Guidelines on STI/RTIservice delivery for HighRiskGroupsand BridgePopulation inTINGOs

NACOSTITEAMAPRIL2010

Introduction: It is an established fact that effective prevention and control of sexually transmitted infections amonghighriskpopulationgroupsisthemostcosteffectiveinterventiontohaltandreversetheHIV epidemicprogress.STI/RTIcontrolprovideswindowofopportunitytopreventnewHIVinfection. Saturated coverage of high risk groups with standardized, high quality and cost effective STI/RTI clinicalservicesisimperativeforthesame. A. PackagesofSTI/RTIServicesandtreatmentguidelinesforHRG STIservicesfortheHRGsincludethefollowing Symptomatictreatment Presumptivetreatment RegularMedicalCheckup BiannualSyphilisscreening

1. ManagementofSymptomaticpatientsthroughsyndromiccasemanagement:Itisexpected that30%ofthecoregrouppopulationwouldsufferfromanepisodeofSTIinayear.These patientsaretobeidentifiedthroughactiveoutreach(peereducatorandoutreachworker) andreferredfortreatment. TABLE:SUMMARYOFSYNDROMICCASEMANAGEMENT STI/RTISYNDROMIC DIAGONOSIS KITPRESCRIBED

Nameofthedrugs

Urethral Discharge/Ano Rectal Discharge/Cervical KIT1GRAY Discharge/Presumptive Treatment/PainfulScrotalSwelling VaginalDischarge(Vaginitis) GenitalUlcerDiseaseNonHerpetic Genital Ulcer Disease Herpetic(AllergictoPenicillin) GenitalUlcerDiseaseHerpetic Lower Abdominal Pain InflammatoryDisease) InguinalBubo (Pelvic Non KIT2GREEN KIT3WHITE KIT4BLUE KIT5RED

Azithromycin(1g)ODSTATand Cefixime(400mg)ODSTAT Secnidazole(2g)ODSTATand Fluconazole(150mg)ODSTAT Benzathinepenicillin(2.4MU)IMSTATand Azithomycin(1g)ODSTAT Doxycycline(100mg)XBDX14DAYSand Azithromycin(1g)XODSTAT Acyclovir(400mg)XTDSX7DAYS Cefixime(400mg)XODSTATand Metronidazole (400 mg) X BD X 14 DAYS and Doxycycline(100mg)XBDX14DAYS. Doxycycline(100mg)XBDX21DAYSand Azithromycin(1g)XODSTAT

KIT6YELLOW

KIT7BLACK

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2. ProvisionofPresumptivetreatmenttoasymptomaticpatients:Itisgiventothesexworkers (maleandfemale)duetothefactthattheymaybeharbouringanasymptomaticinfection due to Gonorrhoea and Chlamydia because of their high risk behaviour; they require treatmentonthispresumption.Kit1isusedforPresumptiveTreatment.Allasymptomatic sexworkers(maleandfemale)attendingtheclinicforthefirsttimeshouldbeprovidedwith presumptive treatment. Presumptive treatment is also to be provided in case the sex workerpresentsasymptomaticallyafternotattendinganyclinicalserviceforsixconsecutive monthsormore.However,presumptivetreatmentshouldnotbeinstitutedperiodically.In case,sexworkersaresymptomaticonfirstvisitorafter6months,theyshouldbetreatedas per their syndrome according to syndromic case management guidelines and PT is not required. Truckers, migrants, IDU and clients of sex workers should not be provided presumptivetreatment. 3. RegularMedicalcheckuponaquarterlybasis:Thischeckupistobedonesoastopromote health seeking behaviour, reinforce preventive messages, internal examination (proctoscopy/ speculum examination) to screen for asymptomatic STI and provide opportunityforsyphilisandHIVscreening.AllFSWandMSMshouldbereferredforroutine examinations on a quarterly basis through active outreach. Truckers, migrants, IDU and clientsofsexworkersdonotrequireRegularMedicalCheckup. 4. Biannual syphilis screening: All core group population (FSW/ MSM/ IDU) should be screenedbiannuallyforsyphilis,andprovidedreferraltoICTCforHIVscreening.TheTINGO can tie up with the nearest laboratory for the same within the cost provided for the test. Alternatively, the test can also be conducted free of cost at the nearest government laboratory.AllHIVtestsmustbeperformedonlyattheICTC.Fortruckersandmigrants,only STIattendeesshouldbescreenedforsyphilis. TABLE:SUMMARYOFPACKAGEOFSERVICESFORTHEHIGHRISKGROUPPOPULATION Diagnose and Treat STI/RTI Provide based on National Presumptive Syndromic treatment Protocol Yes Yes Yes Yes Yes Yes No No

TIPopulation

Syphilis screening Do a regular of all the line STI/RTI checkup listed HRG once every3months every6months Yes Yes No No Yes Yes Yes ONLY for STI/RTI Clinicattendees ONLY for STI/RTI Clinicattendees

