line regimen

Enhanced adherence counselling was provided to the client during the visit

A first enhanced adherence counselling was provided to the client during the visit

The date on which the first enhanced adherence counselling was provided to the client

A second enhanced adherence counselling was provided to the client during the visit

The date on which the second enhanced adherence counselling was provided to the client

A third enhanced adherence counselling was provided to the client during the visit

The date on which the third enhanced adherence counselling was provided to the client

Full name of person providing support to client for adherence, care, treatment and other needs (e.g. ARV pick-up if ill)

Full address or description of home of treatment supporter

Telephone number if available, or else telephone number of neighbour/friend

Name of individual or organization that provides home-based care to client

Counselling provided on diagnoses

Whether counselling was provided to a client who has been diagnosed with hepatitis B

Whether counselling was provided to a client who has been diagnosed with hepatitis C

Whether counselling and treatment was provided to a client who has been diagnosed with syphilis

Whether counselling and treatment was provided to a client who has been diagnosed with syphilis. Additional testing (RPR test) recommended.

Client accepted offer for partner services

Offer voluntary testing for all partners and biological children of positive cases (includes partner services and index case testing), as well as partners and social contacts of people from key populations, where appropriate

HIV status of each family member at time of patient's enrolment, including partner (for mothers)