MATERNITY REGISTER MONTHLY REPORT



Viral Load – Facility Monthly ReportVersion 1Facility NameMayReporting YearReporting Month2017Reporting MonthJanFebMarAprMayJunJulAugSepOctNovDec(circle)↓↓↓↓↓↓↓↓↓↓↓↓Monitoring Cohort andHigh VL CohortJulAugSepOctNovDecJanFebMarAprMayJun▼Source: VL Sample Log ▼Reporting Month (New Samples)Reason for Test1Routine2Targeted3Follow-up after high VL4Repeat / lost / missingTotal Samples Monitoring Cohort OutcomesReceipt of Results50-4 Weeks65-8 Weeks79-12 Weeks813+ WeeksTotal SamplesResults Type9Electronic10PaperTotal SamplesVL Results11<1000121000+13Samples rejected14Results missingTotal SamplesClient Notification150-4 Weeks165-8 Weeks179-12 Weeks1813+ WeeksTotal Samples▼Source: High VL Register ▼High VL Cohort OutcomesInitial High VL: Reason for Test20Routine21Targeted22RepeatTotal high VL patientsIntensive Adherence Counselling233 Sessions completed24Sess. not completedTotal high VL patientsFollow-up VL Results25Not yet collected26<1000271000+28Sample Rejected29Results MissingTotal high VL patientsInitial Decision30Initial decision pending31Cont. current regimen32SwitchTotal high VL patientsFinal Decision33Final decision pending34Cont. current regimen35Switch36Refer to HIV SpecialistTotal high VL patientsReport filledDateNamePhoneNotesReport receivedDateNamePhone ................
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