FSW MSM IDU Trucker

Migrant

Yes

No

No

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B. ModalitiesofSTI/RTIServicedeliveryinHRG NGOs implementing the targeted intervention programme deliver the package of STI/RTI services throughthefollowingmodalities. 1. StaticClinic:Thisisaprojectlinkedcliniclocatedinandaroundtheredlightareaorinthe brothelsettingwherethereisalargecongregationoftargetpopulation.Staticclinicistobe setupinTINGOScateringto800ormoresexworkersoranIDUpopulationof400ormore. Itisalsosuggestedthatifthesexworkerpopulationisnonbrothelbasedandscattered,and eveniftheNGOiscateringto800andmoresexworkers,thestaticclinicapproachmaynot beusedinisolationforprovidingSTI/RTIservices.Thestaticclinicmodelisalsoapplicableto truckers at halt points where there is a large congregation of truckers. The provider identifiedforthispurposeshouldbeanMBBSdoctor. (FSWandMSMabove800,IDUabove400,Truckerswithconcentratedpopulation) 2. Preferred private providers: These are private providers who are identified based on a focussedgroupdiscussionwiththetargetpopulation,whoarelocatedinandaroundthehot spots/ zone of the intervention area and are preferred by the community. The provider shouldbequalified(MBBS).Inexceptionalcircumstances,wherequalifiedprovidersarenot available,nonMBBSproviderscanprovideservicesunderthesupervisionofMBBSprovider/ STI focal person. The non MBBS provider selection must be based on competency assessmentandhe/sheshouldberigorouslytrainedonSyndromiccasemanagement. (FSWandMSMbelow800,IDUbelow400,Migrant) 3. Hybridmodel:Thismodelisapplicablewherethetargetpopulationisscatteredaswellas concentrated and a single approach cannot provide effective services. This is a mix of the static clinic approach with inclusion of preferred providers so as to improve the access to services.OneoftheprovidersispositionedinclinicoperationalwithintheTINGOtocaterto concentratedtargetpopulationandrestoftheprovidersfunctionfromtheirsetupinand aroundhotspot/zone(asdescribedinPreferredProvidermodel).However,alltheproviders willberemuneratedonacasewisebasisandnotonamonthlysalarybasis. (FSW and MSM above 800 with scattered population, IDU above 400 with scattered population,Truckerswithscatteredpopulation) 4. Referral to government health facilities: This model is applicable in the case where the nearest government health facility is the preferred location of accessing services by the HRGs.TINGOhastoensuretheHRGgetsthestandardizedpackageofSTIservicesfromthe governmenthealthfacility. (Migrants,FSW,MSM,IDU,Truckers) 5. HealthCamp:Thismodelisapplicableonlyforthemigrantpopulationsandservestoinstill health seekingbehaviourandamongthem.Acampis periodicallyorganizedataspecified locationandmedicalconsultationmadeavailableonthatparticularday.Theoutreachteam should actively refer patients with STI/RTI complaints to avail services from the camp, whereinSTIservicesshouldbeprovidedtothemigrants. (Migrants) NACOSTITEAMAPRIL2010

TABLE:MODALITIESOFSTI/RTISERVICEDELIVERYFORHRG SNo Modalityofservicedelivery TypeofTIproject 1 Staticclinic BrothelbasedsettingonlyforFSW>800 MSM>800concentratedinasmallgeographicregion IDU>400concentratedinasmallgeographicregion Truckersconcentratedatahaltpoint 2 Preferredprivateprovider(PPP) FSWandMSM<800 IDU<400 Migrant 3 Hybridmodel(Static+PPP) FSWandMSM>800whenpopulationisscattered IDU>400whenpopulationisscattered Truckerswhenpopulationisscattered 4 Referraltogovernmenthealthfacility Migrants FSW/MSM/IDU/ Truckers in the case where the nearest government health facility is the preferred location of accessing services 5 Healthcamp Migrants

Each TI NGO should identify the best model suited for provision of STI services and accordingly preparealistofnamesofserviceproviderswithaddressoftheclinicalongwiththequalificationof theproviderandtheirstatusoftraining. TABLE:FORMATFORTINGOSTI/RTI & Qualification Statusoftraining Name & Type of service provision Name of Address phone No. of Address of TI (PPP/Static/Hybrid/Health Provider NGO clinic/Provider Camp/Linkage to GovernmentFacility) 1 2 3 4

NACOSTITEAMAPRIL2010

 AphotodirectoryoftheprovidersshouldbepreparedaccordingtotheformatatAnnexureIandbe submittedtoSACS/NACOalongwithTINGOwiselistofSTIserviceproviders.Frequentchangesin theprovidersshouldbediscouraged. C. ComponentsofqualitySTI/RTIcare AllclientsshouldbeprovidedwiththefollowingservicesasapartofgoodSTI/RTIcare. 1. EarlydiagnosisandtreatmentofSTI a. Medicalconsultationfromamedicalpractitionerwhoistrainedonsyndromiccase managementapproachandiswillingtoworkwithHRGcommunity b. Examination facilities under audiovisual privacy with facilities for internal examination(speculumandproctoscopy) c. ProvisionofSTI/RTIdrugsaspertreatmentguidelines d. Compliancetotreatment e. Partnernotificationandmanagement f. Followup

2. Syphilisscreening 3. CounsellingservicesthroughTIcounsellororANMandhealtheducation 4. AvailabilityofCondoms(Freeorsociallymarketed) 5. ReferraltoICTCforHIVscreening The following algorithms for STI/RTI service provision for High Risk group populations under TI interventionsareplacedatAnnexureII. FSW/MSM IDU Migrant/Truckers

ThesealgorithmsshouldbemadeavailableanddisplayedintheTINGO.

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D.

Processesofservicedelivery TINGOstaffinteractswiththeHRGs(FSW/MSM/IDU/Truckers/Migrants)inthefield.They educateHRGonbasicsignsandsymptomsofSTI/RTI,consistentcondomuseandsafersex and refers HRGs with STI/RTI symptoms to the nearest static clinic/ preferred provider /governmentclinic/Healthcamp.Theyfilluptheupperhalfofreferralslip. HRG attends the clinic with referral slip to receive consultation and examination from the traineddoctor,drugsfortreatment,counsellingservicesandcondomsfreeofcost. Doctorentersdetailsinthepatientregister,examinesthepatient,fillsuptwocopiesofthe patient wise card and completes lower portion of the referral slip. Patient wise STI/RTI drug distribution register is maintained if drugs are dispensed. Counseling, condoms, partnertreatment,syphilisscreeningandreferraltoICTCarealsoprovided. M&E person/ accountant of the TI NGO examine these records on a weekly or fortnightly basis.Theupperportionofthereferralslipandduplicatecopyofpatientwisecardistobe collected and kept by the TI NGO. The doctor receives Rs. 50 as consultation fees per STI consultation from the TI NGO (for treating STI/RTI case, RMC) at the end of the week/ fortnight/month.Doctorinthestaticclinicreceivesmoneyassalarypermonth@Rs.9000. The numbers of the patients visiting the clinic is to be validated by the TI NGO before releasingpayment. TINGOistocollectweeklyrecordsfromtheclinicsandcompilethesameattheendofthe monthandreporttoSACS/NACOinSTICMISformat. ANM/Counselorusesthepatientwisecardtoupdatedaily/weeklydrugregisterandfills up drug indent register as and when drugs are required. Follow up, RMC and Syphilis screeningarescheduledandfilingofpatientwisecardsistobemaintainedPEwise.

RolesandResponsibilities: TheProgramManageroftheTINGOisoverallinchargeoftheSTIservicesdeliveredtothe HRG. TheNurse/CounsellorwithTINGOiscrucialincoordinatingandplanningtheSTI/RTIservices toHRG,providingcounsellingandcondomsandmaintainingdrugsupplychainlogisticsand recordkeeping. TheOutreachteamisresponsibleforreferralofpatientsforSTIservices. M&E person/ Accountant are responsible for scrutiny of records, collecting data from the doctorsandreleaseofpaymenttothedoctors. The doctor is responsible for providing standardized STI services and maintaining records thereof.

NACOSTITEAMAPRIL2010

ProcessofSTI/RTIservicesdeliveryanddocumentation

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E. Recordkeeping AllTINGOsmustensuretherecordmaintenanceofSTI/RTIservicesprovidedthroughtheminthe requisiteforms,registersandensuretimelysubmissionofthemonthlyCMISSTIreportingformatto SACS.POTSUwillensurecorrectmaintenanceandsubmissionofreportsontime.Allformatsand registersshouldbeprintedasperprototypesatAnnexureIII. NameofRecord ReferralSlip Filled/maintainedby Upper portion educator/ORW Lowerportionbydoctor by Keptin/Submittedto Peer Keptwithdoctorandsubmitted attheendofmonthtoTINGO ANM/Counselor to referralformsinTINGO keep

Patientwisecard

Two copies to be filled by One copy to be given with doctor patient One copy to be kept with doctor and submitted at the endofthemonthtoTINGO. ANM/CounselortokeepPatient wisecardinTINGO

Patientregisterand Patient wise STI/RTI drug distributionregister

Filledbythedoctor/counsellor Kept with the doctor in the orANM clinic. To be verified by M&E officer/ accountant of TI NGO periodically.

Drug indent record and Filled by the ANM/ Counselor MaintainedintheTINGO Daily/weeklydrugrecord ofTINGO STICMISformat Programme manager/ M&EO/ Soft copy to be submitted to Counselor/ ANM to prepare SACSbythe5thofeachmonth. monthly report in STI CMIS format

NACOSTITEAMAPRIL2010

F. STI/RTIdrugs DrugsfortreatmentofSTI/RTIasperthesyndromicprotocolaretobeprocuredandmadeavailable bytheTINGOsoutoffundsreleasedforthepurposetillsuchtimethatNACO/SACSprovidesthem withcolourcodedSTI/RTIdrugkits.DrugsshouldbeprocuredfromWHOGMPcertifiedcompanies asperNACOprocurementnorms. G. Capacitybuilding NGOs must ensure the proper training of all the staff involved with provision of STI/RTI services includingdoctors,programmemanager,ANM/Counsellor,M&EO,ORW,PEtoequipthemfortheir respective roles and responsibilities. The doctors and NGO staff must be deputed for training on syndromic case management as and when SACS organizes the same. Mentoring of the NGOs and serviceprovidersonaregularbasiswillbeensuredbyNACO/TSU/STRC/SACS.

NACOSTITEAMAPRIL2010

 AnnexureI FormatforPhotodirectoryofPPPProviders NameofNGO:________________________________________________________________________ AddressoftheNGO:_________________________________________________________________ ___________________________________________________________________________________ PhoneNo:_____________________________MobileNo:___________________________________ EmailID:_____________________________NGORegistrationNo:______________________ Name:______________________________________________________________________ ClinicAddress____________________________________________________________ ______________________________________________________________________________ District:__________________________State:______________Pin________________ PhoneNo:_____________________________MobileNo:_______________________ Email:_______________________________________________________________________ Timing:____________________________________________________________________ Allopathic/NonAllopathic (ProjectManager) (Dr.__________________)

Annexure II

AlgorithmForSTI/RTIservicedeliveryinHRGpopulationSTITeam,NACO

AlgorithmForSTI/RTIservicedeliveryinHRGpopulationSTITeam,NACO

AlgorithmForSTI/RTIservicedeliveryinHRGpopulationSTITeam,NACO

Annexure III

Patient Wise card-STI Services

DoctorsName:__________________________ Nameoftheclinic:_____________ Qualification:____________________________ ClinicTiming:_________________ PhoneNo.:______________________________ Address:_____________________ Email:__________________________________ NAMEOFPATIENT:...IndexNo..Date:....................................... AGE:.SEX:MALEFEMALETRANSGENDER Typology:FSWMSMIDUMigrantsTruckers TypeofPatient:Purposeofvisit: PATIENTFLOW:DIRECTWALKINREFERRED NewSymptoms&signsofSTI New Followup Old PT RMC Presentingcomplaint:.Sincewhen. KITPRESCRIBED STI/RTISYNDROMIC Nameofthedrugs Counselling DIAGONOSIS Yes *UrethralDischarge(UD) *AnoRectalDischarge(ARD) *CervicalDischarge(Cervicitis) *Presumptivetreatment(PT) *PainfulScrotalSwelling(PSS) VaginalDischarge(Vaginitis) GenitalUlcerDisease(GUD)Non Herpetic GUDNonHerpetic(Allergicto Penicillin) GUDHerpetic LowerAbdominalPain(PID) KIT1GRAY
Azithromycin (1 g) OD STAT Cefixime (400 mg) OD STAT

No

KIT2GREEN KIT3WHITE KIT4BLUE KIT5RED KIT6YELLOW

Secnidazole (2 g) OD STAT and Fluconazole (150 mg) OD STAT Benzathine penicillin (2.4 MU) IM STAT and Azithomycin (1 g) OD STAT Doxycycline (100 mg) XBD X 14 DAYS and Azithromycin (1 g) X OD STAT Acyclovir (400 mg )X TDS X 7 DAYS Cefixime (400 mg) X OD STAT and Metronidazole (400 mg) X BD X 14 DAYS and Doxycycline (100 mg) X BD X 14 DAYS. Doxycycline (100 mg )X BD X 21 DAYS and Azithromycin (1 g) X OD STAT

REFFERAL ICTC/PPTCT LABTEST RPR/VDRL: ARTCENTRE OTHERS:

InguinalBubo

KIT7BLACK

OtherSTI(PleaseSpecifydiagnosis andtreatment) Findings:

A)Partnernotificationundertaken:Yes/No B)NextVisitDate: C)Condomsprovided:Yes/No(ifyes,Number:) Others: Date:SignatureofDoctor

ReferralSlip
NameofthePatient:________________Age:____Sex_______IndexNo./PIDNo.__________ Referredby:PE/ORW/Other: Typology:FSW/MSM/IDU/Migrants/Trucker Date:______________

Referredto:
NameofthePhysician: Referredfor:STI/RTIConsultation/RMC/generalcomplaints/bloodtest/others TearHere (Toberetainedbythepatient.) Date:______________ NameofthePatient:IndexNo./PIDNo.__________ ReferredFor: ChiefComplaints: Diagnosis: Treatment: Remarks: Signature:

PatientRegister:
NameofthePhysician: Nameoftheclinic:,Addressoftheclinic:, Phone/MobileNo:.
` Date Sl. No. Index Nameof No. thepatient Address Sex Age (M/F/TG) Typologyofthe HRG (F/M/C/T/Mi* Diagnosis Treatmentgiven Followupdate Remarks

Note:TypologyofHRG*

F=FemaleSexWorker.,M=MSM.,C=clientoftheHRG.,T=Trucker,Mi=Migrant.

PatientWiseSTI/RTIdrugdistribution
Date: Ifdrugkitsareavailable,thenusethisformat: Date SlNo Nameof patient Total IndexNo. Age
KIT1 GRAY KIT2 GREEN

Nameforthedrugkit(Numberdispensed)
KIT3 WHITE KIT4BLUE KIT5 RED KIT6 YELLOW KIT7BLACK

1. 2 3 4 5

Ifdrugkitsarenotavailable,thenusethisformat: Dat e Sl No 1. 2 3 4 5 Nameof patient Total Index Age No. Azithromycin Namefothedrug(Numberdispensed) Cefexime Metronidazole Doxycycl Inj. Acyclovir ine Penicelline.

Secnidazole

Fluconazole

Weekly/DailyDrugRecord: Date: Whendrugkitsareavailable,usethisformat: Sl No. 1. 2. 3 4 5 6 KitName KIT1 GRAY KIT2 GREEN KIT3 WHITE KIT4 BLUE KIT5 RED KIT6 YELLOW KIT7 BLACK Nameofthedrug
Azithromycin (1 g) OD STAT Cefixime (400 mg) OD STAT Secnidazole (2 g) OD STAT and 1 Cap. Fluconazole (150 mg) OD STAT Benzathine penicillin (2.4 MU) IM STAT, Azithomycin (1 g) OD STAT Doxycycline (100 mg) XBD X 14 DAYS Azithromycin (1 g) X OD STAT Acyclovir (400 mg )X TDS X 7 DAYS Cefixime (400 mg) X OD STAT Metronidazole (400 mg) X BD X 14 DAYS Doxycycline (100 mg) X BD X 14 DAYS. Doxycycline (100 mg )X BD X 21 DAYS. Azithromycin (1 g) X OD STAT

Opening Balance

Drug distributed

Closing Balance

Remarks

7 Note:

1. Openingbalanceistheamountofdrugyoustartwith. 2. Ifyouhaveindentedandreceivedthedrugonthatdaythanaddtotheopeningbalance. Thisbecomesyournewopeningbalance. 3. Thedrugdistributedtodayshouldmatchthepatientwisedrugdistribution. 4. Closingbalanceisopeningbalanceminusdrugdistributed. 5. Closingbalanceofpreviousdayisopeningbalanceoftoday. 6. Indentthedrugwhenitreachesthecriticallevel. 7. UseFEFOprincipalindistributingthedrug. 8. Theclinicshouldhavebufferforatleastonequarter.

Whendrugkitsarenotavailable,usethisformat: Sl Nameofthedrug No. 1. Azithromycin(500mmg) 2. 3 4 5 6 7 8. Cefexime(200mg) Metronidazole(400Mg) Doxicycline(100mg) Acyclovir(400mg) InjBenzathinePenicilline (2.4millionunit) Fluconazole(150mg) Secnidazole(2gm) Opening Balance Drug distributed Closing Balance Remarks

IndentregisterofessentialSTI/RTIdrug
Whendrugkitsareavailable,usethisformat: Kit Name KIT1 GRAY KIT2 GREEN KIT3 WHITE KIT4 BLUE KIT5 RED Balance ontheday ofindent
Secnidazole (2 g) OD STAT and 1 Cap. Fluconazole (150 mg) OD STAT Benzathine penicillin (2.4 MU) IM STAT, Azithomycin (1 g) OD STAT Doxycycline (100 mg) XBD X 14 DAYS Azithromycin (1 g) X OD STAT Acyclovir (400 mg )X TDS X 7 DAYS

Sl No. 1. 2.

NameoftheDrug

Amountto be indented (Date)

Amount received (Date)

Remark

Azithromycin (1 g) OD STAT Cefixime (400 mg) OD STAT

3. 4. 5. 6.

Cefixime (400 mg) X OD STAT KIT6 Metronidazole (400 mg) X BD X 14 DAYS YELLOW Doxycycline (100 mg) X BD X 14 DAYS.

7.

KIT7 BLACK Note:

Doxycycline (100 mg )X BD X 21 DAYS. Azithromycin (1 g) X OD STAT

1. Theclinicmusthavesupplyofdrugforatleastthreemonth. 2. ThereshouldbeacriticallevelofstockforeachSTI/RTIdrug.Wheneversupplyreachesless thanonequarterofsupplytheANMshouldindentthedrug. 3. TheANMshouldfollowthepolicyofFEFO(FirstExpiryFirstOut). Whendrugkitsarenotavailable,usethisformat: Sl No. 1. 2. 3. 4. 5. 6. NameoftheDrug Azithromycin(500m mg) Cefexime(200mg) Metronidazole(400Mg) Doxicycline(100mg) Acyclovir(400mg) InjBenzathine Penicilline(2.4million unit) Fluconazole(150mg) Secnidazole(2gm) Balanceonthe dayofindent Amounttobe Amount indented(Date) received(Date) Remark

7. 8.

Monthly

STI/RTI

Unique ID. No. of STI/RTI Clinic /Gynae OPD /TI NGO MONTHLY REPORT FORMAT FOR STI/RTI CLINICS Name of STI/RTI Clinic/ Hospital to which the Gynaecology OPD is Attached/ TI NGO Sub Type Address : District : Reporting Period : Name of Officer In - charge : Phone no. of Officer In - charge : Name of Centre/service provider : Category Block : Year(YYYY) : Location City :

Month(MM) :

Section 1 : No. of Patients Availed STI/RTI services in this month

Age Group & Sex

Type of Patients
Male

<20
Female TS/TG Male

20-24
Female TS/TG Male

25-44
Female TS/TG Male

>44
Female TS/TG Male

Total
Female TS/TG

Clinic visit with STI/RTI complaint and were diagnosed with an STI/RTI Clinic visit with STI/RTI complaint but were NOT diagnosede with an STI/RTI. Clinic visit for Syphilis Screening (Excluding ANC) For TI-NGOs-RMC,PT,Syphilis Screening( whichever applicable) Follow up visit for the index STI/RTI complaint Total No of visits 0 0 0 0 0 0 0 0 0 0 0 0

0 0

0 0

0 0

Section 2 : STI/RTI syndromic diagnosis (Should be filled by all STI/RTI service providers for clinic visit for STI/RTI compalint only) Age Group & Sex g p Diagnosis
1.Vaginal/ Cervical Discharge(VCD) 2.Genital Ulcer (GUD)-non herpetic 3.Genital ulcer(GUD) herpetic 4.Lower abdominal pain(LAP) 5.Urethral discharge(UD) 6.Ano-rectal discharge (ARD) 7.Inguinal Bubo(IB) 8.Painful scrotal swelling (SS) 9.Genital warts 10.Other STIs 11. Serologically +ve for syphilis Total No of cases No of people living with HIV/AIDS (PLHAs) who attended with STI/RTI complain during the month 0 0 0 Male Female TS/TG Total 0 0 0 0 0 0 0 0 0 0 0 0

Section 3. Details of other services provided to patients attending STI/RTI clinics in this month To be filled in by all STI/RTI Service Providers Male Service
1. Number of patients counseled 2. Number of condoms provided 3. Number of RPR/VDRL tests conducted 4. Number of patients found reactive 5. Number of partner notification undertaken 6. Number of partners managed 7. Number of patients referred to ICTC 8. Number of patients found HIV-infected (of above) 9. Number of patients referred to other services

Female

TS/TG

Total 0 0 0 0 0 0 0 0 0

Monthly Unique ID. No. of STI/RTI Clinic/Gynae OPD/ TI NGO Section 4 : STI/RTI service for HRGs in the month (To be filled in by TI NGO)
Male Female TS/TG

STI/RTI

Total

Number of new individuals visited the clinic Number of Presumptive Treatments(PT) provided for gonococcus and chlamydia Number of regular STI check-ups(RMC) conducted (check-up including internal examination of HRGs once in a quarter) Section 5 : ANC syphilis screening in this month Should be filled by all service providers with ANC service provision Number of ANC first visits in the month (Registration) Number of pregnant woman previouly registered but screened in current month Number of rapid plasma reagin RPR/VDRL tests performed Number of RPR/VDRL reactive (Qualitative) Number of RPR/VDRL reactive above >=1:8 (Quantitative) Number of RPR/VDRL reactive confirmed with TPHA Number of pregnant women treated for syphilis Section 6 : Laboratory diagnosis of STI/RTI Male

0 0 0

Total

Laboratory diagnosis/Tests
1. Total RPR/VDRL tests performed RPR tests reactive >= 1:8 Number of RPR reactives confirmed with TPHA 2. Total Gram stain performed

Female

TS/TG

Total
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Gonococcus + (gram negative intracellular diplococci +) Non-Gonococcus ursthritis (NGU)-Pus cells +ve Non-Gonococcus cervicitis (NGC)-Pus cells +ve None Nugents score +ve 3. Wet mount test performed Motile Trichomonads +ve Whiff test +ve Clues cells + None 4. KOH test performed 5. Availabilty of consumables (Yes=1,No=2) Do you have STI pre-packed kits? Functional Computer AMC of Computer

Section 7 : Drugs & Consumables

Drugs & Consumables Opening stock Number received this month Consumed Damage/Wastage Closing stock Stock Sufficient for approx months

RPR tests TPHA kits (wherever applicable) (Tests) Prepacked STI Kit 1 Prepacked STI Kit 2 Prepacked STI Kit 3 Prepacked STI Kit 4 Prepacked STI Kit 5 Prepacked STI Kit 6 Prepacked STI Kit 7 Condom Pieces Reagent for gram stain Reagents wet mount and KOH test Others

500

200

200

10

490 0 0 0 0 0 0 0 0 0 0 0 0

2.45 0 0 0 0 0 0 0 0 0 0 0 0

Monthly Unique ID. No. of STI/RTI Clinic/Gynae OPD/TI NGO 0

STI/RTI

Section 8 : Details of Staff at the STI/RTI or Gynaecology clinics Human resource details at STI/RTI and /or Gynaecology clinics (Should be filled by all STI/RTI clinics)
Staff Number Sanctioned Number of Person Trained during month Number in place Induction Refresher Others

Medical Officer Staff Nurse Laboratory Technicians Laboratory Attandent Counselor

Guidelines for filling Monthly Report Format for STI/RTI Clinics

General Instructions: Who should fill this? This reporting format should be filled by all STI/RTI service providers and sent to the corresponding reporting authority by the 5th of next month. The STI/RTI service providers include: Providers at all designated STI/RTI and Ob Gyn clinics (sentinel sites like area/district hospitals, teaching hospitals attached to medical colleges etc) Targeted Interventions providing STI/RTI services for High Risk Behaviour Groups

What should be reported? Section 1, 2, 3 and 7 should be reported by all STI/RTI service providers Additional Section 4 should be filled by all Targeted Interventions for High Risk Behaviour Groups Additional Section 5 should be filled by all service providers providing antenatal checkups of pregnant women and STI/RTI services Additional Section 6 should be filled up by NACO designated STI/RTI clinics (sentinel sites) with laboratory services (Laboratory may be located in the clinic or Clinic may be utilizing the general pathological lab in the hospital), section 8 should be filled by the NACO designated STI/RTI clinics or gynaecologic clinic .Write Clinic Unique ID No, name of the Centre, Address, Block, District , Reporting period (months and years to be put in numbers), Name and Phone no. of service provider.

Specific Instructions: Section 1 should be reported by all STI/RTI service providers Clinic visit with STI/RTI complaints and were diagnosed with STI/RTI Fill the number of individuals visited with the particular STI/RTI complaints as per STI/RTI patient wise card. This indicates new STI/RTI episodes.

Clinic visit with STI/RTI complaint but were NOT diagnosed with STI/RTI

Fill the number of individuals visited for complaints of STI/RTI, but were not diagnosed with STI/RTI as per patient wise card. Include the patients who came for syphilis screening to Designated STI/RTI clinics. Do not include ANC attendees. For TI NGOs, fill all those HRG attending the STI clinic for Regular Medical Checkup, Presumptive Treatment Syphilis screening. Fill the number of patients who have come for a repeat visit for a previously documented complaint. This includes STI/RTI follow-ups for any reasons. Fill the number of individuals who have availed STI/RTI services under appropriate age and sex category. Fill in the total number of STI/RTI visits under the specific category

Clinic visit for syphilis screening (exclude ANC) For TI NGOs, RMC, PT, Syphilis screening (whichever is applicable) Follow up visits index STI/RTI complaint

Age Group and Sex

Total no. of visits

Section 2 - Should be reported by all STI/RTI service providers - Should be filled for clinic visit for the index STI/RTI complaint only - Should be filled even if the diagnosis is made on clinical or etiological basis Diagnosis Fill up consolidated number of STI/RTI patients diagnosed with following syndromes 1. VCD - Vaginal/Cervical Discharge a) Woman with symptomatic vaginal discharge b) Asymptomatic patient with vaginal discharge seen on examination c) Cervical discharge seen on speculum examination. (All etiological and clinical STI/RTI diagnosis relating to vaginal or cervical discharge should be included here)

2. GUD - Non Herpetic - Genital ulcer diseaseNon Herpetic

Female or male or transgender with genital or ano-rectal ulceration and with NO blisters (vesicles) (All STI clinical or etiological diagnosis relating to genital ulcers except herpes simplex 2, and LGV should be included here) Female or male or transgender with genital or ano-rectal blisters (vesicles) with ulcers or recurrence. Note: Write the no. of individuals presented with ulcers and blisters under both GUD Non Herpetic and GUD Herpetic.

3. GUD - Herpetic - Genital Ulcer Disease Herpetic

4. LAP - Lower Abdominal Pain

Female with Lower Abdominal Pain or tenderness, or Cervical motion tenderness Male or transgender with intact genitalia with Urethral Discharge with or without dysuria or other symptoms Male, Female or Transgender with symptoms of tenesmus or if Ano-Rectal Discharge seen on exam Individuals with inguinal bubo and NO Genital Ulcer. (Clinical diagnosis of LGV should be included here) Male or Transgender (with intact genitalia) with painful scrotal Swelling Individuals with genital warts Individuals attending with any other STI/RTI related condition (eg. Genital Scabies, pubic lice, Molluscum Contageosum etc) Individuals treated for serological Syphilis. Fill in the total number of STI/RTI diagnosis made during the month.

5. UD - Urethral Discharge

6. ARD - Ano-Rectal Discharge 7. IB - Inguinal Bubo

8. SS - Painful Scrotal Swelling

9. Genital Warts 10. Other STIs

11. Serologically Positive for Syphilis Total No. of episodes

People living with HIV attended with STI/RTI

People living with HIV and attended STI/RTI clinic for STI/RTI related complaints and management.

Section 3 should be reported by all STI/RTI service providers Details of other services provided 1. Number of counselling provided

Fill total number of individuals provided with STI/RTI counselling Fill total number of condoms provided to all STI/RTI patients Fill total number of RPR/VDRL tests conducted* Fill the number detected reactive for RPR/VDRL test* Fill the total number of partner notifications undertaken of index STI/RTI patients treated Fill the total number of partners of index STI/RTI patients attended the clinic and managed Fill the number of STI/RTI clinic attendees referred to ICTC Fill the number detected as HIV reactive, of the referred individuals Fill in the number of STI/RTI clinic attendees referred for any services other services like care and support, tuberculosis screening etc

2. 3. 4. 5. 6.

Number of condoms provided Number of RPR/VDRL tests conducted Number found to be reactive Number of partner notifications undertaken Number of partners managed

7. 8. 9.

Number of individuals referred to ICTC Number found HIV infected Number of individuals referred for other

Section 4 Should be filled by TI NGO providing services to High Risk Behaviour Groups (HRG). Number of new individuals visited the clinic Fill in total number of High Risk Behaviour Group individuals visiting the clinic for the first time for any clinical services. This has no relationship with what complaints they have. This number can be arrived by summing up new clients checked as Yes in patient wise card. Fill in total number of individuals (Sex Worker) provided with treatment for Gonococcus and Chlamydia without any STI signs and symptoms as per NACO STI/RTI technical guidelines August 2007.

Number of presumptive treatments (PT) provided for Gonococcus and Chlamydia

Number of regular STI check-ups (RMC ) conducted (Check up including internal examination of HRG once in a quarter).

Fill in the number of individuals (who attended this clinic at least once in the past) attended for STI/RTI services and received genital examination, which may include speculum or proctoscope examination and found to be not having STI/RTI.

Section 5 - Should be filled by all service providers with ANC service provision - Should fill information for women making first visit for ANC only

Number of ANC first visits in the month (Registration)

Write the number of pregnant women registered for first time with the clinic during the month

Number of pregnant women previously registered but screen in current month

Write the number of pregnant women registered in previous month but got tested for RPR/VDRL in this month. Write the number of registered pregnant women undergone RPR/VDRL test during the month* Write the number of pregnant women found reactive for RPR/VDRL test* Write the number of pregnant women found reactive for RPR/VDRL test* Write the number of RPR/ VDRL reactive samples confirmed confirmed with TPHA test with TPHA test Write the number of pregnant women diagnosed having syphilis undergone treatment

Number of RPR/VDRL performed

Number of RPR/VDRL reactive (qualitative)

Number of RPR/VDRL reactive >= 1:8 (quantitative)

Number of RPR/VDRL reactive confirmed with TPHA

Number of pregnant women treated for syphilis

Section 6 should be filled by all NACO designated STI/RTI clinics with laboratory facilities Total RPR/VDRL test performed Fill in the total number of RPR or VDRL qualitative tests conducted among men, women, and others during the reporting month* (sum of the data recorded in section C)

RPR test reactive >= 1:8

Fill in the number of RPR/VDRL tests reactive at or above 1:8 titres among men, women and others*

No. of RPR/VDRL reactive confirmed with TPHA confirmed with TPHA test* Total Gram stain performed

Fill in the number of sera reactive with RPR/VDRL tests

Fill in total number of gram stain performed among men (urethral smear) and women (endo-cervical smear and vaginal discharge smear)*

Number of Smears +ve for Gonococcus Criteria for urethral smear

Fill in number of smears positive for gonococcus > 5 PMN/hpf and intracellular gram negative diplococci inside poly morphonuclear cells

Criteria for endocervical smear

Numerous PMN/hpf and intracellular gram diplococci inside poly morphonuclear cells

negative

Non Gonococcal Urethritis/cervicitis-Pus cells + Fill in number of smears positive for non-gonococcal Urethritis/cervicitis

Criteria for urethral smear > 5 PMN/hpf and NO intracellular gram negative diplococci inside poly morphonuclear cells Criteria for endocervical smears >10 PMN/hpf and NO gram negative diplococci inside poly morphonuclear cells Fill in number of smears negative for both < 5PMN/hpf and NO intracellular gram negative diplococci inside poly morphonuclear cells <10 PMN/hpf and NO gram negative diplococci inside poly morphonuclear cells Number of smears +ve for Nugents score Fill in the number of smears +ve for Nugents score. Nugents score is +ve when the score is between 7 to 10 Wet mount tests performed Fill in the total number of wet mounts performed among women Fill in the number of wet mounts demonstrated Motile trichomonads seen under light microscope (10x) Fill in the number of wet mounts demonstrated Clue cells more than 20% of all epithelial cells in any view under light microscope Whiff test + Fill in the number of wet mounts released fishy odours of amines, when a drop of 10% potassium hydroxide is placed on vaginal secretion on a glass slide None None of the above tests are positive KOH test performed Fill in total number of KOH tests performed among women

None Criteria for urethral smear

Criteria for endocervical smear

Motile trichomonads +

Clues cells +

Candidiasis+

Fill in the number of wet mounts demonstrated budding yeast/hypea under light microscope Fill in the number of wet mounts not demonstrated budding yeast/hype under light microscope

None

Availability of consumables, functional computers and AMC of Computers.

Check yes or no for availability of the STI/RTI colour coded drug kits, functional computers and its AMC.

*The information on number of test conducted and /or results may or may not be available with facility providing clinical services. The providers are to ensure collection of the laboratory data from the concerned providers/departments/or facilities (microbiology/pathology/general lab).

Section 7 - Should be filled by all service providers at STI/RTI clinic - Provide details of stock of RPR test, TPHA tests kits, Per-packed STI kit 1, kit 2, kit 3, kit 4, kit 5, kit 6 and kit 7, condom pieces, reagents for gram stain, wet mount and KOH test and others if any Opening Stock Write the number of STI/RTI drug kits/ reagent/RPR, TPHA test kits available on the first day of the month. Number received in this month Write the number of STI/RTI drug kits/ reagent/RPR, TPHA test kits received during the month. Write the number of STI/RTI drug kits/ reagent/RPR, TPHA test kits were utilised or distributed during the month. Write the number of STI/RTI drug kits/ reagent/RPR, TPHA test kits were wasted or damaged during the month. Closing stock Write the number of STI/RTI drug kits/ reagent/RPR, TPHA test kits available on the last day of the month. Stock sufficient for approximate month This indicator will be automatically calculated by the software. (closing stock/drugs consumed plus damaged /wasted) Every clinic to ensure one quarter (3 months) drug/testing kits/ reagent supply for the clinic.

Number consumed

Damage/Wastage

Section 8 should be filled by all STI/RTI clinics and contains human resource details at STI/RTI clinics. Details of staff Medical Officer/s Staff Nurse Number of doctors posts sanctioned, Number in place Number of the doctors trained (Induction/Refresher/Other) Number of Staff Nurse posts sanctioned, Number in place Number of the staff nurse trained (Induction/Refresher/Other) Number of Lab Technician posts sanctioned, Number in place Number of the Lab Technician trained (Induction/Refresher/Other) Number of Lab Attendant posts sanctioned, Number in place Number of the Lab Attendant trained (Induction/Refresher/Other) Number of Counsellor posts sanctioned, Number in place Number of the Counsellor trained (Induction/Refresher/Other)

Lab Technician

Lab Attendant

Counsellor